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Fraud with BullhornAs a business owner, you know the importance of carrying workers compensation insurance to protect your bottom line and your employees. While accidents happen, there are a few obvious red flags that all employers should be familiar with in order to detect and identify potentially fraudulent claims. An increase of claims can increase your insurance premium, contribute to lost productivity, and decrease morale. So, keep an eye out for the following situations.

The Accident Happens on a Friday Night or Monday Morning

This could indicate that the employee wanted a longer weekend or the injury happened outside of the work premises. If there was a lag in reporting, especially by days or weeks, this should also be a signal to investigate the claim further.

History of Claims

If the employee in question has a history of filing claims, this is another red flag. Be aware, though, that a history of prior claims won't come to light unless you get this intel through an enhanced physical (where the question is asked by a medical provider) or if an employee has a claim with you (the employer) and the insurance carrier can check records for other events, states HNI.

The Recount of the Incident is Spotty

If there are no witnesses, or recounting the story varies each time by the injured employee, this is a sign that there might be some fraudulent activity going on.

They Are Hard to Contact

The claimant is hard to reach (even during regular business hours), doesn't show up for scheduled appointments, and doesn't answer phone calls.

They Consistently Request One Doctor or Lawyer

Physicians are required to coordinate recovery programs with the employer and the insurance company. However, if this particular employee requests a specific doctor or lawyer — perhaps one they have worked with in the past and has experience handling suspect claims — proceed with caution.

Fleming & Riles Insurance can help your business get the correct coverage. Call us at (800) 833-4379 for a free Georgia workers compensation insurance quote.
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