2 Things That Can Make Workers' Comp Suspicious Of Your Claim

16 July 2018 by Jonathan Phillips

The Insurance Crime Bureau asserts that workers' compensation fraud is one of the fastest growing forms of insurance fraud, resulting in $7.2 billion being paid out on duplicitous claims each year. To identify claimants who may be trying to pull a scam, the insurance will look for a number of red flags, which could lead to you having a harder time getting approved for benefits if they're present in your case. Here are two you should be aware of and how you can minimize the risk of being accused of fraud.

Delayed or Strangely Timed Reporting

The first thing workers' comp will look at is when you reported your injury to your employer. This is primarily because the law requires claimants to notify employers about their injuries by a certain time, usually within 30 days after the incident, and the insurance company wants to be sure you complied with the requirements before it goes through the trouble of evaluating your claim.

However, if you wait too long to file a claim without providing a good explanation for the delay or the circumstances surrounding the reporting seem suspicious, your case could get flagged as possible fraud, which may delay its resolution. For instance, if you file an injury claim after you've been fired from the job, workers' comp may think you're trying to retaliate against the company or secure compensation to make up for your lost paycheck.

To avoid this issue, it's essential you report your injury as soon as you can. If your injury happens on a Monday, Friday, or around the time when there is a change in your employment, take care to obtain evidence (e.g., video recordings or witness testimony) confirming the incident occurred. This could allay the insurance company's concerns and prevent your case from dragging on longer than necessary.

Seen by Questionable Providers

Another thing that can give workers' comp pause is if you choose questionable providers to assist you with your case. This goes beyond choosing an attorney workers' comp may consider problematic. Even your choice of healthcare providers can spark suspicions if the person has a history of being a part of fraudulent claims.

It's critical you choose your helpers wisely. You want someone competent who will provide you with the care and advice you need. However, be cognizant of the person's reputation in the industry and pick someone who is respected and known to behave ethically.

For more information about this issue or help with your workers' comp claim, contact a law office like Prediletto, Halpin, Scharnikow & Nelson, P.S.

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