Our goal is to find the truth - either validating an injured workers' claim or developing evidence to submit to the state fraud division and prosecutors for criminal charges.
Red Flags Of Possible Fraud From The Injured Employee - While most workers' compensation claims are legitimate, some are inflated or fraudulent. By spotting signs of possible fraud, you can help Zenith identify claims that merit closer scrutiny.
A Red Flag Does Not Prove Fraud, of course, and even the presence of several indicators does not mean fraud has occurred. But by knowing what to look for, you can begin to see troubling patterns and notify Zenith investigators, so that they may conduct a thorough investigation. Click here to learn more about how Zenith investigates fraud.
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If an injured worker: |
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Has a suspicious prior history of reporting subjective injuries |
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Protests excessively about a modified position or returning to work and never seems to improve |
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Has a questionable identity, residence or contact information |
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Was experiencing financial difficulties prior to submission of a claim and inquires about a quick claim settlement |
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Is retiring, on probation, involved in a labor dispute, disgruntled, a poor job performer or subject to disciplinary action |
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Is never at home, does not answer telephone or avoids the use of U.S. Mail |
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Is unusually familiar with the workers' compensation system or terminology |
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Stays out of work longer than the doctor prescribed |
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Is a new employee, nomadic, a seasonal worker or on short-term employment |
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Refuses medical tests or examinations to confirm an injury |
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RED FLAGS OF POSSIBLE FRAUD ABOUT THE ACCIDENT
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If an accident/injury: |
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Lacks witnesses |
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Occurs late on a Friday afternoon (especially if not reported until Monday) or early on a Monday morning |
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Is not associated with employee's job duties |
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Is not reported to the employer in a timely way |
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Also watch for: |
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Injury complaints inconsistent with facts of the accident |
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Vague details or rumors at work that an accident was staged or illegitimate |
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Accident occurred in an area not frequented by employee |
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Multiple versions of how the accident occurred |
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