Why You Need To Understand Workers' Compensation Fraud Even If You Have A Legitimate Case
As many as 3 million people every year report on-the-job injuries, and those can be costly for employers and taxpayers -- and, of course, for you as an injured employee. Workers' compensation insurance is supposed to cover you if you're hurt at the workplace, but a significant percentage of claims are denied according to U.S. Department of Labor stats.
Why are so many claims denied? It could range from mistakes in filling out the proper paperwork to outright fraud, and that's why you need to know why claims are denied or found fraudulent in order to improve your own case.
What to Do to Prevent the Appearance of Workers' Comp Fraud
Cases labled "fraudulent" and denied may not actually involve an intent to deceive. While there are some workers who claim job-related injuries when they were really hurt elsewhere or who magnify the extent of their injuries, most claimants have legitimate cases.
Here are three ways to ensure your case isn't immediately considered suspicious:
- Report your injury immediately. If you wait, it may look like you are hiding something. Even if you don't think your injuries may be serious, follow your workplace rules for reporting them in case they do get worse.
- Talk to co-workers who were in the area when you were hurt. Not having a witness can make your case harder to prove. Even if a co-worker was across the room or didn't get a good view of an incident that hurt you, make sure they see the immediate impact -- the cabinet that fell on you and is now off the wall, the flat tire on the forklift that caused it to skid, the blood that is coming from a wound before you clean it up, etc. Well-meaning employees may clean up the mess before others see it and can attest to the circumstances of what happened.
- Document the incident as soon as you can, in writing. Take photos of any malfunctioning equipment, the injury site and your injuries. If your injury requires off-site medical care, ask a trusted co-worker to do that for you before you leave.
Top Problems That Identify Workers' Comp Fraud
Understanding the main reasons why claims are found fraudulent can help you avoid the same fate.
- You report an injury sustained Friday on Monday morning. This makes it look like you were hurt over the weekend and pretended it was a job-related injury. Report any injury as soon as it happens.
- You refuse treatment. If you say no to a test or diagnostic procedure, you'll look like you have something to hide.
- You don't answer the phone at home. In these days of caller ID, it's not unusual to ignore unknown calls. But if a medical provider or insurance company is trying to reach you, being difficult to contact can be a warning sign. You'll look like you were not at home when you should have been resting or recovering from your injuries.
- You have past claims. You can't do anything about legitimate injuries sustained, but remember that it does look suspicious if you are constantly getting injured on the job -- especially if your co-workers manage to stay uninjured. You'll need to be especially diligent about reporting and documentation.
If you suspect that your claim may have issues, or you are uncertain as to whether your employer will challenge your case, it may be wise to consult a workers' compensation attorney, like Hardee and Hardee LLP. An attorney can make sure all your paperwork is submitted correctly and on time, and that you navigate the complex world of workers' comp insurance correctly.