Floyd Arthur Presentation - Protect your business against fraudulent workers compensation claims http://carmoongroup.com How to Spot a Fraudulent Workers’ Compensation Claim Even a trained physician is not always able to determine if an injury is real or when and how it occurred. However, there are a sometimes indications that a claim of an on-the-job injury may not be quite what it seems. These include: Timing: Injuries reported on Monday actually may have occurred over the weekend. Similarly, any injury reported at the beginning of the work day may have happened the night before. Ask other employees if the injured worker displayed any signs of injury before the reported injury occurred. Delayed reporting: An injury reported several days after it allegedly occurred may be legitimate, but it may not. Witnesses: A lack of witnesses to an accidental injury is sometimes a red flag. Repeat claims: About 35 percent of workers compensation claims involve a second injury. However, this is not always an indicator of worker fraud. Examine the workplace environment where the injury occurred. Are there safety hazards that have not been addressed? If so, more repeat claims are likely to occur. Inconsistencies in reporting: When a worker makes a claim of an on-the-job injury, always require a written report. Later, interview the employee about the incident and compare his verbal statement to the original document. Although a certain level of inconsistency is normal, the employee’s statements about how and where the injury occurred should be essentially the same. Motive for retaliation: Employees who have recently been disciplined, demoted or had their work hours or compensation cut may have a stronger motive to defraud the employer. Floyd Arthur #floydarthur http://floyd-arthur.com

1. Carmoon Group Ltd. Business
Insurance Hempstead New York
Protect Your Business Against
Fraudulent Workers’ Compensation
Claims By Floyd Arthur
Floyd Arthur Insurance Expert New York
http://floydarthur.info * http://carmoongroup.com * http://floyd-arthur.com

2. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
If you are an employer in the United States, you
pay workers’ compensation insurance
premiums to protect your employees who are
hurt on the job. A benefit for both workers
and employers alike, workers’ compensation
insurance covers a portion of an injured
workers income as well as medical and
rehabilitation costs, and protects employers
against expensive lawsuits.

3. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
Unfortunately, the workers compensation
system is far from fool proof: Unscrupulous
employers and employees often attempt to
scam the system for personal gain. And
though the rate of worker’s compensation
fraud by employees is actually quite low
(studies indicate that it is less than 1 percent*)
employers still need to be aware of the signs
that a claim may be less than legitimate.

4. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
What Workers Compensation Insurance Covers
Worker’s compensation is government by state
law. However, statutes are fairly consistent
across the United States.

5. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
Typically, workers’ compensation covers any
employment related injury, including sudden
accidents and injuries that occur over time,
such as repetitive stress injuries or the
physical effects of exposures to toxic
chemicals. It also covers injuries that occur
outside the workplace if they occur while the
employee is “on the clock”.

6. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
Workers compensation typically excludes:
• Injuries caused by drugs or alcohol intoxication
• Injuries that occur because the employee violated
company policy (including safety rules)
• Self-inflicted injuries
• Injuries that occur as a result of a physical
altercation
• Injuries a worker suffers off the job
• Injuries claimed by an employee who has been
fired or laid off

7. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
Types of Worker’s Fraudulent Workers
Compensation Claims
According to the insurance industry, fraudulent
workers’ compensation claims by employees
tend to fall into five basic categories:

8. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
• Employees who are hurt off the job and claim the injury
occurred at work. For example, an employee injures his
shoulder playing softball and claims it happened on the job.
• Minor injuries that the employee claims are more serious,
such as reporting that a minor back muscle strain is major
sprain
• Fake injuries—these are often soft-tissue injuries, which are
difficult to prove or disprove.
• Old injuries that the employee claims are job related, for
example, a knee injury that never completely healed that
flares up after some period of time
• Malingering after a job-related injury has healed.

9. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
How to Spot a Fraudulent Workers’
Compensation Claim
Even a trained physician is not always able to
determine if an injury is real or when and how
it occurred. However, there are a sometimes
indications that a claim of an on-the-job injury
may not be quite what it seems. These
include:

10. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
• Timing: Injuries reported on Monday actually may have
occurred over the weekend. Similarly, any injury
reported at the beginning of the work day may have
happened the night before. Ask other employees if the
injured worker displayed any signs of injury before the
reported injury occurred.
• Delayed reporting: An injury reported several days
after it allegedly occurred may be legitimate, but it
may not.
• Witnesses: A lack of witnesses to an accidental injury is
sometimes a red flag.

11. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
• Repeat claims: About 35 percent of workers compensation claims
involve a second injury. However, this is not always an indicator of
worker fraud. Examine the workplace environment where the injury
occurred. Are there safety hazards that have not been addressed? If
so, more repeat claims are likely to occur.
• Inconsistencies in reporting: When a worker makes a claim of an
on-the-job injury, always require a written report. Later, interview
the employee about the incident and compare his verbal statement
to the original document. Although a certain level of inconsistency
is normal, the employee’s statements about how and where the
injury occurred should be essentially the same.
• Motive for retaliation: Employees who have recently been
disciplined, demoted or had their work hours or compensation cut
may have a stronger motive to defraud the employer.

12. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
Guarding Against Workers’ Compensation Fraud
The best protection against workers compensation
claims is a safe workplace. Let your employees
know that you care about their welfare and take
injury prevention seriously by encouraging them
to report hazards and remedying issues promptly
when they occur. Partner with key workplace
leaders, including managers, supervisors and
employees, to ensure that worker safety is a high
priority.

13. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
Additionally, institute a zero-tolerance policy for
behaviors that put employees at risk, such as
drug or alcohol use, intimidation, harassment or
fighting. These behaviors not only endanger
those who engage in them, they put your entire
workforce in harm’s way.
To decrease the potential for fraud, have a clearly
defined policy for documenting workplace
injuries and treating them promptly when they
occur. At minimum, the documentation should
include:

14. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
• An evaluation by a health care professional
immediately after the injury and, if state law
allows, a blood or urine test for drugs or alcohol
• Witness reports, including statements from other
employees, supervisors and non-employee
witnesses.
• A description of the conditions at the workplace
at the time. For example, was all equipment in
working order and properly secured?
• A supervisor’s statement regarding all actions
taken after the event

15. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
What to Do If You Suspect a Worker’s Compensation
Claim Is Fraudulent
In many places the United States, insurance fraud is a
crime. Any employer who has valid reasons for
believing an employee has filed a fraudulent workers’
compensation claim should report it to the
Department of Insurance in his or her state. Contact
information for the appropriate officials and agencies is
available online at the U.S. Department of Labor’s
Office Workers Compensation Programs.

16. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
Additionally, it’s important to notify your workers
compensation insurance provider of any
suspicious claims and keep your coverage up to
date. If you have questions or concerns, contact
us at 516-292-3780 any weekday between 9 a.m.
and 6 p.m. to set up an appointment for an
insurance review, or request a free consultation
online now.
* The Myth of Workers' Compensation Fraud

17. Protect Your Business Against Fraudulent Workers’
Compensation Claims By Floyd Arthur
www.CarmoonGroup.com
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