Warning Signs That Warrant Heightened Scrutiny of Workers’ Compensation Claims Warning Signs That Warrant Heightened Scrutiny of Workers’ Compensation Claims

Warning Signs That Warrant Heightened Scrutiny of Workers’ Compensation Claims

  1. Monday Morning Injury: The alleged injury occurs first thing Monday morning, or the injury occurs late Friday afternoon but is not reported until Monday.
  2. Employment Change: The accident occurs shortly before or immediately after the end of a lengthy project, the conclusion of seasonal work or before or after job termination or layoff.
  3. Suspicious Providers: The claimant’s doctors and/or legal counsel have a history of handling suspicious claims.
  4. No Witnesses: There are no witnesses to the accident, and the claimant’s own description is not consistent to support the cause of injury.
  5. Conflicting Descriptions: The claimant’s description of the accident conflicts with the medical history or the First Report of Injury.
  6. History of Claims: The claimant has a history of numerous, suspicious or litigated claims.
  7. Life Circumstances: The claim occurs at the same time as other circumstances such as childcare issues, commencement of a business venture, home improvement project, school attendance or a supplement to retirement income. 
The mere presence of the aforementioned circumstances does not in and of themselves constitute evidence of fraud or abuse. The presence of any one of the enumerated warning signs, however, reflects circumstances that give cause to heightened claim scrutiny.

For more information on worker's compensation claims, contact Corey Crognale or another member of our Worker's Compensation Team.

This publication is intended for general information purposes only and does not and is not intended to constitute legal advice. The reader should consult with legal counsel to determine how laws or decisions discussed herein apply to the reader’s specific circumstances.
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