05/22/2012
INDICATORS OF WORKERS' COMPENSATION FRAUD
Claimant is disgruntled, soon-to-retire, or facing imminent firing or layoff
Employee is involved in seasonal work that is about to end
Employee took unexplained or excessive time off prior to injury
Employee takes more time off than the claimed injury seems to warrant
Employee is nomadic and has a history of short term employment
Employee is new on the job
Employee changes physician when a release for work has been issued
Employee has a history of reporting subjective injuries
Review of a rehab report describes the employee as being muscular, well-tanned, with calloused hands and grease under the fingernails
First notification of injury or claim made after employee is terminated or laid off
Has several other family members also receiving workers' compensation benefits
Demands quick settlement decisions
Demands quick payments for medical providers, etc.
Is unusually familiar with workers' compensation claim handling procedures and laws
Is consistently uncooperative
Employee refuses to allow visits or rehabilitation at home or specifies plenty of warning time prior to visit
Employee, participates in contact sports or physically demanding hobbies
After injury, employee is never home or spouse/relative answering phone states the employee "just stepped out" or may have to contact him/her by pager
Return calls to residence have strange or unexpected background noises which indicate that it may not be a residence
Employee protests about returning to work and never seems to improve
Employee cancels or fails to keep appointment, or refuses a diagnostic procedure to confirm an injury
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