fraud claims

Where’s Perry Mason when you need him?

Perhaps the legendary detective had this list in his briefcase when workers’ compensation fraud was in question.  Here we find clues that may result in discovering the crime that is insurance fraud in the workers’ compensation field.

A claim usually does not pass the smell test when we find:

  1. No witness to the purported incident.
  2. The claimant refuses standard medical treatment.
  3. The explanation is inconsistent.
  4. The claimant has a history of compensation claims and / or changing jobs.
  5. The incident happened just before the claimant was terminated.
  6. The claimant has a side gig.
  7. The claimant is found to be performing tasks or demonstrating abilities inconsistent with the injury.
  8. The claimant hires an attorney, visits a chiropractor, and begins to accrue bills right away.
  9. The claimant pushes for a fast settlement.
  10. The claimant is strangely inaccessible.

Keep in mind, legitimate claims may have one or more of these factors.  The claim is more likely to be fraud when more than one of these factors are in play during the claims process. 

Coast General Insurance Brokers has real-life strategies that can help mitigate the damage of fraudulent claims.  Let’s talk