AlphaStaff Identifies the ’Red Flags’ of Fraudulent Workers’ Compensation Claims
Fort Lauderdale, Fla. – November 9, 2011 – AlphaStaff Group, Inc. (“AlphaStaff”), one of the nation’s largest professional employer organizations (PEO), recently examined workers’ compensation insurance and while it is a legal necessity it is a complex product for a business to secure and maintain.
AlphaStaff suggests the following information to employers seeking guidance and assistance in deceptive claims, and in simplifying the administration process overall.
1. The late report of an injury: If an employee submits a claim and reports an injury well after it allegedly occurred, employers should pay close attention and should determine the cause of the delay, while reminding the employee of the proper guidelines for reporting injuries.
2. Injuries reported early on a Monday, or after time off: In some cases, injuries that occurred off the job over the weekend may be fraudulently reported as work-related incidents. Employers can ask a reporting employee about their weekend activities, and can report findings to the insurance adjustor.
3. Cumulative problems: In some cases, a combination of off-the-job injuries may lead to conditions that are attributed to work-related incidents. In cases of generalized trauma, employers should determine the date of the onset of symptoms, and can ask employees if there was any delay in reporting.
4. News of outside activity: Employers should pay close attention to any reports they hear of employees who have filed claims, yet remain active while off the job.
5. Report of injury following a disciplinary action: When an employee who is facing disciplinary action files a claim, employers should pay extra attention.
6. New employees who have declined medical benefits: In some cases, employees may turn to workers’ compensation to take care of medical issues that are not related to work. Employers should take note.
7. Inconsistencies in injury reports and medical reports: When an injury report is filed, HR managers or benefits administrators should check to make sure the reports match any verbal accounts of the incidents. In cases of inconsistencies, further investigation is warranted.
8. Injured employee cannot be reached at home: When an employee is off the job because of an injury and collecting workers’ compensation, he or she should likely be recuperating, and should be reachable by phone.
These red flags can help to detect suspicious cases, but they are not in and of themselves evidence of fraud. Employers should therefore be careful not to make unjust assumptions before a thorough investigation is carried out. Understanding how to spot fraud is an important first step for employers, because it can help reduce overall costs while sending a message that fraud and abuse will not be tolerated in the workplace. By weeding out and discouraging deceptive claims, employers can develop a manageable workers’ compensation program that positively impacts their bottom line and creates a more productive workforce.
AlphaStaff Group, Inc., a full range of human resource outsourcing (HRO), delivers services to small and medium sized businesses and mid-market companies through a shared employment model. The company specializes in helping companies save money, time and free up administrative resources while reducing risk and ensuring compliance. Unlike other Professional Employment Organizations (PEO) or HRO providers, AlphaStaff has a unique, coordinated delivery approach as they work exclusively with insurance broker partners to distribute services. AlphaStaff’s experienced HR professionals deliver personal and flexible service to more than 1,300 client companies in the U.S. For more information, visit www.alphastaff.com.
- Contact Information
- Kristy Kennedy
- Account Executive
- rbb Public Relations
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