Businesses may be uncertain about how workers’ comp fraud can be addressed as a preventative measure. Some proactive measures include applying a zero-tolerance policy regarding fraud. This and other efforts give employees safe approaches to reporting suspected fraud and cultivating a safe workplace culture. As a result, there can be fewer injuries and less opportunity for injury exaggeration. 

Your business insurance specialist can carry out fraud investigations to ensure your business is protected. With a combination of law enforcement and related prosecutorial experience in the field, the investigations department of your insurance provider can carry out measures dedicated to preventing insurance fraud at your business. 

In addition to applying a fraud management program, they can investigate and report instances of insurance fraud suspicion and work with local and state law enforcement to achieve the necessary outcomes.

You and your specialist can discuss warning signs of fraud and what to look for to build your claim. From there, they can notify the attorneys and related investigators for further review of your claim. For more information on how auditors can detect workers compensation claim fraud, continue reading. 

Auditors can detect workers compensation claim fraud by considering the warning signs.

Auditors can detect fraudulent behavior like workers compensation claim fraud by highlighting the common signs that suggest fraud has occurred. Some of these signs include:

  • a lack of witnesses for injuries
  • injuries are reported at the start of Monday morning
  • The accident description conflicts with the employee’s reporting of the incident.
  • The claimant is not easily contacted.
  • There is a history of questionable claims that were managed by the claimant’s legal representative/medical providers. 

They’ll get authorities and investigators involved. 

While warning signs of potential workers compensation claim fraud can give your auditor some indication of where to go next, these warning signs are not always a guarantee that fraudulent behavior has occurred. For these reasons, the authorities and investigators must continue to review your case. Workers’ compensation fraud is a criminal offense punishable by jail time. 

Business owners are at risk of facing higher insurance premiums as a result of fraudulent claims. Injured workers are at risk of facing scrutiny despite their ongoing honesty and legitimate injuries on the job. With workers’ compensation fraud prevention, your business can stay protected. 

Auditors are trained to identify fraud.

A premium auditor has the training and skill to identify different kinds of workers compensation claim fraud through the audit process. They’ll look at essential documents, including Certificates of Insurance, and the legitimacy of coverage as it applies to the claim. For example, if the worker is paid as a subcontractor, they may not be a policyholder and, therefore, not have grounds to pursue the claim. 

Investigate suspicious claims.

When you work with an auditor, you can detect any potential workers compensation claim fraud and identify the pitfalls in these claims to protect your business. For the safety of your company and its employees, get in touch with a premium auditor today and start investigating suspicious claims.