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Top 10 Warning Signs of Fraud

 
Be sure you know the warning signs to help prevent fraud.
 
  1. MONDAY MORNING REPORTS: The alleged injury occurs first thing on Monday morning, or the injury occurs late on Friday afternoon but is not reported until Monday.
  2. SUSPICIOUS PROVIDERS: An employee’s medical providers or legal consultants have a history of handling suspicious claims, or the same doctors and lawyers are used by groups of claimants.
  3. CONFLICTING DESCRIPTIONS: The employee’s description of the accident conflicts with the medical history or first report of injury.
  4. TREATMENT IS REFUSED: The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.
  5. CLAIMANT IS HARD TO REACH: The allegedly disabled claimant is hard to reach at home.
  6. EMPLOYMENT CHANGE: The reported accident occurred immediately before or after a strike, job termination, layoff, end of a big project or at the conclusion of seasonal work.
  7. NO WITNESSES: There are no witnesses to the accident and the employee’s own description does not logically support the cause of injury.
  8. HISTORY OF CLAIMS: The claimant has a history of a number of suspicious or litigated claims.
  9. LATE REPORTING: The employee delays reporting the claim without a reasonable explanation.
  10. CHANGES: The claimant has a history of frequently changing physicians, changing addresses and numerous past employment changes.

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Insurance coverage in all states other than Utah is provided by Advantage Workers Compensation Insurance Company, a wholly-owned subsidiary of WCF Mutual Insurance Company, doing business as WCF Insurance. Advantage is domiciled in Indiana; NAIC number: 40517. Administrative office: P.O. Box 571918, Salt Lake City, UT 84157-1918.
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