Watch for these warning signs. Especially in combination, they are the most typical characteristics of fraudulent claims, although legitimate claims may have them too.
Look for these signs:
- Is cutting back hours or downsizing and laying off employees
- Notified employee of poor performance, tardiness, etc.
- Is involved in seasonal work that is about to end
- Has taken unexplained or excessive time off prior to claimed injury
- Is disgruntled, soon to retire, or facing imminent firing or layoff
- Is experiencing financial difficulties
- Has a history of drug or alcohol abuse
- Has other family members who receive workers’ compensation or unemployment benefits
- Has a history of filing questionable claims over the years
- Is unusually familiar with workers’ compensation procedures and laws
- Is never home, or the spouse or relative always calls in
- Participates in contact sports or other activities where he or she could easily get hurt
- Occurred late Friday or early Monday
- Occurred just before or after a holiday
- Was not witnessed
- Occurred in an area where the employee does not work
- Is vague or the details are contradictoryo Is described in different, possibly conflicting ways–one way to the employer and another way to the doctor and still another way later on after the First Report was filed
- Is rumored to have never really – occurred or to have occurred off work.
If you suspect fraud, call the HEMIC Fraud Hotline. Callers may remain anonymous.
Oahu: 522-5279 and Neighbor Islands Toll Free: 1- 888-522-5295