You heard a rumor. You got a tip. Or you noticed something that made you wonder whether an employee’s claim is a bum steer.The primary precaution is the common sense need to be discreet so you don’t alert the suspected employee before your suspicion is investigated. There are two important reasons for discretion. First, many injuries that appear suspicious are proved legitimate after thorough investigation. Keeping your suspicions confidential protects your employee from unnecessary embarrassment and stress.
Second, once a dishonest employee is aware of your suspicion, he/she is more difficult to catch. Appropriate action on your part protects innocent employees and makes it easier to catch those who are guilty.
When you suspect fraud:
If the injury or the circumstances surrounding the incident arouse your suspicions, explain them on a separate sheet of paper, and attach the sheet to your First Report of Injury.
WARNING: Never express your suspicions directly on your First Report of Injury. By law, HEMIC must send a copy of the First Report of Injury to the claimant. So put your suspicions on a separate, attached sheet. Or call your claim representative. Details are important. The more the investigator has to work with, the faster and more effective the investigation will be.
If you’ve already filed a First Report of Injury and later come across some information that raises your suspicions, call your claim representative or HEMIC’s confidential Fraud Hotline on Oahu: 522-5279. From the Neighbor Islands Toll Free: 1-888-522-5295.
Keep your ear to the ground. If you learn that the claimant is involved in inappropriate activities either inside or outside your workplace, notify your claim representative. Think about co-workers the claimant confides in: Which of those co-workers would tell the truth if asked, as well as keep a conversation with HEMIC investigators confidential? Pass the name along to your claim representative so HEMIC can follow up. HEMIC will begin surveillance when there is a reasonable likelihood that claim fraud has occurred.
Remember, most employees are honest and most claims are legitimate. It is just as important to verify the legitimacy of a claim as it is to confirm fraud.