Unfortunately, the word “fraud” is commonly associated with workers’ compensation claims. This is because fraudulent insurance claims collectively cost businesses billions of dollars annually and can take on many different forms. Fraudulent claims can have a number of participants, including claimants and their attorneys, insurance agency adjusters that tamper with evidence, and dishonest employers.
Of course, when employers are exposed for workers’ compensation fraud, there’s a lot at stake, including the reputation of their business and the potential need to lift a stop-work order in Florida. For defense, construction businesses should turn to a workers’ compensation defense attorney in Florida. In this article, we will discuss some of the most common types of fraudulent claims and ways you can prevent workers’ compensation fraud from occurring at your workplace.
Common Types of Fraud by Claimants
Workers’ compensation fraud is a serious matter. If a business or individual is found guilty of insurance fraud, they can experience significant fines and even a prison sentence. Here are some of the most common types of fraud that plague the construction industry:
- Perfectly Coordinated: Although you want to trust all of your workers, employers should be wary of the Monday morning injury. If a worker is injured in their personal time over the weekend, they may elect to come into work Monday and report the injury on company time.
- Poorly Coordinated: Conversely, if an employee is extremely delayed in making an injury report or filing a claim, this can also be an eyebrow raising act as it makes little sense why a worker would wait to report an injury.
- The Individual: As construction work requires long hours and, on some occasions, remote work, a worker that experiences an injury all alone is always a bit questionable, considering that no witnesses can attest to the accident occurring.
- Inconsistencies: If the employee is providing conflicting reports of what exactly occurred during their accident or is dodging communication with their employer after filing a claim, this is pretty suspicious behavior.
- The Disgruntled One: If an employee is outspoken, unhappy, recently reprimanded, or experiencing a significant change in their role at a company (schedule shift, demotion, suspension, ending a project), they may be prone to an erroneous claim.
- The Exaggerator: Some workers with a mild injury may greatly exaggerate their condition to receive some paid time off work. A prolonged recovery time is common with a worker that exaggerates their condition.
- The Repeat Offender: Although some workers have bad luck and experience multiple injuries, employees that have a history of making fraudulent claims will obviously raise red flags anytime they file a claim.
- The Uncooperative One: If a worker is injured on the job and files a workers’ compensation claim but refuses to be evaluated or seek medical treatment, this is another example of questionable behavior.
- Shady Providers: Sometimes, it may not be the worker’s behavior but who they associate themselves with that raises red flags. For example, if their attorney or medical provider has a history of fraudulent dealings, this can be a major indicator of fraud.
- The Business Owner: Some employees are growing a business on the side while working for a reputable company. Some employees take medical leave and continue working their other job while they are allegedly out injured.
Combating Insurance Fraud
Although the above acts of fraud commonly occur, many workers will simply file a false claim or stage an accident to receive benefits. Although it’s not possible to entirely eliminate people from making false claims or exaggerating their injuries, employers can perform certain tasks to greatly reduce the likelihood of workers filing fraudulent claims including:
Finetune Your Employee Manual
Construction firms need to establish company policies that clearly communicate that certain conduct (like fraud) will not be tolerated. An anti-fraud policy should detail what actions are deemed fraudulent, along with the formal procedures employees should take to report fraud. Moreover, the policy should establish the investigation process and clearly notify employees that a violation of this policy will result in the termination of the employee’s employment and be reported to the proper authorities. Consult a workers’ compensation defense lawyer in Florida to draft your employee manual.
Create the Right Culture
A comprehensive employee manual is a great starting point, but employers need to create an environment where employees feel empowered to do the right thing and report potential workers’ compensation fraud without fear of retaliation. Construction firms should train their workforce on the formal procedures to take to report fraud by creating an anonymous reporting system for employees to utilize. Along with encouraging anti-fraud procedures, employers should ensure that they are promoting safety in the workplace to reduce the chances of injuries occurring.
Consult a Construction Attorney
Combating fraud is a collective effort and involves everyone from the employer to supervisors to the workforce to experienced professionals away from the jobsite like construction attorneys. When you partner with the experienced workers’ compensation defense lawyers in Florida from Cotney Construction Law, you receive direct access to legal professionals that are extremely knowledgeable in all aspects of construction law, including laws related to workers’ compensation coverage. Whether you need assistance today lifting a stop-work order with a stop-work order attorney in Florida or you want to implement policies into your employment manual to protect your business long-term, consult our construction law firm.
If you would like to speak with our workers’ compensation defense attorneys in Florida, please contact us today.
Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.