How to Spot Workers’ Comp Fraud At Your Office

January 29, 2018

Did you know that one in 10 small businesses is worried that an employee on its team will fake an injury and commit workers’ comp fraud? In a recent article for Property Casualty 360˚, AmTrust’s resident workers’ compensation expert outlined six signs of a false workers’ compensation claim. Thankfully, he also offers several ways to spot the fake claim.




Is Your Employee Faking a Workers’ Comp Injury?


Here are six signs of a potentially fraudulent workers’ compensation claim, according to AmTrust Workers’ Compensation Insurance Product Manager, Matt Zender:


  1. You’ve heard employees gossip about the employee’s injury.

  2. You can’t get a clear idea of what actually happened from those involved.

  3. The injured party is refusing diagnostic procedures like an X-Ray or MRI.

  4. There aren’t any witnesses to the injury event.

  5. The claim is reported on a Monday morning.

  6. The claim is reported more than seven days after the injury occurred.

Individually, these signs do not conclusively mean a workers’ comp injury is false, but when more than three  of them are present, it might be time to take a closer look at the situation and the employee’s claim. Workers’ compensation claims are expensive both at the time of injury and over the long run. However, there are ways to help mitigate the costs of a workers’ compensation claim – check out “Help Your Agency Clients Create a Win-Win Return-to-Work Program.”


How to Handle Workers’ Compensation Claims


As an employer, it’s not unusual to be skeptical of a false workers’ compensation claim and see some as a neon “STOP” sign every time an employee is injured on the job. But consider these facts before thinking the worst of your employees:


  • Experts estimate that only 1-2% of workers’ compensation claims are fraudulent. Because of this, it’s highly unlikely that your employee is faking their injury. Consider the situational factors that might have contributed to the circumstances of the suspicious injury and claim.

  • New employees are three times more likely to be injured on the job than seasoned and experienced team members. At the same time, it’s important to consider the employee’s age, experience, and job training while considering whether a workers’ compensation claim is legitimate.

  • The costs associated with training new employees on safety and compliance is both expensive and time-consuming – the recruiting, hiring, and training process can cost your business in a big way.

How to Report Workers’ Comp Fraud


If one of your employees has made a fraudulent workers’ compensation claim, it’s important to understand and follow the proper procedure to ensure that your business is protected. If you feel one of your employees is taking advantage of your workers’ compensation coverage after investigating the incident, report your findings to your claims adjuster. Armed with the facts and specifics, this professional will be able to take care of everything quickly and with minimal disruption to your business.


Learn more about Workers’ Compensation Insurance for small and mid-sized businesses and find out, “Is Workers’ Compensation Mandated?”


This material is for informational purposes only, summarizes coverages and services that may be available in a policy, and is not legal or business advice.  Neither AmTrust Financial Services, Inc. nor any of its subsidiaries or affiliates represents or warrants that the information contained herein is appropriate or suitable for any specific business or legal purpose.  Readers seeking resolution of specific questions should consult their business and/or legal advisors. Individual coverage may vary and may not be available in all states.  In the event of a conflict with the material herein, the terms and conditions of any issued policy will control.


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