Depending on the business and sector, occupational accident and disease threats vary. Although accounting companies are typically not exposed to serious workplace dangers, often there are frequent employee injuries such as slides, trips and falls, back injuries and repetitive stress injuries. There is the potential for workers’ compensation insurance fraud to occur if an employee gets injured.

Workers’ compensation insurance fraud is a serious crime that costs employers $30 billion annually, according to the National Insurance Crime Bureau. One common type of fraud is claim-related fraud, which is when an employee tries to receive a worker’s compensation insurance payout by falsely claiming that an accident or illness occurs at work or by exaggerating an actual injury or illness.

Alert Signs for Fraud

Although there is no specific science for detecting the compensation fraud of claim-related employees, accounting firm owners should be aware of any “red flags”:

  1. Injury reports on Monday morning-The suspected injury happens first on Monday morning, or the injury happens late on Friday afternoon but is not confirmed until Monday.
  2. Change in employment – The recorded accident occurs shortly before or after the termination of a job, layoff, termination of a large project, or seasonal work completion.
  3. Suspicious services-The medical providers or legal consultants of an employee have a history of managing suspicious cases, or the same physicians and attorneys are used by groups of claimants.
  4. No witnesses-the accident has no witnesses and the employee’s explanation does not logically support the cause of the injury.
  5. Conflicting descriptions: The description of the accident by the employee contrasts with the medical history or diagnosis of the injury.
  6. Claims history-The complainant has a history of making dubious claims.
  7. Treatment is denied- To confirm the existence or degree of an accident, the claimant rejects a medical test.
  8. Late reporting – Without a fair excuse, the employee delays reporting the allegation.
  9. The complainant is difficult to reach-It is difficult to reach the allegedly disabled claimant at home.
  10. Changes-The complainant has a history of changing doctors, addresses, or occupations regularly.

Experience indicates that there is a risk that the claim could be false if two or more “red flags” are present in a worker’s compensation claim. Bear in mind, these indicators are actually indicators. Before or after a job transition, many perfectly valid cases are filed directly and some claimants can be difficult to access at home.

Conclusion:

Workers’ compensation fraud is a severe crime that can have a real effect on business owners and their staff. Accounting firm owners can help minimize the risk of fraud in their workplace by showing a zero-tolerance stance on fraud, reinforcing practices and standards, and understanding what signs to look for.

If you want to cut costs in hiring full-time claims processing professional, outsourcing your needs to a transcription service provider agency, specializing in text-to-text transcription services, can be a help for your business to process genuine workers’ compensation claims.

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