Employers and their insurers are constantly on the watch for fraudulent workers’ compensation claims – despite the fact that the vast majority of claims are wholly justified.
Some of the signs of fraud that employers watch for make sense. You’d probably be suspicious too if someone didn’t report their injury for several days or there were rumors among the staff that the “injury” was planned. However, employers are also told to consider a claim suspect for reasons that have little or nothing to do with your injury.
Why some workers’ comp claims get red-flagged
Your claim can be held up or even denied simply because:
- You were injured on a Monday or a Friday. This is supposedly a sign that you were injured over the weekend and are just trying to pass the injury off as work-related. (If you do the math, however, you quickly realize that means an injury that happens during 40% of the work week is somehow suspect.)
- You have financial trouble. You aren’t going to get rich off of a workers’ comp claim, but there are plenty of insurance companies that push the narrative that an employee who is struggling financially is probably faking their injuries for the benefits.
- You have “strenuous” hobbies. How dare you golf, play basketball, hike, ride a bike or do anything else in your spare time that might injure you, right? Obviously (to the insurance company) that’s a clear sign your injury might not be from work.
- You can’t be reached at home. You’re supposed to be sitting around trying to get well, so why aren’t you taking your boss’s phone calls at any hour of the day?
When you consider how little it takes to make a claim “suspect,” it’s easy to understand why your workers’ comp claim may be denied. If you’re having trouble with your claim, get some experienced legal guidance.