Worker’s Compensation Fraud Indicators "Red Flags"

• Early attorney involvement – notorious claimant attorney
• Repetitive medical – no change in condition, continued conservative treatment
• Physician changes – notorious claimant physician
• Conflicting medical
• Rumors – Anonymous tips
• Soft tissue injuries
• Disability beyond normal AMA guidelines
• Claimant never home or unable to come to the phone
• Missed therapy and medical appointments
• Refuses to cooperate with case managers
• Claimants that "live" claim every day constantly complaining or contacting employer
• No witnesses accidents
• PO Boxes
• Unreasonable demands (i.e. advances, medical procedures/tests, equipment, etc.)
• Claimant history of malingering/exaggerating
• Injury prior to termination, lay-off or disciplinary action
• Change of address
• Claimant history of self-employment
• Disgruntled employee
• New employee
• Appearance – calluses, grease on hands and nails, muscular, tan
• Threatens/complains to upper management
• Claimant history of recreational or sporting activities
• Claimant exaggerate, pain and symptoms
• Employer/examiner intuition