Top 20 Red Flag Indicators
- Injured worker is disgruntled, seeming to retire, or facing imminent firing or layoff.
- Accident occurs late Friday afternoon or shortly after the employee reports to work on Monday.
- Accident is not witnessed.
- Fellow worker hears rumors circulating that the accident was not legitimate.
- Accident occurs in an area where injured employee would not normally be.
- After injury, injured worker is never home or spouse/relative answers phone saying injured worker just stepped out or is in the shower, etc.
- Injured worker changes physician when release for work has been issued.
- Injured worker has a history of reporting subjective injuries
- Several employees from same employer have similar injuries and use same doctors and/or attorneys.
- First notice of claim comes from attorney or medical clinic.
- First notification of injury or claim made after employee is terminated or laid off.
- Employee cancels or fails to keep appointment or refused a diagnostic procedure to confirm an injury.
- Attorney is known for handling suspicious claims.
- Physician is known for handling suspect claims.
- Boiler plate medical reports are identical to other reports from same doctor.
- Diagnosis inconsistent with medical treatment.
- Injuries are all subjective (i.e. pain, headaches, nausea, inability to sleep) and there are no credible objective findings.
- Surveillance or tip indicates the totally disabled worker is currently employed elsewhere.
- Claimant overly familiar with the workers’ compensation system and terminology.
- Background investigation reveals evidence of self‐employment, prior claims, motor vehicle accident and/or domestic violence issues.
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