How To Prevent Fraud at Work: An Employer's Guide

Sunday, September 15, 2002 | 0

There are some basic steps the employer can do to help prevent workers' comp fraud. Implementation of some or all of these tips will help:

All accidents need to be investigated. Not only will an investigation assist in correcting any hazardous conditions that could have contributed to the injury, but you may also uncover signs of potential fraud. Review video of the accident scene if available. Separate witnesses and interview them as soon as possible following an accident.

Don't be afraid to discuss workers' compensation policies and procedures with employees, including what to do when an injury occurs, your stance on fraud and return to work. The Los Angeles MTA recently took this step utilizing the services of the Deputy District Attorney assigned to workers' compensation fraud. Tailgate discussions were held throughout the district to let employees know that fraud won't be tolerated, and advising of appropriate procedures to take if fraud is suspected.

Show employees how much workers' compensation per employee costs, and what impact that cost has on benefits employees might otherwise enjoy if costs were under control. Also, tell them that while workers' comp is there to help employees who are injured, fraud is a crime.

Be on the look out for fraud indicators. The National Insurance Crime Bureau has come up with these signs that a claim might be fraudulent when two or more are present:

Rumors of foul-play.
An unusually long time between when the claim occurred and when it is reported, especially if the injury is serious.
The employee can never be reached at home or provides a pager as his main number.
The employee switches doctors after being released to work.
The employee's story of the accident changes.
The claim is older than three months and: --The accident occurred on a Friday afternoon or Monday morning
--The accident happened just before a strike, layoff, termination or the end of seasonal work
--The accident happened outside of the employee's normal working hours.
There were no witnesses to the injury.

Have a return-to-work program - transitional duty for injured employees makes fraud less tempting.

Ofter the first step to preventing fraud is making sure you hire the right person in the first place. Conduct criminal background and drivers' license checks before hiring new employees. Verify references and information listed on job applications. People who lie on applications or have criminal records may be more likely to lie about an injury.

Your safety program should include regular inspections of the work area and equipment. Fix any hazards immediately and document all checks and repairs. Such safety records could later become evidence.

Finally, hold exit interviews and be sure to double ask about any potential injuries, problems or complaints the employee may have. Be sure this is documented, and it is also helpful to have a signed statement from the employee as to whether or not they experienced an unreported injury at work. This won' t be dispositive, but can help later to challenge the veracity of a comp claimant if fraud is suspected.