The presence of one or more “red flags” does not necessarily mean that fraud actually has occurred. They are simply warnings signs to investigate further for potential fraud until proven in a court of law. Until proven in court, it is only a suspicion.
Common Red Flags
Was there an unexplained or unreasonable delay by the employee in reporting the injury?
Are there no eyewitnesses to the injury?
Did the injury happen at an odd time (break, lunch, etc.) or where the employee was not suppose to be?
Have you had trouble reaching the injured employee at home while he or she is supposed to be off work due to the injury?
Is there an unusual coincidence between the employee’s alleged date of industrial injury and his or her need for personal time off?
Does the employee have any new or unusual financial problems? Has the employee borrowed money from coworkers or the company or request pay advances?
Do you have suspicions regarding weekend activities that may explain the “first thing Monday morning” injury?
Does the employee have hobbies or play sports that could cause an injury similar to the alleged work injury?
Does the employee have any preexisting medical conditions similar to the alleged industrial injury?
Does the employee do volunteer work or have another paying job?
Does the employee have a history of short-term employment?
Is the employee disgruntled, soon-to-retire, or facing imminent firing or layoff?
Does the employee protest about returning to work?
Does the employee’s injuries never seem to improve?