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These fraud indicators should only be considered red flags, and do not prove the presence of fraudulent activity.
THE CLAIMANT, PRIOR CLAIM HISTORY and CURRENT WORK STATUS
The Injured worker…
- Is disgruntled, soon-to-retire, or facing imminent firing or layoff.
- Is involved in seasonal work that is about to end.
- Took unexplained or excessive time off prior to claimed injury.
- Has a history of short-term employment.
- Is new on the job.
- Is experiencing financial difficulties.
- Wants to change physicians when a release to work has been issued.
- Has a history of reporting subjective injuries.
- Is rumored or known to have another job or secondary employment.
- Is rarely home when called by employer or member of the claim team.
- Enlists the services of an attorney before or immediately upon filing a claim.
CIRCUMSTANCES OF THE ACCIDENT
- Accident occurs late Friday afternoon or shortly after the employee reports to work on Monday (or after days off).
- Accident occurs without witnesses.
- Accident occurs in an area where the employee would not normally be.
- Accident occurs just prior to a strike or near the end of probationary period.
- Fellow workers hear rumors that accident was not legitimate.
- Accident is not the type that an employee should be involved with (example: office worker lifting heavy objects on a loading dock) .
- Details of the accident are vague.
- Details of the accident on the first report contrast with those in the medical history.
- Employee does not promptly report incident to supervisor.
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