You can't control when a work injury happens, who sees it happen, or how many times you've been hurt at work, but these details could make your workers' comp claim look suspicious to your employer, Managed Care Organization (MCO), or the Bureau of Workers' Compensation (BWC). If the BWC suspects fraud, they could deny your claim and even report you for breaking the law. If your claim is legitimate but has one or more of these potential red flags, contacting a workers' comp lawyer early could be a smart move.
What the BWC Might See as a Sign of Fraud
Unfortunately, individuals, employers, and health care providers defraud or try to defraud the Ohio BWC every day. These crooks make it harder for everyone by forcing the BWC to examine every claim with a suspicion of fraud. Claims adjusters are trained to look for certain factors common in fraudulent claims, and some employers will look for any excuse to prevent you from filing a claim. If your legitimate claim has any of these factors, your claim could be further scrutinized and could even be denied.
- You report your accident on a Monday. If you were injured late on Friday—or even on a Monday morning—and you report your injury on Monday, your employer or the BWC might suspect you were actually injured in a non-work-related incident over the weekend and are trying to claim you were injured at work for the benefits. However, this should not prevent you from filing an accident report promptly—even if it is a Monday!
- There are no witnesses. If you don't have witnesses or video footage of you falling, dropping a sander on your foot, or crashing a forklift, investigators could call your report of the incident into question. While witnesses can always help a claim, do not think your claim is worthless without one.
- You have a side job. You may do whatever you choose outside of the hours you work your main job, but if you own a business on the side or work a contract position on the weekends, it can raise suspicion you might have been injured in your side hustle and are only claiming it happened at your full-time job because that's your only access to workers' comp.
- You have lodged complaints recently or are close to retiring. It can look suspicious to your employer or claims adjuster if you have been disgruntled with work or are counting down the days to retirement and then report a work injury.
- You know a lot about workers' comp. You might be a read-the-instructions kind of person, but if you seem to know more about the worker's comp process than your employer or HR manager, that could raise a red flag for them. Someone trying to bilk the system would make sure they knew the rules before committing fraud.
- This is not your first workers' comp claim. Workers' comp fraudsters are often repeat offenders, so if you have the misfortune of suffering a work injury more than once in your career, that might raise suspicions that you are taking advantage of the system.
As I said, if your claim is legitimate, you can't help it if some of these facts are also true. However, you can help your case by talking to a workers' comp attorney if you are worried about your claim looking suspicious or if your employer or claim manager doesn't believe you.
Get Help From Monast Law Office
With over 30 years of experience as a workers' comp attorney in Ohio, I have helped injured workers overcome obstacles put in front of them by their employers and the BWC. If you think your claim might raise suspicions, contact Monast Law Office to discover how we can help. Learn more by requesting a free copy of our book, The Worker's Guide to Injury Compensation in Ohio, then fill out our online contact form or call our Upper Arlington office at 614-334-4649 to get started.