Page 32 - Network Magazine Summer 2019
P. 32

      Is My Employee’s Work Injury Legit?
Red Flags A Claim May Be Bogus
 Pennsylvania employees reported 174,216 work injuries in 2017. This is an increase of more than 15,000 on-the-job in- juries reported in 2016 when Pennsylvania employers and insurers paid out a whopping 3.1 BILLION to cover lost wages and medical treatment. As this figure illustrates, the costs associated with employee injuries can be stag- gering and while workers’ compensation is an unavoidable cost of doing business, how many injuries are not legiti- mate? How many accidents are phony or staged turning a pre-existing condition into a work-related liability? It’s impossible to gauge the number of bogus claims or what impact they have on premiums, but business owners are not helpless. Companies can take simple measures when conducting injury investigations to effectively uncover and stamp out bogus claims improving their bottom line.
It should be a no-brainer that all claims, no matter how big or small, must be investigated but many companies surprisingly have no formal procedure in place or their “investigation” is limited to completing a report which con-
tains only basic information. After all, isn’t it the responsibility of the claims professional to conduct the investigation? Yes and no. While the insurer should do its own investigation, the devil is in the details and the most critical information can only come from the employer. An excellent starting point, whether you’re a mom and pop shop or huge conglomerate, is to promptly gather all essential information and look for any red flags.
Here’s a checklist to jumpstart the investiga- tion.
ü Neworrecenthire.
ü Injuryisreportedwhileemployeeis
working through a temporary agency.
ü Delayinreportinginjury.
ü InjuryallegedlyhappensonaFriday but is not reported until the following week.
ü Injury occurs prior to news of a layoff, strike or plant closure.
ü Injury reported after employee was fired or laid off.
ü Employee is disgruntled (i.e., denied vacation, demoted or passed over for a promotion, poor performance review, job dissatisfaction, conflict with co-worker(s)).
ü Recent discipline and termination imminent.
ü Spike in absenteeism.
ü Injury coincides with change in personal circumstances (i.e., illness of spouse, pregnancy of employee/spouse, end of seasonal work or project, spouse relocation, separation/divorce, childcare issues, enrollment in college).

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