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Defending against fraudulent workers’ compensation claims

As an employer, you bear an important responsibility to provide sufficient workers' compensation coverage to your employees. Ideally, this coverage provides for their needs when they suffer job-related injuries while shielding you from lengthy, costly lawsuits. Unfortunately, many workers' compensation claims are not legitimate, and seek compensation that the substance of the claim does not justify.

If you suspect that an employee filed a claim that does not hold up to scrutiny, you may have grounds to challenge the claim, ensuring that you don't shoulder unnecessary costs that may harm your business as a whole.

Whether an employee submits a claim improperly or attempts to fraudulently obtain compensation, you have the right to examine the matter carefully. Do not overlook any legal tools and resources that are available as you consider how to address a potentially invalid workers' compensation claim.

Improper filing

Even if the substance of a claim has merit, if the employee does not submit the claim in the proper manner or within the prescribed timeframe, you may dismiss it on these grounds.

Commonly, employees may not submit a report of injury until after the law requires them to do so. These windows are important to maintain, because they help employers and insurers properly investigate the nature of the injury and its causes. The greater the time that passes between the occurrence of an injury and the victim reporting it, the greater likelihood that inconsistencies may develop in the account. Also, evidence that may contradict the account of the employer may no longer be available.

Fraudulent claims

In some cases, an employee may seek compensation for a self-inflicted injury or fabricated injury for the purpose of receiving what he or she may consider automatic compensation. If you suspect that an employee inflicted harm on oneself or received the injury in circumstances not related to employment, it is important to carefully scrutinize the account of the injury and evidence that the claim presents. Make sure that your business is not on the hook for compensation it does not rightfully owe.

It is also wise to closely follow how the victim responds to the injury, especially if he or she does not pursue proper medical care, or does not follow through on prescribed treatments. These sorts of violations of protocol may justify terminating the process.

Don't simply assume that all workers' compensation claims are as strong as they may seem at first. All claims must stand up to scrutiny before they receive compensation, or else, your business may not have the capacity to cover the costs of these claims. Take every opportunity to look very carefully at all workers' compensation claims, for the sake your company and all of its employees.

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