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How to spot a phony comp claim

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HC Online | 12 Aug 2014, 10:24 AM Agree 0
Have you ever suspected an employee of making a less than legitimate workers’ compensation claim? Here are some tips for spotting the fakers.
  • Deborah Pearson | 12 Aug 2014, 11:22 AM Agree 0
    Having an employee submit what you suspect is a phony Workers Comp claim is one thing. Having the insurance agency agree with you is another. If it's easier for them to simply pay it out than dispute it - guess what their going to do? And it's our premiums that take the hit. I believe insurance agencies need to be more accountable for their decisions and the role they play.
  • Ron | 12 Aug 2014, 11:35 AM Agree 0
    We have proceeded with five of these cases over the years. Two were found in our favour, three we gave up largely because the insurers just werent interested. The turnover in workers compensation insurers means you rarely get anyone who cares and its easier for them to accept a claim than challenge it
  • Lisa | 12 Aug 2014, 03:32 PM Agree 0
    Agree Ron, case workers are often not interested in the challenging cases. We had an employee who was working overseas for 3 months while on workers comp and they wouldn't even question him...not to mention the doctor shopping that goes on.
  • Her Ladyship | 12 Aug 2014, 07:36 PM Agree 0
    Having challenged several phoney claims and had them disputed, two things are essential: good investigation skills (your own) and a supportive insurance company. If it seems fishy on your first examination it probably is fishy. Be prepared to question the employee and the managers for the truth. Your insurance company is your partner - you need to get the service you require. Cultivate an effective relationship with your case manager for best results!
  • Geoff | 12 Aug 2014, 08:49 PM Agree 0
    Only 6% of claims are fraudulent. So let's focus on the injured workers who need support. The NSW Government has abandoned workers and employers by abolishing medical costs for the majority of injured workers. So if someone needs medical support to keep them economically viable, they don't get it, which then impacts on their performance, and then they lose, out, their employer loses productivity, and the federal health system then is forced to take up some of the gap and costs. Election in NSW in March 2015. Do the right thing by injured workers who want to be productive.
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