False Workers’ Compensation Claims Are Rare, But You Should Still Be Wary

Depending on the industry your business operates in, there may be an increased risk of injury to your workers. The truth about operating a business is that work-related accidents need to be treated as an eventuality rather than a possibility. It’s for this reason that all businesses need to have a workers’ compensation program in place, not just as a measure to help injured workers, but also as a means to protect your business from legal complications. However, there are instances when employees try to game the system by filing a false workers’ compensation claim. Here are some signs that you should look out for:

Report Is Delayed Until Monday Morning

Normally, an injured worker would file a report right after an accident. However, the reason why a Monday report should come off as suspicious is because there’s a good chance that the accident may have happened over the weekend, and not during work hours. It’s not uncommon for an employee to use a workers’ compensation benefit in order to pay for a treatment that isn’t covered by their health insurance.

Claimant Refuses to Undergo a Medical Examination

A claimant who refuses a medical evaluation should already be treated as a red flag, especially when you’ve offered to shoulder the costs of the examination. A reasonable person would not refuse a chance to prove that they’ve sustained injuries, especially when it’s free.

Vague Accident Account

While a vague account of the accident does not necessarily mean that a worker is lying, this should be understood as a prompt to investigate the details of the accident further. This is especially true if the details provided by the injured worker are self-contradicting and when there seems to be an active effort to mask the truth. You may want to ask members of the same team, as well as people that the claimant spends more time with about the details of the accident and on the condition of the claimant.

No Witnesses or Evidence

Business owners should be more vigilant with cases wherein the claimant asserts that there were no witnesses or evidence to prove that the accident actually happened. This is made more improbable with large companies that have thousands of employees. Since a claimant needs to prove that an accident occurred at work, they would need to assert their claim through the evidence they gather. To claim to have an injury without any evidence to support such a claim is self-contradicting and it defeats the purpose of filing a workers’ compensation claim.

Late Injury Report

A late injury report is dubious for three reasons. The first is that any serious injury would likely have been reported immediately, as this would ensure that the claimant gets the needed medical attention. The second reason is that there would have been far too many things that could have further aggravated the injury before it was finally reported. Finally, a late report is also subject to corresponding fines and penalties depending on the state you live in.

None of these reasons should be used as a basis to claim that a worker filed a false workers’ compensation claim, but rather, it should be used as a sign that further investigation needs to be conducted. Should an attorney like Williams & Kamb prove that the claim is legitimate, you can at least be assured that you performed your due diligence.


Dee is a well-respected business journalist with a deep understanding of global financial markets and a talent for uncovering the stories behind the numbers. With over 20 years of experience covering the business beat, Dee is known for his in-depth reporting and analysis of industry trends, as well as his ability to make complex financial concepts understandable to a wide audience.