Bonezzi Switzer Polito & Hupp Co. L.P.A.
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Red flags of possible workers' compensation fraud

Sometimes, a claim an employee files with the Ohio Bureau of Workers’ Compensation does not smell right. But finding a smoking gun proving that the employee is committing fraud can be hard to find for employers.

To that end, BWC has come up with a list of red flags that suggest possible workers’ compensation fraud. Though BWC cautions that the presence of any of these things does not automatically mean the worker is a fraud, they can mean that it is time to submit a Fraud Allegation Form to BWC.

Among BWC’s red flags include:

  • Documents have cross-outs, white-outs or erasures on them
  • Injured worker moves out of state shortly after filing the claim
  • The alleged accident or injury occurred immediately prior to a strike, layoff, job termination etc.
  • The date, time and/or place of the accident is unknown
  • The injury is not consistent with the nature of the business
  • The injured worker is seen with signs of having worked recently, like calluses on his or hands or grease under the fingernails
  • The reporting of the injury was not timely and immediate
  • Nobody witnessed the accident
  • Co-workers provide tips that make the claim suspicious

BWC takes reports of possible fraud seriously. It has a special investigations department, where special agents investigate claims, gathering evidence and analyzing the facts to determine whether criminal charges should be pursued against the worker. In this way, the system attempts to prevent abuse and fraud by workers who invent or exaggerate their injuries to obtain undeserved workers’ compensation benefits.

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