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Workers’ compensation flags that will make you see red

On Behalf of | Aug 26, 2021 | Firm News |

You were injured in a workplace accident, and your injury is serious enough to keep you out of work for a while. You dutifully reported your injury to your employer right away, followed all the proper steps to obtain medical treatment, filed your claim and waited.

Now, you’re either still waiting or you just found out that your employer (or their insurer) is contesting your claim. What’s going on?

Well, your claim may have been “red-flagged” through no fault of your own.

What’s it mean when a claim is red-flagged?

Insurers and employers are always looking for signs that a worker is trying to defraud the system in one of three ways:

  • Claiming to be injured when they’re not
  • Claiming to be more seriously injured than they really are
  • Claiming a non-work injury actually occurred on the job

How do they decide if a worker falls into one of those categories? They look for red flags like:

  • You were hurt on Monday. In an employer’s mind, that’s clearly a sign that you were actually hurt over the weekend.
  • You are “disgruntled.” That basically means anything your employer wants it to mean, whether you were just denied a day off or you recently got into a verbal spat with your supervisor.
  • You have hobbies. Do you bowl, jog, garden or hike? Your employer may decide that you probably injured your knee or back on your personal time, not work.
  • You aren’t sitting at home. Maybe the insurer or your employer tried to call you and you didn’t answer or they drove by your house looking for you and your car wasn’t there. Surely, they decide, if you’re well enough to be out and about, you’re well enough to work.

Frankly, there’s quite a list of reasons that your claim may be suspect, and many of them follow some pretty thin logic. If your workers’ compensation claim has been delayed or denied because of suspected fraud, don’t waste your time trying to argue your innocence. Find out more about your legal options, instead.