Employers are increasingly concerned about workers who may be exaggerating or even faking injuries for financial benefits. If you find yourself in such a situation, donโt worry; we have got you covered!ย
This guide will provide comprehensive insights into how to handle employee faking injury, taking legal actions, and implementing preventive measures. With our expert guidance, you can confidently tackle this issue and protect your employee relations and business from potential loss.
1. Questioning the Details
When an employee files a workersโ compensation claim, it is in the employerโs best interest to inquire further about prior claims and what happened. Asking when they got hurt, where they got hurt, and how they got hurt helps determine whether their claims are accurate.
1.1. Finding Out When They Got Hurt
Ask employees when they first noticed any signs of pain or discomfort that could be related to the alleged injury. Compare these answers with work schedules and talk to colleagues who work alongside them to uncover any discrepancies.
For example:ย
An employee says that their back started hurting after an inevitable shift but the worker then follows up by saying that it happened on a day they didnโt workโ this would raise concerns about them faking it.
1.2. Determining Where They Got Hurt
Detailed information on where an injury occurred is crucial in finding out if an injury happened on company property or while working outside of office hours.
For example:
An employee says they cut their hand at work even though all signs point towards them being ill and rarely leaving their deskโ this would raise suspicions about them lying.
1.3 Figuring Out How They Got Hurt
Knowing how an accident happened provides clarity on whether the situation was avoidableโ dishonest employees may struggle with explaining these details properly as they have never experienced it.
For example:
If an employee slips and falls at work and you ask them to describe how it happens, every time you ask, they give you a different response; this can serve as evidence of fraud.
1.4 Keeping In Touch
Maintaining regular contact and communication with injured employees is essential as it aids in identifying authentic cases and fosters a sense of trust between the two parties.
Obtain Written Consent for Investigations
Alex Freeburg, the Owner ofย Freeburg Law, discusses strategies for employers to respect privacy while verifying injury claims:
โThe best course of action an employer can take is to obtain written consent from the employee before probing further. It signifies that employees are acknowledging and permitting the employer to conduct necessary investigations.
This explicit agreement helps avoid potential legal complications and ensures that the employerโs actions are well within the boundaries of the law.
If an employee claims a workplace injury and the employer decides to conduct surveillance without proper consentโitโs going to be deemed invasive and could lead to legal pitfalls for the organization.
On the other hand, with written consent in place, the employer has a clear legal foundation for their investigative measures. And, letโs not forget that this cultivates a culture of openness and fairness within the organization.
Your team members are more likely to cooperate when they understand the reasons behind monitoring and surveillance, especially when it pertains to the validation of injury claims.โ
2. Taking Action Against Fake Injury Claims
2.1 Confronting Employees
After gathering substantial evidence linking to the fraud, you must approach the employee in question with your concerns. By doing so, you can better understand the situation, and the employee can have a chance to explain their side.
Some may confess to their wrongdoing, while others may deny everything. Nevertheless, itโs always best to get both sides of the story before making any decisions. This will ensure you make an informed and fair decision based on all the facts.
2.2 Reporting To Insurers
If you suspect someone is faking an injury, you must immediately report it to your insurance company. Whether you are working with a Professional Employer Organization (PEO) or an insurer, keeping them informed can help you deal with legal matters and receive the compensation you are entitled to. It would take a long time to investigate and get your rightful claim.
2.3 Consider Employerโs Liability Insurance
Are you worried about potential lawsuits from workers or their families filing a claim against your company for disputing a workersโ compensation claim? If so, employersโ liability insurance could be your perfect solution.
This coverage offers legal protection to safeguard your business when facing litigation outside workersโ compensation claims. Itโs an excellent option for companies that require extra security, and itโs worth considering if you want to avoid costly legal battles over workers compensation fraud. Donโt take risks with your business โ invest in employersโ liability insurance today.
Document Injury Reports and Seek Verification
Andy Gillin, Attorney & Managing Partner atย GJEL Accident Attorneys, offers key legal considerations for employers dealing with suspected injury fraud:
โWhen dealing with a suspected fraudulent injury claim, employers need to remain cautious and follow several steps to safeguard both the company and the employeeโs rights.ย
First, ensure all injury reports are detailed and documented accurately. This includes the circumstances surrounding the incident, eyewitness accounts, and any relevant CCTV footage.
Second, maintain open communication. Encourage the employee to openly discuss their situation without making direct accusations. If inconsistencies emerge, these can be addressed appropriately.
Third, consider seeking medical verification of the injury claimed. If serious doubts persist, this might involve an independent medical evaluation to confirm the injuryโs nature and severity.
Fourth, involve your insurance company early. Most insurance policies mandate cooperation in investigating potential fraud. This could involve sharing all records relevant to the claim.
Itโs crucial never to retaliate or discriminate against the employee for filing a workersโ compensation claim. In all instances, maintaining a balance between empathetic human understanding and a firm stand for justice is pivotal.โ
3 Preventive Measures And Communicating Policies
3.1 Policies In Writing
Once youโve dealt with a false claim, youโll have to do everything you can to make sure as few people as possible try it again. Specify the consequences for anyone who attempts a fraudulent claim. Reinforce that such behavior isnโt tolerated at the company.
3.2.Offering Rewards for Fraud Detection
Another way to reduce fraudulent claims is by encouraging employees to report anything they suspect. And offering rewards for reporting them can incentivize this behavior.
Emails, meetings, and announcements are all great ways to communicate this throughout the company.
3.3.Building Trust with Employees
A less sneaky way of keeping your workers honest is developing trust between them and you. Regular communication, making yourself available, and an environment where injured worker that they can speak up about their concerns will help.
3.4.Maintaining Ongoing Employee Communication
Consistently talking with your workers will make them feel appreciated and valued. This alone can significantly decrease their chances of resorting to dishonesty due to perceived grievances.
Building Trust Through Transparency
โAs the co-founder ofย Frostbeard Studio,ย Roxie Lubanovicย has navigated the delicacies of constructing a transparent and trust-filled relationship with both their employees and customers, especially regarding company policies that could potentially foster fear or distrust.
Theyโve addressed issues such as fraudulent claims or dishonest behavior head-on, not just through strict policies, but through a culture of open dialogue and shared values.
One key strategy they implemented was the development of a detailed employee handbook that clearly explained not only the rules around fraudulent claims but also the reasoning behind these policies and the protection they offer to everyone in the company.
By involving employees in the creation of these policies and openly discussing their implications, we built a sense of ownership and shared responsibility.
This approach led to very few issues around this sensitive area because everyone understood the importance of integrity for the collective well-being and success of the company.
Trust-building activities and open Q&A sessions with leadership further cemented this transparent culture, ensuring that policies were seen as protective rather than punitive.โ
4. Frequently Asked Questions
4.1.How can employers avoid being overly suspicious of legitimate injury claims?
The easiest way is by treating every single injury claim precisely the same. Show no bias or favoritism towards anyoneโs claim during your evaluations.
For all workers compensation benefits, e.g., Establishing a standardized questionnaire for all injury claims helps create an unbiased process. This ensures that legitimate claims are thoroughly evaluated without subjecting employees to undue scrutiny based on individual perceptions.
4.2.What legal steps can employers take when suspecting a fake injury?
Before doing anything legally related, please consult a professional who knows what theyโre discussing first! But if you want a general idea:
Consultation:ย You must talk with someone who understands legal actions before attempting anything yourself.
Confrontation:ย Without violating rights, ask the employee about their potentially fake illness or injury.
Report:ย If youโre sure itโs a serious form of fraud, report the suspicion to insurers.
Procedure:ย Lastly, follow whatever procedure your company has for this sort of thing.
4.3.How does maintaining trust with insurers benefit employers?
If you have a good relationship with your insurance provider, they will be more willing to work with you. This means faster claim handling and lower costs.
Also, trusting relationships with insurers enhances the efficiency of the claims process. When insurers have confidence in the employerโs commitment to fraud prevention, they may offer tailored solutions and potentially reduce premiums based on the demonstrated risk management efforts.
Closing Thoughts
Taking care of a false injury claim is just step one. After that, youโll need to start implementing preventive measures.
Create an environment where no one feels inclined to lie. Be upfront about the consequences for those who do try it. Ensure your employees are honest by speaking regularly with them and showing genuine care for their concerns.
By doing all this, we can make it so fraudulent behavior isnโt even considered at our companies anymore.
Guest AUthor: Saket Kumar
Last Updated on by Saket Kumar