Workers' compensation fraud can involve employers, injured employees, medical providers, or others. While some situations may raise questions or warrant additional review, a warning sign alone is not proof of fraud.
The examples below highlight common warning signs that may indicate additional information or investigation is needed. WSI reviews each report carefully to determine the facts before reaching any conclusions.
Important
A warning sign is not proof of fraud. Many situations have legitimate explanations. WSI evaluates every report based on the facts and circumstances of each case.
Common warning signs
Warning signs may involve the injured employee, the reported injury, the employer, or the medical provider. Select a section below to learn more.
Examples might include:
- Multiple workers' compensation claims over time.
- Statements that are inconsistent or change over time.
- Activities that appear inconsistent with reported work restrictions.
- Returning to work while receiving wage-loss benefits without reporting earnings.
- Difficulty contacting the injured employee during normal recovery periods.
Examples might include:
- Delayed reporting without a clear explanation.
- Conflicting accounts of how the injury occurred.
- No witnesses when witnesses would normally be expected.
- An injury that appears inconsistent with the reported work duties.
- Circumstances that require additional clarification.
Examples might include:
- Underreported payroll.
- Employee classifications that appear inconsistent with job duties.
- Employees reported as independent contractors who may not meet the legal definition.
- Cash payroll practices that are inconsistent with reported wages.
- Failure to maintain required workers' compensation coverage.
Examples might include:
- Billing for services not provided.
- Billing patterns that appear inconsistent with treatment.
- Altered or incomplete documentation.
- Duplicate billing.
- Billing for more expensive procedures than those performed.
What to do if you notice warning signs
If you observe warning signs that concern you, document the facts as you know them and report your concern to WSI. You do not need to determine whether fraud has occurred before making a report. WSI reviews every report to determine whether additional investigation is warranted.
Fraud Hotline: 800-243-3331
Related information
Report Fraud
Learn how to report suspected workers' compensation fraud and what happens after a report is submitted.
Fraud Prevention Tips for Employers
Learn practical steps employers can take to reduce the risk of workers' compensation fraud.