How You Can Dispute Illegitimate Workers Comp Claims

Don’t let questionable claims increase your workers compensation costs.

Approximately 80-90% of all workers compensation insurance claims are accepted.  While this ensures that you can get the coverage you need, this high acceptance rate can cause issues when it comes to questionable claims.  If a fraudulent claim does go through, then your business’s rates will increase.  To avoid this loss, it’s important to know how to dispute questionable workers comp claims.  Here are some of the things to consider.

  • Always Report Claims

Even if the evidence indicates that a claim is fake, you still need to inform your insurance provider.  This is because claims adjusters have the necessary training and certification to deal with a fraudulent claim officially.  Failing to report an employee claim is dangerous because an employee can sue you for negligence.  Additionally, you could face other repercussions such as legal fines, increased premiums, and so on.  So, always report injury claims, even if you are sure that they are fraudulent.

  • Understand What Makes a Claim Questionable

There are several factors that can suggest that a workers compensation claim is fraudulent.  For instance, if the employee has a history of making questionable claims, holds a vendetta against the company, or has recently fallen on hard financial times, then this should raise a red flag.  Other signs of fraudulent claims include the injury being more severe than the incident calls for, a lack of witnesses, and the employee being unwilling to participate in the claims process.  Because you may not notice these signs at the outset of the claim, it’s important to monitor the situation closely.  If at any time you suspect the legitimacy of the claim, then inform your adjuster immediately.

  • Work with Your Claims Adjuster

If you suspect the validity of the claim, then it’s important to tell your claims adjuster so they can flag it for special consideration.  From there, it’s important to work with your adjuster so they can make an accurate determination.  Help your adjuster get employee statements, obtain medical records, and conduct background checks so they can objectively determine the validity of a questionable claim.

This is how you can dispute questionable workers compensation insurance claims.  Do you have additional questions about your workers comp coverage?  If so, then contact the experts at PMC Insurance Group.  Our dedicated team is eager to assist you with all your business insurance needs today.