To ensure their legitimacy, claims in these categories need to be viewed along with the circumstances of the injury and the extent of the medicals versus the lost time. If a cumulative cloud of duplicity forms then the claim warrants closer scrutiny by field investigation and surveillance.
- Seasonal help and temporary help –Employees can be hired as a temporary solution, but some can become a full time problem when it is decided that a workers’ comp claim is a way to extend cash flowing past the season.
- Staff affected by location closings or moving – This group feels abandoned and so their allegiance wanes quickly. Where they might have quickly returned to work so as not to leave co-workers shorthanded and shouldering their load, employees of a closing or relocation lose their connection socially as well as economically. Watch for employees that know they might lose their job to lay the ground work for a potential worker’s compensation claim for a past minor injury from which they have returned to work.
- The principles of a small retailer – An owner or principle involved with day to day operations of retail seldom has a contingency plan to be out sick for a week, never to mind considering being out for an extended period with a Workers Comp injury. A principle will usually find a way back into the store, if they don’t, that is a red flag by itself. They might actually be back in the store, but drawing worker’s comp checks also. This can be a side effect of financial necessity/ poor cash flow.
- Employees with attendance and disciplinary issues – By definition a person in this category is not an automatic abuser of compensation benefits, but anyone disgruntled does have a higher probability of seizing upon an opportunity to stage, elaborate or misrepresent an injury for the double purposes of creating a way out from the employer with whom they have had problems, and a way to “stick it to the man”.
- Comp clusters – This is a group of claims usually created by poor management that doesn’t provide for advancement, training or give encouragement or considerations for extra efforts. This boils up into a closed loop of employees complaining to each other how badly a manager or company policy treats the peons. So, once an employee of this network happens onto a worker’s compensation claim, it becomes viewed as an escape from the job and retribution to the lousy work environment. Friends and co-workers quickly share the antidotes of the company reaction, the process and qualifications to make it work. The collective absolve does not see a frivolous claim as wrong as everyone is doing it, the company deserves it, and it is only do it for awhile until something else comes along.