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As the Policyholder, What Should You Look For?

As a NYSIF Policyholder, you part of the front line of defense in the fight against Workers' Compensation Fraud. As an employer, what should you be looking for? Here are some Red Flags of Fraud:
  • Changes in claimant's employment history with your company- Did the claim occur after recent disciplinary action, layoff notification, demotion, etc?
  • Frequent changes in claimant's employment status at previous jobs - Does the employee have a history of job-hopping?
  • Timing of the Claim - Did the accident in question occur first thing on a Monday morning or upon returning from vacation time? How quickly was the accident reported to management? (ie. Did the accident occur on Friday but was not reported until Monday the following week?)
  • Circumstances of the accident in question - Were there any witnesses to the accident? Do the witness accounts contradict the claimant's story?
  • Claimant's behavior - Has the claimant been impossible to reach after the accident was reported? Has the claimant maintained contact during their time out of the office?
One of these Red Flags on their own may not be an indication of fraud; however if you observe multiple Red Flags with one of your ongoing claims the claim should rightfully be examined thoroughly to ensure that the case is not fraudulent. 
Workers' Compensation Fraud is a felony in the state of New York. If you suspect that a claim is fraudulent or have any questions regarding workers' compensation fraud we ask that you contact our Claims Department at
201-652-2015. 
Contact the Claims Department at Innovative Risk Concepts, Inc.
Copyright © 2015 IROC Family of Company, All rights reserved.


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