Your Claims Questions Answered – What do I do if I suspect workers’ comp fraud?

Workers’ compensation fraud hurts business owners by causing higher premiums. That’s why we take fraud seriously at Texas Mutual and have a team dedicated to investigating these concerns. In 2016, Texas Mutual investigated more than 1,600 referrals and discovered more than $1 million in claimant fraud.

In our next video in the Your Claims Questions Answered series, we talk about what you should do if you suspect fraud. Watch the video below and take a look at our top three tips to remember when it comes to fraud.

Always contact Texas Mutual first when you suspect fraud.
If you suspect someone at your workplace is committing fraud, the first step is to contact Texas Mutual. We have a dedicated team of licensed professionals that will investigate your referral. Don’t confront the employee, but instead trust the professionals to investigate. To report suspected fraud, call (800) 488-4488 or email fraudstoppers@texasmutual.com.

Maintain a good relationship with the injured worker.
It’s important to maintain a positive relationship with the injured worker throughout the recovery process. Instead of jumping to conclusions, voice your concerns to Texas Mutual. There could be many reasons why an employee is not home on bed rest and making accusations to an injured worker could lead to more problems for your business.

Put a return-to-work program in place.
Focus on a return-to-work plan with the injured worker. If they are unable to perform the job duties they did before their injury, then determine what modified job duties they can do that will help them contribute to the team. Injured workers out six months or more have only a 50 percent chance of ever returning to work. Getting an injured worker back on the job will prevent you from being in the middle of a fraud investigation. We recently covered how to create a return-to-work program. Remember, it’s never too early to get started.

You can watch the full Your Claims Questions Answered series here. Visit texasmutual.com for FraudStoppers posters, red flags of fraud, and more information on reporting fraud.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: