False workers’ compensation claims can disrupt a business and increase insurance costs. Texas companies have options to address these situations while protecting their rights. It is helpful to have an overview of steps businesses can take if an employee files a false claim.
Investigate the claim thoroughly
The first step is to conduct a detailed investigation into the claim. Review incident reports, medical records, and witness statements to identify inconsistencies or evidence of fraud. Surveillance or video footage can also provide valuable insights.
Notify the insurance carrier
Informing the workers’ compensation insurance carrier is essential. Insurance companies often have specialized teams to handle potential fraud cases and can help gather evidence to determine the validity of the claim.
Request an independent medical evaluation
If the claim involves questionable medical conditions, a company can request an independent medical evaluation (IME). This allows a neutral medical professional to assess the employee’s injuries and determine if they align with the reported incident.
Document all relevant details
Keep thorough records of all interactions, evidence, and steps taken to address the claim. Detailed documentation can strengthen your case if the matter escalates or requires legal intervention.
Report suspected fraud to the state
In Texas, you can report suspected workers’ compensation fraud to the Texas Department of Insurance (TDI). The state investigates fraudulent claims and can take action, such as imposing penalties or pursuing criminal charges against the claimant.
Improve workplace policies and training
Prevent future false claims by implementing strong workplace policies and training programs. Educate employees on the importance of honest reporting and outline the consequences of filing fraudulent claims. Regularly review safety procedures to reduce incidents that could lead to claims.
False workers’ compensation claims are a serious issue, but companies have multiple ways to address them. Taking proactive steps and understanding the available options can help protect your business from unnecessary financial burdens.