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We have all heard the story about the business bilked out of tens or even hundreds of thousands of dollars by a bookkeeper that was defrauding the company to fund a gambling habit. The reason we have heard the story is because it is true. A quick Google search will identify a number of examples. In all of these cases, the opportunity for fraud was created when the business failed to exercise appropriate supervisory control over an employee in a position of trust.
Workers’ compensation claim fraud, just like the fraud of the gambling bookkeeper is a crime of opportunity. At ForensIQ Risk Intelligence we believe that no single factor can increase the opportunity risk for claim fraud more than late reporting of injuries.
You may also have heard the story about the worker that arrives at work on Monday morning to report that they were injured at work on the previous Friday afternoon. The problem is; if the accident that caused the alleged injury was not witnessed, and the worker did not seek medical attention on the Friday, what evidence is there that the claimed injury actually happened at work? Is it possible that the injury occurred between when worker left work on Friday and arrived at work on Monday? Of course it is. The opportunity for fraud exists in this case because the worker failed to report the injury before leaving work on Friday.
The extent to which the opportunity to commit fraud can be reduced is a critical element of your claim fraud deterrence strategy. To that end, ForensIQ offers our proprietary On Time Every Time (OTET) Injury Reporting Initiative training. We believe that employers that implement OTET initiatives and work towards achieving 100% on time injury reporting create a strong competitive advantage by significantly reducing claim fraud opportunity risk.