In a workers' compensation claim, which action by the injured worker would be the most pertinent fraud indicator?

In a workers' compensation claim, which action by the injured worker would be the most pertinent fraud indicator?

• A. Lifting a box
• B. Waiting to report
• C. Asking for referral
• D. Asking about check

Answer: (C)

In workers’ compensation fraud detection, red flags come from behaviors that suggest someone is altering the medical record or benefits to fit a false or exaggerated claim. Asking for a referral is a strong indicator because it can point to doctor shopping—seeking a new or different physician to obtain a diagnosis, treatment, or opinion that supports a larger payout or different benefits. This pattern of pursuing multiple providers or specific referrals to shape the claim is more suspicious than routine activities. Lifting a box, waiting to report, or asking about a check can occur for legitimate reasons or routine administrative matters and are not as strongly tied to fraudulent intent.

In workers’ compensation fraud detection, red flags come from behaviors that suggest someone is altering the medical record or benefits to fit a false or exaggerated claim. Asking for a referral is a strong indicator because it can point to doctor shopping—seeking a new or different physician to obtain a diagnosis, treatment, or opinion that supports a larger payout or different benefits. This pattern of pursuing multiple providers or specific referrals to shape the claim is more suspicious than routine activities.

Lifting a box, waiting to report, or asking about a check can occur for legitimate reasons or routine administrative matters and are not as strongly tied to fraudulent intent.