Here are Some Workers’ Comp Claims That Raise Questions

Here are Some Workers’ Comp Claims That Raise Questions

All of the statistics that I have viewed and the articles which I have read confirm to me that most work related claims are legitimate.  I realize that some of my clients and other employers question my conclusions.


A fellow member of the workers’ comp community, Rebecca Shafer, JD, wrote a recent article outlining the “Red Flags” that should alert all of us as to what may be a questionable claim.


Here are some points that Rebecca made about those claims which should get our attention:


  • Monday morning claims – the chances are the injury occurred over the weekend
  • Unwitnessed accident – a large share of back, neck and other musculoskeletal injuries seem to occur without any witnesses. Many of these employees have other physical issues that they bring into the work place
  • Late reporting of an injury – the late reporting of an injury is inexcusable and are an indication that the incident probably occurred elsewhere
  • Injured worker forgot the details – this is an indication that there may be other medical issues that are masking the alleged injury or the incident is a fabrication
  • Unhappy employee – many use the workers’ comp system as a means to avoid working
  • Migrating injury – this occurs when the injury is first reported on one part of the workers’ body and as the treating physician works with the employee, other body parts begin to show signs of injury and the creep of more medical treatment and higher claims costs
  • The cheat – this is the greedy person who wants to “game” the system so it is a moral decision of the employee to hide the truth and to get as much money as possible


Rebecca makes a profound closing comment in her article: “Any time you feel there is something just not right about an employee’s workers’ comp claim, your instinct is often correct.”


In my work with employers to help them manage insurance and their related costs, my experience with instinct has brought me to the same conclusion. 


The best way to control an employer’s total workers’ comp costs is to take the following approach:

  • Work with a qualified workers’ comp advisor
  • Commit to a consistent proactive program to select the right employees for the right job
  • Provide transparency to all employees as to how the workers’ comp system functions


For more information go to, contact me at or phone 916-265-3837


Listen – Learn – Call Into “Insurance Matters” every Tuesday 8 a.m. on Sacramento’s Money 105.5 FM, phone 866-576-1055; plus the first Saturday of the month at 9:30 a.m. on 1380 AM KTKZ, phone 888-923-1380 – Online at Small Biz Talk Radio

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Tom Bone
Risk Insurance Advisor
ISU Insurance Services
2266 Lava Ridge Court
Roseville, California 95661
Phone 916.960.8758 or 800.823.4852 ext. 8758
Fax 916.773.4484
Mobile 925.285.6790
License #0306692