Tips for Staffing Firms When Investigating a Workers’ Comp Claim

Whenever an employee makes a workers’ compensation claim, the employer needs to take the time to do a thorough review of the claim. Each investigation needs to be designed around the details of the claim. For staffing firms, an investigation often requires an extra layer of complexity due to the involvement of the client.

Have clear goals.

An investigation should have several aims. The first is to verify that the claim has validity—that is, that the injury took place during working hours and was not submitted on a fraudulent basis. Staffing firms can face greater challenges in this area than conventional employers, simply due to the variety of locations where their employees work. Bear in mind that the insurer will also conduct a review of these questions, and the two investigations might be run in parallel to save time and cost. But bear in mind that the insurer and employer may not always be aligned in their interests.

Another goal of an investigation is to identify the underlying causes of the injury. One hopes that the client is receptive to participating in this process, because the secondary aim is to resolve hazards to prevent injuries in the future. Identifying hazards and working through solutions is a good way to deepen the staffing firm’s relationship with its client.

Know the red flags.

Claims fraud is an unfortunate fact of life in the workers’ compensation world. Insurers are diligent in protecting themselves against fraudulent claims, but employers should also be aware of signs that an employee may be hiding important facts or fabricating a story. Red flags that might trigger a more detailed enquiry include things like these:

  • An employee’s history of making claims—fraudsters are known to try the same trick more than once.
  • Alleged workplace accidents that occur with no other witnesses present.
  • Inconsistent statements about the incident.
  • Behavior that is inconsistent with the claimed injury.
  • Claims made by an employee who is at the end of a long assignment.

Be prepared to get outside help.

Few staffing firms have the in-house capacity to run a claim investigation without outside assistance. For many claims, the help of an experienced advocate may be sufficient. In other cases, specialists may be required. Claims related to auto accidents or complex diseases may require extra assistance.

The team at Gunnin specializes in serving the workers’ compensation and risk management needs of the temporary staffing industry. We work closely with clients to ensure that their claims management process is thorough and protects the client from fraud and other problems. Call Gunnin today to learn more about how we can help your firm succeed.