--- title: 13 Ways to Spot an Employee’s Fraudulent Worker’s Compensation Claim description: Workers compensation fraud occurs when claims are faked or overstated. Discover 13 signs that help protect your business from false or suspicious claims. image: https://blog.axcethr.com/hubfs/fraudulent%20workers%20comp%20claim-1.jpg --- - [Client Portal](https://www.axcethr.com/client-services/) - [Employee Login](https://www.axcethr.com/client-services/) [![AxcetHR Solutions Blog](https://blog.axcethr.com/hubfs/AxcetHR2021%20Blog/axcethr_logo_white%20(1).png)](https://www.axcethr.com/) - [About Us](https://www.axcethr.com/about-us/) - [Corporate Philantropy](https://www.axcethr.com/about-us/corporate-philanthropy/) - [Meet the Team](https://www.axcethr.com/about-us/meet-the-team/) - [Values and Culture](https://www.axcethr.com/about-us/values-and-culture/) - [Kansas PEO](https://www.axcethr.com/about-us/kansas-peo/) - [Missouri PEO](https://www.axcethr.com/about-us/missouri-peo/) - [Careers](https://axcethrsolutions.prismhr-hire.com/) - [Why Axcet](https://www.axcethr.com/why-axcet/) - [Why Choose Axcet?](https://www.axcethr.com/why-axcet/) - [About PEOs](https://www.axcethr.com/why-axcet/about-peos/) - 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- - - [whatsapp://send?text=https://blog.axcethr.com/13-ways-to-spot-an-employees-fraudulent-workers-compensation-claim](whatsapp://send?text=https://blog.axcethr.com/13-ways-to-spot-an-employees-fraudulent-workers-compensation-claim) - [mailto:?subject=13%20Ways%20to%20Spot%20an%20Employee’s%20Fraudulent%20Worker’s%20Compensation%20Claim&body=https://blog.axcethr.com/13-ways-to-spot-an-employees-fraudulent-workers-compensation-claim](mailto:?subject=13%20Ways%20to%20Spot%20an%20Employee’s%20Fraudulent%20Worker’s%20Compensation%20Claim&body=https://blog.axcethr.com/13-ways-to-spot-an-employees-fraudulent-workers-compensation-claim) ![fraudulent workers comp claim](https://blog.axcethr.com/hs-fs/hubfs/fraudulent%20workers%20comp%20claim.jpg?width=1200&name=fraudulent%20workers%20comp%20claim.jpg) Employers pay for workers’ compensation insurance to protect their companies and support their employees if an on-the-job injury occurs. Most of the time, workers’ compensation claims are legitimate, and employees [who are injured](https://blog.axcethr.com/dont-force-it-avoiding-overexertion-injuries-at-work) or become ill on the job rightly receive the medical and indemnity benefits they deserve. In about [1 to 2% of cases](https://www.pbs.org/wgbh/pages/frontline/shows/workplace/etc/fraud.html), however, the claims are fraudulent. While the percentages are small overall, the National Insurance Crime Bureau reports that, nationally, those false claims can amount to billions of dollars in annual costs. This fraud has a ripple effect, driving up an employer’s workers’ compensation premiums and perhaps inhibiting the company’s ability to give [raises](https://blog.axcethr.com/how-to-respond-when-you-hear-i-want-a-raise) or bonuses and necessitating increases in customer prices. It may not be possible to eliminate all worker’s compensation fraud. But, as a small business employer, you can reduce it by watching for these 13 signs a workers’ compensation claim may be fraudulent. [Related: How Opioids Affect Workers' Compensation Costs >>](https://blog.axcethr.com/how-opioids-affect-workers-comp-costs) ## 1. Nobody Else Saw the Incident Happen If the employee typically works around others but professes to have been alone at the time of the incident, you might want to give the claim a second look. ## 2. The Story Keeps Changing When the employee repeatedly changes details about how the injury happened, it’s reason to suspect he or she is not telling the truth. ## 3. The Evidence Doesn't Support the Employee's Story The claim is suspect if the company reviews the [incident scene](https://blog.axcethr.com/workplace-safety-risk-management) and the evidence gathered doesn’t match up with the employee’s description. The same is true if a medical exam indicates the injury isn’t consistent with the worker’s description of how it happened. ## 4. The Employee Has a Pre-Existing Medical Condition Similar to the Alleged Work Injury [![returning to work after workers compensation](https://no-cache.hubspot.com/cta/default/2652187/interactive-167541582886.png)](https://blog.axcethr.com/hs/cta/wi/redirect?encryptedPayload=AVxigLJ390pV1glBSM4hvDyn%2FSxmAqJklKEP5Y%2FrErJi%2FwX%2BERjBitAiuJZ5mOFWH5dMVxRydzllClb3MXkUVY0KVPFhpayAbB1YTFkYsg6c3dYkj3OJcrIgubNdk5JNrcZPgMczjZG2%2F0RDGNukqCiYrPhtkS6%2Fx7YuUMKawDP%2FhRSAvVEZ9IyqMKsypONMibRuBkbc84djpAUFPPmtBW%2FX35E5k4VImcPW%2B%2BrnZkB983iN7cU%2BS6FpqW86xyaZCEg%3D&webInteractiveContentId=167541582886&portalId=2652187) ## 5. The Employee Says the Injury Happened Days or Weeks Ago But is just now making the claim and can't explain the delay. ## 6. The Timing is Strangely Coincidental There is reason to doubt a claim’s veracity if the employee submits it after having been terminated, after a change in job responsibilities or when the alleged injury coincides with the employee’s need for personal time off. Likewise, an employee who claims an injury first thing Monday morning may be trying to cover for an accident that actually happened over the weekend. ## 7. The Employee is Historically Dissatisfied Workers who have been disciplined for performance or behavioral issues or who always [seem disgruntled](https://blog.axcethr.com/staying-out-of-harms-way-handling-disgruntled-employees) may have decided that filing a worker’s compensation claim is a way to “get even” with the company. ## 8. The Employee Has a Checkered History Their history includes frequent job, address and physician changes and/or a history of filing workers’ compensation claims. [Related: Workers' Compensation Laws in Kansas and Missouri >>](https://blog.axcethr.com/workers-compensation-laws-in-kansas-and-missouri) [![Workers' Comp Insurance for Small Business](https://no-cache.hubspot.com/cta/default/2652187/interactive-184991639090.png)](https://blog.axcethr.com/hs/cta/wi/redirect?encryptedPayload=AVxigLIvZxHd67lukufAcRa43iUP3REfp3bQQh0c9WgXVcy9iyJTAdD%2FIAYKwLEYyatAQa8cw3lHZgagr6htmNmsu46uq9Qnk6vzjw2zmOt5T30rCOtBnmnxgRsOjD9gf2ak2LMIEAIYM41Vy9aHJ0jlVbpvDOiL58HeoycIsMM84HEticx8BPao0FN8r0Jl6BUsdOu41cEHrWUEn1jfRqzputZeZzGKGvLAaaApI3bXL0XBBXb2P%2BQGOibq9RN6ZBdmVKwpnpXbRyluRybiWkYn1mdO7zmOOV0qtEB1V%2BGjP7x2xmRQRhzd2ObPF6RVi1IAg0OBZdxOh71KjxPq4as%3D&webInteractiveContentId=184991639090&portalId=2652187) ## 9. The Employee Refuses to See a Doctor A physician’s diagnosis can determine whether the claimed injury exists. If it does, the doctor can determine how severe it is and determine the proper course of action to promote healing. Employees with legitimate injuries should welcome medical treatment. ## 10. Financial Problems May Be a Factor Employees who have requested pay advances or asked to borrow money from colleagues may be financially strapped. If they haven’t been successful in getting funding elsewhere, a workers’ compensation claim may look like a way to meet their financial needs. ## 11. You Can't Reach the Employee A worker who’s out on leave because of an injury at work shouldn’t be hard to contact. If the employee doesn’t answer repeated calls, it may be a sign that the worker’s compensation claim is fraudulent. [Related: 10 Best Practices for Workers' Compensation Claims Management >>](https://blog.axcethr.com/10-best-practices-for-workers-compensation-claim-management) ## 12. An Attorney Gets in Touch Neither pushing for a quick claim settlement nor immediately hiring an attorney is a sign that the employee is operating in good faith. An employee who refuses to cooperate or who swiftly hires a lawyer may have something to hide. ## 13. Activity Tells a Different Tale An employee receiving worker’s compensation benefits for a severe back injury who simultaneously is seen lifting heavy weights at the gym, or one posting photos on social media of a just-completed 10K while supposedly home with a broken foot has certainly filed a fraudulent claim. Being aware of the warning signs of a fraudulent worker’s compensation claim will help you protect your small business. Axcet HR Solutions also can help by vigilantly monitoring workers’ compensation claims submitted against its clients, as well as helping clients [minimize employee recovery time and overall claims costs](https://www.axcethr.com/services/workers-comp-and-employee-safety-risk-management/workers-compensation-insurance/). [![New call-to-action](https://no-cache.hubspot.com/cta/default/2652187/a32596fb-7822-4c00-b63b-2b0aae9c6020.png)](https://cta-redirect.hubspot.com/cta/redirect/2652187/a32596fb-7822-4c00-b63b-2b0aae9c6020) [![Steve Donovan](https://blog.axcethr.com/hs-fs/hubfs/Steve-10.jpg?width=80&height=80&name=Steve-10.jpg)](https://blog.axcethr.com/author/steve-donovan) Written by #### [Steve Donovan](https://blog.axcethr.com/author/steve-donovan) Director of Risk Management Read more [View all posts →](https://blog.axcethr.com/author/steve-donovan) ### Get HR Updates ### Table of Contents ### Related Resources - [services Risk Management](https://www.axcethr.com/services/workers-comp-and-employee-safety-risk-management/) - [services workers' compensation](https://www.axcethr.com/services/workers-comp-and-employee-safety-risk-management/workers-compensation-insurance/) #### [Four Ways to Counter the Great Resignation ![the great resignation of 2021](https://blog.axcethr.com/hubfs/the%20great%20resignation%202021%20(1)%20(1).jpg)](https://blog.axcethr.com/four-ways-to-counter-the-great-resignation) #### [![Jeanette Coleman Director of Human Resources Axcet HR Solutions Kansas City](https://blog.axcethr.com/hubfs/Jeanette%20Coleman%20Director%20of%20Human%20Resources%20for%20Axcet%20HR.jpg) Governor Laura Kelly Signs New Kansas Vaccine Exemption Law](https://blog.axcethr.com/governor-laura-kelly-signs-new-kansas-vaccine-exemption-law) ## Let us know what you think... ![AxcetHR Blog](https://blog.axcethr.com/hubfs/AxcetHR2021%20Blog/axcethr_logo_white%20(1).png) - [Why Axcet](https://www.axcethr.com/why-axcet/) - [What We Stand For](https://www.axcethr.com/about-us/what-we-stand-for/) - [Expertise](https://www.axcethr.com/expertise/) - [Employee Benefits](https://www.axcethr.com/services/employee-benefits/) - [Human Resources](https://www.axcethr.com/services/human-resources/) - [Payroll Services](https://www.axcethr.com/services/payroll-and-tax-administration-services/) - [Risk Management](https://www.axcethr.com/services/workers-comp-and-employee-safety-risk-management/) - [Meet the Team](https://www.axcethr.com/about-us/meet-the-team/) - [Subscribe to Latest Resources](https://www.axcethr.com/subscribe-to-the-latest-resources/) - [Resource Library](https://www.axcethr.com/expertise/resource-library/) - [\[ Client Portal \]](https://www.axcethr.com/client-services/) - - - - - Search for: Copyright © 2023 Axcet HR Solutions – Kansas City's PEO Since 1988 | [Privacy Policy](https://www.axcethr.com/privacy-policy/) | [Terms and Conditions](https://www.axcethr.com/terms-conditions/) | [**Join our Team – Careers »**](https://axcethrsolutions.prismhr-hire.com/) 10975 Grandview Drive Suite 200, Corporate Woods Building 27, Overland Park, KS 66210 | Call us: 913-383-2999 *The IRS does not endorse any particular For more information on [certified professional employer organizations](https://www.axcethr.com/why-axcet/certified-peo/), go to [www.irs.gov](https://www.irs.gov).* Remove cookies ![](https://dc.ads.linkedin.com/collect/?pid=43031&fmt=gif) ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Steve Donovan", "url" : "https://blog.axcethr.com/author/steve-donovan" }, "dateModified" : "2026-09-20T19:21:40.187Z", "datePublished" : "2021-12-07T17:58:35.000Z", "headline" : "13 Ways to Spot an Employee’s Fraudulent Worker’s Compensation Claim", "image" : [ "https://blog.axcethr.com/hubfs/fraudulent%20workers%20comp%20claim-1.jpg" ], "mainEntityOfPage" : { "@id" : "https://blog.axcethr.com/13-ways-to-spot-an-employees-fraudulent-workers-compensation-claim", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://blog.axcethr.com/hubfs/_logo_axcethr_primary.png" }, "name" : "Axcet HR Solutions" } } ``` ```json { "@context" : "https://schema.org", "@id" : "https://www.axcethr.com/#organization", "@type" : "Organization", "address" : { "@type" : "PostalAddress", "addressCountry" : "US", "addressLocality" : "Kansas City", "addressRegion" : "MO" }, "aggregateRating" : { "@type" : "AggregateRating", "bestRating" : "5", "ratingValue" : "5", "reviewCount" : "100" }, "areaServed" : { "@type" : "Country", "name" : "United States" }, "award" : [ "IRS Certified Professional Employer Organization (CPEO)", "Award-Winning HR Solutions Provider", "SHRM Certified HR Professionals", "HRCI Certified HR Professionals" ], "contactPoint" : { "@type" : "ContactPoint", "areaServed" : "US", "availableLanguage" : "English", "contactType" : "Customer Service" }, "description" : "Award-winning Professional Employer Organization (PEO) providing comprehensive HR solutions, payroll services, employee benefits, and risk management to small and mid-sized businesses. 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Most of the time, workers’ compensation claims are legitimate, and employees who are injured or become ill on the job rightly receive the medical and indemnity benefits they deserve. In about 1 to 2% of cases, however, the claims are fraudulent. While the percentages are small overall, the National Insurance Crime Bureau reports that, nationally, those false claims can amount to billions of dollars in annual costs. This fraud has a ripple effect, driving up an employer’s workers’ compensation premiums and perhaps inhibiting the company’s ability to give raises or bonuses and necessitating increases in customer prices. It may not be possible to eliminate all worker’s compensation fraud. But, as a small business employer, you can reduce it by watching for these 13 signs a workers’ compensation claim may be fraudulent. Related: How Opioids Affect Workers' Compensation Costs >> 1. Nobody Else Saw the Incident Happen If the employee typically works around others but professes to have been alone at the time of the incident, you might want to give the claim a second look. 2. The Story Keeps Changing When the employee repeatedly changes details about how the injury happened, it’s reason to suspect he or she is not telling the truth. 3. The Evidence Doesn't Support the Employee's Story The claim is suspect if the company reviews the incident scene and the evidence gathered doesn’t match up with the employee’s description. The same is true if a medical exam indicates the injury isn’t consistent with the worker’s description of how it happened. 4. The Employee Has a Pre-Existing Medical Condition Similar to the Alleged Work Injury 5. The Employee Says the Injury Happened Days or Weeks Ago But is just now making the claim and can't explain the delay. 6. The Timing is Strangely Coincidental There is reason to doubt a claim’s veracity if the employee submits it after having been terminated, after a change in job responsibilities or when the alleged injury coincides with the employee’s need for personal time off. Likewise, an employee who claims an injury first thing Monday morning may be trying to cover for an accident that actually happened over the weekend. 7. The Employee is Historically Dissatisfied Workers who have been disciplined for performance or behavioral issues or who always seem disgruntled may have decided that filing a worker’s compensation claim is a way to “get even” with the company. 8. The Employee Has a Checkered History Their history includes frequent job, address and physician changes and/or a history of filing workers’ compensation claims. Related: Workers' Compensation Laws in Kansas and Missouri >> 9. The Employee Refuses to See a Doctor A physician’s diagnosis can determine whether the claimed injury exists. If it does, the doctor can determine how severe it is and determine the proper course of action to promote healing. Employees with legitimate injuries should welcome medical treatment. 10. Financial Problems May Be a Factor Employees who have requested pay advances or asked to borrow money from colleagues may be financially strapped. If they haven’t been successful in getting funding elsewhere, a workers’ compensation claim may look like a way to meet their financial needs. 11. You Can't Reach the Employee A worker who’s out on leave because of an injury at work shouldn’t be hard to contact. If the employee doesn’t answer repeated calls, it may be a sign that the worker’s compensation claim is fraudulent. Related: 10 Best Practices for Workers' Compensation Claims Management >> 12. An Attorney Gets in Touch Neither pushing for a quick claim settlement nor immediately hiring an attorney is a sign that the employee is operating in good faith. An employee who refuses to cooperate or who swiftly hires a lawyer may have something to hide. 13. Activity Tells a Different Tale An employee receiving worker’s compensation benefits for a severe back injury who simultaneously is seen lifting heavy weights at the gym, or one posting photos on social media of a just-completed 10K while supposedly home with a broken foot has certainly filed a fraudulent claim. Being aware of the warning signs of a fraudulent worker’s compensation claim will help you protect your small business. Axcet HR Solutions also can help by vigilantly monitoring workers’ compensation claims submitted against its clients, as well as helping clients minimize employee recovery time and overall claims costs.", "author" : { "@id" : "https://blog.axcethr.com/author/steve-donovan#author", "@type" : "Person", "name" : "Steve Donovan", "url" : "https://blog.axcethr.com/author/steve-donovan" }, "dateCreated" : "2021-12-07", "dateModified" : "2026-09-20", "datePublished" : "2021-12-07", "description" : "Employers pay for workers’ compensation insurance to protect their companies and support their employees if an on-the-job injury occurs. Most of the time, workers’ compensation claims are legitimate, and employees who are injured or become ill on the job rightly receive the medical and indemnity benefits they deserve. 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