Employee Red Flags
– Is seldom available at home
– Delays return to work after maximum medical improvement
– Refuses light duty opportunities
– Is vague or contradictory about how the injury occurred
– Was in jeopardy of termination or probation prior to injury
– “Shops” for a provider and/or is noncompliant with treatment
– Conceals pre-existing medical information relevant to the claim
– Delays reporting the injury
– There is evidence that the employee has other concealed employment and/or is participating in activity that is contradictory to reported physical limitations
– There is no witness to the injury nor resulting symptoms
Employer Red Flags
– Fabricates location or type of operation
– Under reports payroll
– Medical Provider Red Flags
– Bills for services not actually rendered
– Bills for products not actually provided
– Over bills
– Fabricates procedures
– Unbundles services