Managed Care

Red Flags to Look for in a Workers’ Compensation Claim

Andrea Kiener
Red Flags to look for in a workers’ compensation claim
Reading time 3 Mins
Published on May 25
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Due to the nature of an injury, some workers’ compensation claims can be more difficult to manage. However, there are some warning signs that employers should look for indicating a difficult claim.

Some of these red flags are:

  • The injury was reported before/after vacation; just prior to retirement; shortly after announced lay-offs; or there was a lag time between the date of injury and the date it was reported.
    -Any workplace injury should be reported immediately, and employers should have a procedure in place to address this need.
  • Injuries reported on Mondays or Thursdays.
    -This could indicate the injury took place over the weekend, especially if reported first thing on a Monday morning.
    -Injuries reported on Thursdays could be suspect because some may want a long weekend, especially if it is payday.
  • There was no witnesses to the accident.
    -There may be a legitimate reason for no witnesses to an accident; however, many employees work in close proximity to other employees. Only you, as the employer, would know if it would be out of the norm for no other employee to witness the accident.
    -You should also exam if the injured employee was not in his/her normal work area when the accident occurred and that is the reason for no witnesses.
  • Injured employee has work performance issues, including but not limited to attendance issues and issues with his/her supervisor.
    -Some employees with performance issues may be close to termination and could lead to a workers’ compensation claim filed for job protection.
    -If an employee with attendance issues has used all of their allotment of time off, they could potentially look to file a claim in order to get paid time off.
  • Lack of communication with the injured person.
    -The injured employee needs to communicate with all parties to the claim to ensure he/she received the appropriate treatment for their injury and to discuss progression of the claim.
  • The injured employee either treats with the same doctor as other injured employees or has multiple changes in doctors.
    -This could mean that employees are discussing workers’ compensation injuries and where to seek treatment.
    -Some injured employees will treat with multiple doctors in order to remain off work as long as possible or continue to receive prescriptions for medication.

Each workplace injury is different, and there are many reasons these red flags could occur in a claim. However, if an injured employee shows one or more of the signs listed above, you may have a difficult claim to manage. Work closely with your Managed Care Organization to develop a strategy to deal with all claims but especially those with early warning signs.


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