Second, the handbook specifically noted the possibility of insurance fraud by managed care companies. Although most claims are legitimate, many are inflated or fraudulent and the adjuster should review all claims for possible fraud. These indicators, or fraud possibility factors, should help isolate those claims meriting closer scrutiny. No one indicator by itself is necessarily suspicious. Even the presence of several indicators, while suggestive of possible fraud, does not mean that a fraud has definitely been committed.
Injured worker is involved in seasonal work that is about to end.
Injured worker took unexplained or excessive time off prior to claimed injury. Injured worker takes more time off than the claimed injury seems to warrant. Injured worker is nomadic and has a history of short-term employment. Injured worker is new on the job. Injured worker is experiencing financial difficulties.