The Fraudulent Claim
When the adjuster has questions about a claim it may be denied or suspended pending investigation. Receiving a Notice of Dispute or Suspension of Benefits does not mean the claimant (injured worker) is suspected of fraud, it just means there is an ongoing investigation to determine the validity of the claim- the claim is being substantiated.
A claimant has to be very bold, and ready to risk probable legal action from both the carrier and the state were the claim is filed. Filing a fraudulent claim is not very rewarding, and the down side is huge — which is probably why true fraudulent claims are rare.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
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