Protecting Yourself from Insurance Fraud: What Should You Do If A Worker Is Injured?

Situations where your workers have been injured must be tackled with caution and care. The most important to have in mind after an injury at work is the recovery of the worker and their return to work. Taking part in a process like this can be long and tiresome. Besides the injured worker and the employer, the participants here are the doctor and the insurance agent, unless the employer owns a license and can pose as a self-insurer. It is important to know what to do so to protect yourself from insurance fraud.

Here are the things to do when a worker is injured in the work place:

The Employer

1. In case of an injury at the workplace, before taking further action, it is necessary to provide first aid to the injured worker and then make sure that the threats to the health of other employees are removed.

2. Injuries and illness register must be filled in. Employers are in obligation to keep this register up to date and according to a strictly defined content.

3. If employers have not obtained a self insurer’s license by meeting the pre-determined criteria, the next step for them would be to hire a licensed insurer. Those employers who own this license, are not required to pay for an authorized insurer, but to provide security and keep claim administration in order on their own.

The Worker

1. Within the first 24 hours of sustaining an injury, the worker must inform the employer.

2. After receiving medical treatment, the worker needs to obtain a worker’s compensation medical certificate from the doctor and the claim form from employer. The properly filled in claim form is submitted to the employer, along with compensation medical certificate.

From the moment the employer becomes aware of the injury, he is in obligation to notify the insurer (in case he does not own a self insurer license) about the injury within 3 days. This can be done either by telephone, e-mail or fax. In addition, it is the obligation of the employer to inform the worker that they have a right to claim within 14 days since the injury has occurred.

The Insurer

1. Based on Workers compensation and rehabilitation act 2003, the insurer will notify the worker and the employer of receiving the claim, as well as about their rights, roles and responsibilities.

The claim will be considered valid if it is submitted in time, if the injured person is employed and if the injury was caused at work and is work-related.

Back to Work

An important part of the recovery is encouraging workers to return to work as soon as possible. This is done with the doctor’s permission and in respect to the worker’s physical and mental condition, since being away from work can cause family relationship breakdowns, social isolation and depression.

The human factor is the key in people making fraud attempts with the aim of achieving an illegal profit. Employers must be careful and protect themselves as consequences of fraud are not insignificant.

Some of the ways in which employers can fight against fraud are checking the background of the workers before hiring and even creating reward programs for reporting suspicious claims. In cases when the incident was already reported, collecting information from eyewitnesses accompanied by a detailed examination of workers can lead to uncovering fraud attempts.


Miles Wiseman

Miles Wiseman is a writer and blogger from Brisbane who takes particular interest in finance, business and employment. He writes about all the interesting things related to job search, career progress, small and medium businesses, etc.


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