Examples:

• The injured worker is a new hire or working at a family owned business.

• The Claimant took unexplained or excessive time off prior to claimed injury. 

• The alleged injury occurs prior to or just after a strike, layoff, plant closure, job termination, completion of temporary work, or notice of employer relocation.

• Claimant reports an alleged injury immediately following disciplinary action, notice of probation, demotion, or being passed over for promotion. 

• Claimant has a history of personal injury, workers' compensation claims, and/or of reporting "subjective" injuries. 

• Claimants job history shows many jobs held for fairly short periods of time. 

• Claimant uses addresses of friends, family, or post office boxes; has no known permanent address or moves frequently. 

• Claimant's family members know nothing about the claim. 

• Claimant was experiencing financial difficulties and/or domestic problems prior to submission of claim. 

• Claimant has a high-risk activity, such as skydiving, or mountain climbing.
    
  
• Lawyer's letter of representation or letter from medical clinic is first notice of claim.
   
  
• The lawyer's letter is dated the same day as the reported incident or shortly thereafter. 
  
  
• There is a repeated pattern of doctor/attorney referrals; the same doctor and attorney work together on a large volume of claims. 
  
  
• There are no witnesses to the accident, or witnesses to the accident conflict with the Claimant's version or with one another. 

• Claimant fails to report the injury in a timely manner. 

• Accident or type of injury is unusual for the Claimant's line of work. 

• Facts regarding accident are related differently in various medical reports, statements, and employer's first report of injury. The Claimant's version of the accident has inconsistencies.

• Claimant cannot be reached at home during working hours although claims to be disabled from working; or message taker is vague and non-committal. Claimant is otherwise unavailable and elusive. 

• Several of Claimant family members are receiving workers' compensation,  unemployment, Social Security, welfare, etc. 

• Income from workers' compensation and collateral sources (unemployment, Social Security, long-term disability, etc.) meet or exceed wages after taxes. 

• Claimant refuses diagnostic procedures to confirm injury, or refuses to attend a scheduled medical exam. 

• Claimant's co-workers express opinion that injury is not legitimate. 

• Alleged injuries are all subjective; i.e., soft-tissue, pain, and emotional injuries. 

• Claimant changes version of accident after learning of inconsistencies: misrepresentation or fabrication by any party. 

• Claimant frequently changes physician, or does so after being released to return to work. 

• Physical description of Claimant indicates muscular, well-tanned individual, with callused hands, grease under fingernails, or other signs of active work. 
  
  
• Medical treatment is inconsistent with injuries originally alleged by employee. 

• Claimant undergoes excessive treatment for soft tissue injuries. 

• Claimant cannot describe either diagnostic tests or treatment for which employer was billed. 

• The doctor ordered diagnostic testing that is not necessary to determine extent of Claimant's injury; or, diagnostic testing is performed, yet there is no request by doctor in medical files. 

• Diagnostic tests are performed by a vendor not in close proximity to doctor's office or Claimant's home, vendor uses post office boxes on all documents, or cannot supply diagnostic records. 

• Doctor or medical clinic has ownership share in diagnostic group. 

• Various reports by a doctor on different Claimant's cases read identically or similarly. 

• Post office box used for a clinic/doctor address, instead of street address. 

• Medical reports appear to be second- or third-generation photocopies. 

• Physician cannot be located at address shown on documentation. 

• Doctor's report never identifies claimant by gender of gets gender wrong. 

• New or additional medical problems are alleged and attributed to the original injury. 

• Specific "soft tissue" injury develops psychiatric overtones. 

• Treatment as reported by Claimant is different from doctor's statement in medical report. 

• Claimant is examined by several doctors when one doctor could have taken all the information and reached a diagnosis. 

• Claimant reports seeing doctor for a very brief period of time; however, reports and billing indicate a lengthy visit. 

• Claimant sends in medical reports that appear to be altered. 

• Claimant lives far from medical facility, yet receives frequent treatment. 

• Surveillance shows Claimant's activities are inconsistent with physical limitations related in medical reports and deposition. 
  
  
• Medical reports contain inaccurate terminology, spelling errors, variations in physician's signature or are rubber-stamped with the doctor's name. 

• Medical facility uses multiple names or changes name often. 

• Billings are received for unnecessary or not rendered services. 

• Medical facility has consistently billed both WC carrier and auto, health, etc., insurance carrier and has received payments from both. 

• Claimant is unable to define medical ailments as listed on claim form. 

• Claimant alleges doctor or clinic found through a "hot line." 

• Claimant filed for unemployment or disability benefits before visiting attorney or clinic. 

• Claimant is overly pushy, demanding a quick settlement, commitment, or decision. 

• Claimant is unusually familiar with claims-handling procedures, workers' compensation rules, and proceedings. 

"Red flags" do not automatically guarantee guilt, but are simply indicators of potential fraud and surveillance should be considered.