Conducting Background Checks on Injury Claimants

Workers compensation is a vital safety net that provides employees with compensation for injuries sustained during the course of their employment. However, as with any system, there are opportunities for abuse. Workers who submit false or exaggerated claims can exploit the workers compensation process for financial gain, putting significant financial strain on businesses and insurers.

One of the most effective methods for identifying fraudulent claims is by conducting background checks on injury claimants. Background checks allow employers and insurers to uncover relevant information that may indicate whether a claim is legitimate or whether the worker is attempting to take advantage of the system. These checks provide invaluable insights into an employee’s history, including previous workers compensation claims, employment history, and even any history of fraudulent behaviour.

In this blog, we will explore the importance of conducting background checks on injury claimants, the types of information that can be uncovered, and best practices for carrying out these checks in a compliant and ethical manner. By following these strategies, employers can minimise the risk of fraudulent claims and ensure that only legitimate claims are processed.

Why Conduct Background Checks on Injury Claimants?

Background checks play a critical role in identifying fraudulent or exaggerated workers compensation claims. In a system where injuries are often self-reported, and medical certificates can sometimes be manipulated, it is essential to gather as much information as possible to assess the legitimacy of a claim.

1 Identifying Previous Fraudulent Claims

One of the most significant risks for employers is workers who have a history of filing fraudulent claims. A claimant who has a pattern of submitting false or exaggerated claims can cost employers substantial sums in compensation, legal fees, and insurance premiums. By conducting thorough background checks, employers can uncover:

• Previous workers compensation claims filed with the same or other employers.
• A history of multiple, inconsistent injuries, particularly if the injuries reported are inconsistent with the job or have no clear causation.
• Frequent changes in medical providers or a lack of corroborating medical documentation.

Uncovering this information early in the process can help employers identify high-risk claimants and take appropriate action to investigate or dispute the claim before it escalates.

2 Verifying Employment History and Job Description

Employers need to confirm that the reported injury is related to the worker’s job duties. A background check can help verify the worker’s employment history, including:

• Previous employers and roles.
• Job responsibilities and whether the reported injury aligns with the tasks the worker was performing.
• Any previous injuries reported during their employment with other companies.

In cases where the injury does not seem to align with the claimant's reported duties or is inconsistent with their job description, a background check can provide valuable context to determine the legitimacy of the claim.

3 Detecting Non-Work-Related Injuries

Some workers may try to claim compensation for injuries sustained outside of work. If an employee is injured while engaging in personal activities or outside of work hours, they may attempt to file a workers compensation claim by fabricating or misrepresenting the cause of the injury. Background checks can help uncover:

• Social media posts or other publicly available information where the claimant may have discussed the injury occurring outside of work.
• Previous medical records that show the worker had the same or a similar injury before the alleged workplace incident.
• Personal injury claims that the employee may have filed in the past, suggesting that the injury is non-work-related.

By cross-referencing information gathered from a background check, employers can verify whether the injury claim is likely to be legitimate or fabricated.

4 Preventing Repeat Fraudulent Claims

Background checks can also help prevent repeat offenders who may have a history of submitting fraudulent or exaggerated workers compensation claims. Workers who have previously defrauded the system may attempt to do so again, and if their history is not flagged, they may continue to take advantage of the system. By conducting thorough background checks, employers can identify:

• Repeat claimants who have a history of filing multiple claims across different employers.
• Workers who have been terminated or disciplined for previous fraudulent activities or misconduct.
• Patterns of injury that appear suspicious, such as claiming injuries at multiple workplaces that could suggest a broader attempt to exploit workers compensation benefits.

Flagging repeat offenders early can help employers address fraudulent claims more effectively and prevent future exploitation of the system.

Types of Information to Uncover During Background Checks

Background checks on injury claimants can uncover a range of important information that can help verify the legitimacy of a workers compensation claim. Below are some of the key data points to focus on when conducting a background check:

1 Employment History

Verifying a claimant’s employment history is crucial for understanding the nature of the work they were performing when the injury occurred. Important factors to consider include:

• Job titles and roles: Ensure that the worker’s job description aligns with the reported injury. For example, if a worker claims a back injury, but their role did not involve heavy lifting or physical labour, this discrepancy may require further investigation.
• Previous employers: Check with former employers to see if the worker has a history of filing workers compensation claims with them. This may indicate a pattern of fraudulent behaviour.
• Employment gaps: Look for unexplained gaps in employment that could signal potential issues, such as previous injuries that were not reported to the employer or prolonged absences from work.

By cross-checking the claimant’s employment history, employers can uncover inconsistencies or patterns that suggest the injury is not work-related.

2 Medical History

A claimant’s medical history is one of the most important factors in assessing the legitimacy of a workers compensation claim. Background checks can uncover:

• Previous injuries: Check for any past injuries that may be similar to the reported injury. A history of similar injuries could indicate that the current claim is related to a pre-existing condition rather than a new workplace injury.
• Medical provider changes: Frequent changes in medical providers or the use of different providers for the same injury can suggest that the claimant is attempting to find a doctor who will issue a more lenient report or extended leave.
• Other personal injury claims: Check whether the worker has filed personal injury claims outside of the workers compensation system. This could be an indication that the injury occurred outside of work.

By reviewing the medical history, employers can verify whether the reported injury is legitimate or whether it has been exaggerated or fabricated.

3 Social Media and Public Records

Social media has become an essential tool for gathering information about employees and claimants. By reviewing a claimant’s social media profiles, employers can uncover:

• Posts or photos showing the claimant engaging in activities that contradict their reported injury (e.g., lifting, exercising, or participating in physical activities).
• Public statements about the injury or the work environment that could suggest the injury is exaggerated or fabricated.
• Location check-ins or photos that place the claimant in situations that contradict their injury (e.g., a gym or hiking trail).

Employers must be cautious when gathering information from social media, ensuring that they only access publicly available content and respecting the claimant’s privacy.

4 Criminal and Legal History

In some cases, a claimant’s criminal and legal history may provide additional context for their workers compensation claim. While not all criminal records are relevant, certain types of legal history can help employers identify potential risks, including:

• Fraud convictions: A background check can reveal whether the claimant has been convicted of fraud, theft, or similar crimes in the past.
• Previous workers compensation fraud: Some individuals may have a history of filing fraudulent workers compensation claims, either with their current employer or other organisations.
• Personal injury claims: If the claimant has a history of filing personal injury lawsuits, it could suggest that they are more likely to exaggerate or fabricate injuries for financial gain.

By understanding the claimant’s criminal and legal background, employers can gain insight into whether the worker is more likely to exploit the system.

Best Practices for Conducting Background Checks on Injury Claimants

Conducting background checks on injury claimants requires careful planning and adherence to legal and ethical guidelines. Below are some best practices for ensuring that background checks are conducted effectively and responsibly:

1 Obtain Consent from the Claimant

Before conducting a background check on a worker, it is essential to obtain their written consent. Many jurisdictions have strict privacy laws that govern the use of personal information, and employers must ensure that they comply with these regulations. Inform the worker that a background check will be conducted as part of the claims process and obtain their consent in writing before proceeding.

2 Work with Legal and HR Professionals

Employers should consult with legal and HR professionals to ensure that the background check process complies with privacy laws and workers compensation regulations. Legal experts can guide employers on what information can be accessed and how it should be used in the claims process. HR professionals can ensure that the background check is conducted in a non-discriminatory and ethical manner.

3 Use a Reputable Background Check Service

Employers should use a reputable and compliant background check service to ensure that the information gathered is accurate and legally obtained. Professional background check services can help employers access relevant data, such as employment history, medical records, criminal records, and social media activity, while ensuring compliance with privacy laws.

4 Focus on Relevant Information

When conducting a background check, employers should focus on relevant information that pertains to the worker’s injury and the workers compensation claim. Avoid collecting unnecessary personal information or data that is unrelated to the claim. Be mindful of privacy rights and ensure that the background check is focused solely on verifying the legitimacy of the injury.

5 Maintain Confidentiality

All information gathered during the background check process must be treated with the highest level of confidentiality. Employers should store background check results securely and ensure that only authorised individuals have access to this information. Sharing background check results without proper justification can lead to privacy violations and legal consequences.

Conducting background checks on injury claimants is an essential part of identifying fraudulent workers compensation claims and ensuring that only legitimate claims are processed. By verifying employment history, medical records, and other relevant information, employers can uncover discrepancies and protect their business from financial and operational risks.

Employers should approach background checks responsibly, ensuring compliance with legal regulations, protecting the privacy of the claimant, and focusing on relevant information. By following these best practices, employers can effectively manage workers compensation claims and reduce the risk of fraud.

An effective background check system not only protects the business but also maintains the integrity of the workers compensation system, ensuring that legitimate injured workers receive the support they need while preventing abuse of the system.