How to Identify Fraudulent Light-Duty Requests

Workers compensation is an essential system designed to support employees who sustain injuries at work. However, not all claims submitted to workers compensation providers are honest. Some individuals may take advantage of the system, exaggerating the severity of their injuries or seeking to extend their time off work for personal gain. A common tactic in these fraudulent claims is the request for light-duty work, where an employee may claim that they are unable to perform regular tasks but can carry out limited, less demanding duties.

While light-duty work is an important aspect of the recovery process for injured workers, it can be a potential avenue for fraud. Employees who are genuinely injured may request light duties as part of their rehabilitation and recovery, but some workers may misuse the system by requesting light duties to avoid returning to full work. This can be detrimental to employers who may face operational disruptions and financial losses due to fraudulent claims.

In this article, we will explore how employers can identify fraudulent light-duty requests, the signs to watch for, and how to effectively manage and prevent this type of fraud. We will also discuss the importance of a clear return-to-work policy, the role of medical assessments, and how to handle light-duty requests in a way that is fair to both employees and employers.

Understanding Light-Duty Work in Workers Compensation

Light-duty work, also known as modified or transitional duties, refers to tasks that an injured worker can perform while recovering from their injury. The goal of light-duty work is to help the worker return to their role in a way that accommodates their injury, reduces strain on their recovery, and allows them to maintain income while avoiding a prolonged absence from work. Light-duty tasks can include:

• Performing office-based duties instead of manual labour
• Working fewer hours per day
• Carrying out less physically demanding tasks
• Job modifications that align with the employee’s medical restrictions

Employers are often eager to help workers return to their roles as soon as possible, as this reduces the financial and operational impacts of prolonged absences. However, the legitimacy of light-duty requests can sometimes be questioned, especially if an employee’s behaviour or claim history suggests that they may be misusing the system.

Why Fraudulent Light-Duty Requests Are a Problem

Fraudulent light-duty requests are problematic for several reasons. First and foremost, they can lead to unnecessary financial costs for employers. If an employee is given light duties but is not truly injured or capable of returning to full duties, the employer is essentially paying for work that could have been avoided. Additionally, light-duty work often involves creating accommodations or modifying tasks, which can cause disruptions in business operations.

For businesses, fraudulent light-duty requests can lead to:

• Increased insurance premiums: Fraudulent claims can result in higher workers compensation premiums, as insurers view the business as a higher risk.
• Operational disruption: If employees request light-duty work but are actually capable of performing full duties, they are likely to be taking up space and resources that could be better allocated elsewhere.
• Employee morale issues: Other workers may become frustrated if they believe that someone is abusing the system while they are working harder or doing more demanding tasks.
• Legal risks: Mishandling a fraudulent light-duty request or failing to investigate can expose the business to legal action, including claims of discrimination, retaliation, or wrongful termination.

Employers need to be vigilant in identifying fraudulent requests early to prevent these negative consequences from escalating.

How to Identify Fraudulent Light-Duty Requests

Not all light-duty requests are fraudulent, and it is essential for employers to distinguish between legitimate requests for modified work and those made to take advantage of the system. The key is to monitor employee behaviour and request a consistent stream of documentation and evidence to support the claim. Below are some signs that may suggest a light-duty request is fraudulent:

1 Inconsistent or Contradictory Statements

One of the first signs of a potentially fraudulent light-duty request is inconsistent or contradictory statements made by the employee. For example, a worker who claims they are unable to lift more than 5kg but is later seen carrying heavy bags or performing physical activities outside of work is raising a red flag. Similarly, if an employee provides multiple, changing accounts of their injury — such as conflicting reports about when the injury occurred or how it happened — this should raise suspicion.

Employees who cannot provide clear details about the injury, recovery process, or treatment plans may also be attempting to cover up a fraudulent claim.

2 Unwillingness to Return to Full-Duty Work

In many cases, fraudulent light-duty requests are made by employees who don’t want to return to full work. These employees may request light duties indefinitely or extend their period of light-duty work unnecessarily. If an employee is not actively engaging in recovery activities or making progress toward a full return to work, it could indicate that they are abusing the system.

Employers should look for:

• Repeated extensions of light-duty work periods without medical justification
• Lack of improvement or effort to return to full duties after the prescribed recovery period
• Resistance to participation in rehabilitation programs or light-duty tasks

3 No Clear Medical Restrictions

Employees requesting light-duty work should have clear medical documentation outlining their restrictions. If the worker fails to provide updated medical certificates or documentation, or if the documentation does not clearly support the need for light-duty work, this may suggest that the employee is not genuinely injured or is overstating the severity of the injury.

Employers should:

• Request detailed medical certificates from healthcare providers outlining the employee’s limitations
• Ensure that the medical documentation matches the requested light-duty tasks
• Ask for updates or clarifications from the employee’s doctor if the medical information is vague or incomplete

4 Discrepancies Between Work-Related Injury and Outside Activities

A worker who claims to be unable to perform certain tasks due to an injury but is seen engaging in physical activities outside of work may be attempting to deceive the employer. Common signs that suggest fraudulent behaviour include:

• Exercising, running, or engaging in sports: If an employee claims to have a back injury but is seen jogging or participating in physical activities, this suggests that the injury is not as severe as claimed.
• Lifting, carrying, or performing tasks that contradict the employee’s reported physical limitations, such as carrying groceries or moving furniture.
• Secondary employment: Employees working in another physically demanding role while on light-duty leave may be attempting to take advantage of the system by collecting workers compensation benefits while earning additional income.

Surveillance can be a powerful tool to detect these behaviours and provide evidence of fraud.

5 Reluctance to Participate in Return-to-Work Programs

Many workers compensation schemes include a return-to-work program, which encourages employees to gradually return to their full duties as they recover. Employees who are genuinely injured will typically be motivated to follow the program and participate in rehabilitation.

However, employees who are attempting to take advantage of the system may resist or refuse participation in these programs. Common signs of reluctance include:

• Repeated cancellations of rehabilitation appointments
• Refusal to engage in any modified duties
• Failure to attend follow-up medical assessments or work assessments
• Avoidance of workplace discussions about return-to-work planning

A worker who continuously refuses to participate in a structured return-to-work program may be attempting to extend their period on light-duty leave indefinitely.

6 Sudden Onset of Injury or Claim Around Key Events

Another red flag is the timing of the injury. Fraudulent claims are often linked to significant events in the employee’s personal or professional life. For example, a worker may suddenly report an injury:

• Around a disciplinary action or performance review
• Immediately before a holiday or planned time off
• After a conflict with management or a colleague

While there are legitimate reasons for an injury to occur at any time, if the timing seems suspicious, it may indicate that the worker is trying to exploit the system to avoid work or other responsibilities.

Steps Employers Can Take to Prevent Fraudulent Light-Duty Claims

Preventing fraudulent light-duty claims requires a combination of clear policies, ongoing monitoring, and a structured approach to workers compensation claims. Below are some steps that employers can take to minimise the risk of fraudulent light-duty claims:

1 Implement a Clear Return-to-Work Policy

A well-defined return-to-work policy should outline the process for employees who require light-duty work. The policy should:

• Clearly explain the process for requesting light-duty work, including the necessary medical documentation
• Detail the specific tasks that can be performed as part of light-duty work and the duration of such assignments
• Establish expectations for returning to full duties once the worker has recovered

This policy should be communicated to all employees at the start of their employment and reviewed regularly to ensure it remains up to date.

2 Regularly Monitor and Review Claims

Employers should monitor the progress of all workers who have requested light-duty work. Regular reviews of the employee’s progress, combined with updated medical certificates, can help employers determine if the worker is making genuine progress toward returning to full work duties.

Employers should:

• Conduct frequent check-ins with employees to assess their recovery and discuss return-to-work plans
• Request updated medical documentation if the worker is not progressing as expected
• Document any observations or concerns about the worker’s behaviour and recovery

3 Use Surveillance to Verify Claims

If a worker’s light-duty request seems suspicious or inconsistent with their reported injury, employers may consider using surveillance to gather evidence. Surveillance can help verify whether the worker is engaging in activities that contradict their reported injury.

Surveillance should be conducted by licensed private investigators and must comply with privacy and legal regulations. Employers should not attempt to conduct surveillance themselves, as this could result in legal liabilities.

4 Encourage Early Return-to-Work Engagement

Employers should encourage employees to engage in the return-to-work process as soon as possible, even if it involves light duties. Early involvement in a return-to-work program has been shown to accelerate recovery and reduce the likelihood of long-term claims.

Offering meaningful light-duty work can help employees feel valued and engaged during their recovery, while also limiting the opportunity for fraudulent behaviour to develop.

Light-duty requests are an important tool for supporting injured workers and helping them return to work in a safe and sustainable manner. However, these requests can be abused by employees who are seeking to take advantage of the workers compensation system. Employers must remain vigilant and aware of the signs of fraudulent light-duty claims to protect their business and ensure that the system remains fair for everyone.

By implementing clear return-to-work policies, monitoring claims closely, using surveillance when necessary, and encouraging early engagement in the return-to-work process, employers can reduce the risk of fraudulent claims and ensure that legitimate workers receive the support they need.