How to Use Effective Litigation Fraud Management

Risk Management, June 1996 | Go to article overview

How to Use Effective Litigation Fraud Management


"While most workers' compensation claims are legitimate, some are inflated, and a corporation can't afford not to have a fraud management program in place," said speaker Susan Fortin, director of risk management, Shaw's Supermarkets, Inc., at The Litigation Fraud Squad.

"Risk managers need a uniform system to fight fraud," said Charles O'Connor, Esq., product manager, litigation management, Liberty Mutual Group in Boston. Some of the worst cases were linked to organized crime rings, which can infiltrate the insurance system on every level--from the claimant, doctors and lawyers, to government officials, including police departments, according to Mike Powell, regional vice president, National Insurance Crime Bureau.

Mr. Powell recommended the use of "red flag indicators," or fraud possibility factors, to help isolate claims meriting closer scrutiny. Red flag indicators include: an employee involved in seasonal work that is about to end; an employee with a history of reporting injuries; an accident that is not witnessed; an accident that occurs late Friday or earl Monday; or an incident that is not promptly reported by an employee to a supervisor. While no one indicator is necessarily suspicious, a corporation can use them as part of a uniform program.

Companies should also be leery of physicians known for handling suspect claims and of "boilerplate" medical reports from the same doctor. …

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