Inflated claims are different from fraudulent claims in that they begin with an injury or illness that the employee later attempts to manipulate into additional time off with pay or a higher disability award.  An example of this type of claim is when employee, who is nearing retirement and is injured, attempts to use workers compensation disability benefits as a bridge to retirement.  Another example is a second wage-earner who discovers that it is very convenient to be home during the day and decides to extend a disability as long as possible.

Below is a list of the characteristics of inflated claims:

• The injury lingers long after it should have been resolved;
• The employee is not actively seeking or seldom seeks treatment;
• The employee frequently misses or reschedules medical appointments and may not consistently attend treatment sessions;
• The employee hires an attorney when there appears to be nothing in dispute on the claim;
• The employee refuses Temporary duty assignment;
• The employee is a frequent user of the personal leave plans or has poor attendance.

If the Claim Coordinator encounters any of these telltale signs he or she should consider doing the following. First stay in close touch with the employee and the treating physician.  Inflated claims occur when the employee senses that nobody is monitoring their claim, when nobody is watching, when they do not hear from anyone from your company or the adjuster on a regular basis, and when nobody seems to care about issues such as missed scheduled medical examinations. Under these circumstances the employee, and the employee’s doctor, may conclude that nobody cares if and when they come back to work. Staying in close touch with the employee and the treating physician is the best way to discourage malingering.

Second, find a temporary duty job for the injured employee as soon as possible. One of the inherent benefits of a temporary duty program is that it gets the employee back to work rather than staying at home. The longer the employee is off of work the greater the chance they will lose the “working habit.” They may find that they no longer need to address issues like childcare, work clothes, transportation, and even getting up in the morning. In addition, you are better able to stay in close contact with the employee, monitor their rehabilitation progress, and attitude. Finally, the employee feels far less threatened and less inclined to retain an attorney.