Spot the Red Flags: Monday Morning Injuries

Monday Morning Injury or Monday Morning Accident is a term for when an employee approaches you on the first morning of the working week to report an injury sustained at work on a Friday. Usually followed by the question – Is the injury truly work-related or did it happen over the weekend?

These incidents often leave us scratching our heads, wondering if there’s more to the story than meets the eye. It is a fact that more worker’s compensation claims for injuries are filed on Monday than any other day of the week. An employee who suffered an injury over the weekend might try to play it off as an onsite injury and file for workers compensation on Monday. Keep in mind that these claims rely on the fact that no one was there to see what happened and are surrounded by a cloud of uncertainty.

What to Look out For on Monday Morning Injury Claims:

1. Late Reporting: It happened over the weekend but claimant is filing it as a workweek accident. Perhaps they might be claiming they forgot to report it on Friday or that the pain got worse over the weekend.
2. Facts are Inconsistent: They go back and forth on what happened. You have also heard them change and tweak their story every time they are asked about it.
3. No Witnesses: If there was no one there to see it you have to rely solely on your employees word. It’s okay if there wasn’t any witnesses as long as there is no other suspicious activity going on.
4. History of Claims: If this employee is known for filing claims you may want to do some more digging and verify this isn’t a fraudulent claim.

Sometimes you don’t know what you don’t know. In the instance of our latest client there was so much left out of their claimants’ story it was hard to look past the missing gaps. The employee was at work on Tuesday September 5th when they slipped on a rock and broke their ankle while walking on a construction site. This is a reasonable, unfortunate accident that could happen to anyone working on a construction site. However, the adjuster sensed that the story wasn’t lining up and decided to keep digging.

Don’t Risk Paying for Old Injuries

This is not to say a worker’s injury isn’t legitimate. An employee can be in a rush for the weekend to start and brush off a work injury only to notice it’s gotten worse over the weekend. An example of common soft tissue overuse injuries is strains and sprains. Unfortunately, these are also the injuries with the highest Monday report rate. But are they all legitimate?

What Can Good Managers do to Prevent?

This is why managers must develop a comprehensive policy for reporting injuries and keep their eyes open to potential fraudulent claims. It’s good practice to end the week by reminding workers that all incidents should be reported to management on the day they occur. This prevents Johnny from hurting himself doing a backflip into the pool on Saturday and then claim it happened at work the following Monday.

Be sure to ask the following questions: Did they endure a specific accident or was it a gradual onset of symptoms that worsened over time? If it was gradual, how long ago did the symptoms start? Are they feeling worse now after some rest or better? Has the pain stayed in the same location or spread?

Poor communication from management can also cause delayed injury claims. Perhaps the employees didn’t know they were supposed to report injuries within a certain timeline or alert supervisors of hazardous conditions.

How to Identify Legitimacy:

1. Check Medical Records: Request and review the claimant’s medical records, including doctor’s notes, hospital reports, and any diagnostic tests. Look for evidence of pre-existing conditions or inconsistencies in the medical history.
2. Assess Timing: Evaluate the timing of the injury in relation to the claimant’s work schedule. If the injury allegedly occurred over the weekend, consider whether it’s plausible that it could have been related to work activities or if it more likely resulted from personal or recreational activities.
3. Review Surveillance Footage: If available, examine any relevant surveillance footage from the workplace or other areas that may have captured the claimant’s activities during the weekend.
4. Examine Social Media: Some claimants may inadvertently provide information on social media that contradicts their injury claims. Monitor the claimant’s public social media profiles for any posts or photos that could dispute their assertions.
5. Seek Expert Opinions: Consult with medical experts or investigators when necessary to evaluate the medical aspects of the claim. They can help determine the causation and severity of the alleged injury.
6. Consider Past Claims: Review the claimant’s history of previous claims, if applicable, to identify any patterns of frequent claims or suspicious behavior.

It’s important for insurance adjusters to approach their work objectively, gathering all available evidence and information to make an informed decision about the claim’s legitimacy. If there are substantial doubts or inconsistencies in the claim, the adjuster may recommend further investigation or denial of the claim based on the available evidence.

If you feel a claim seems suspicious – make sure that you know for sure.