These are employees who were injured on the job, have legitimate claims, and have no intent of committing fraud. They follow the rules and cooperate with claims management activities and efforts by:

Promptly reporting their injuries to the proper supervisors or managers.
Working with their employer, adjuster, nurse case manager, or primary physicians to see the medical provider best qualified to treat them.
Following all instructions regarding their medical care and treatment, including the reasonable use of prescriptions.
Providing documentation as requested during their claim, such as medical reports and return to work or continuing disability notes.
Participating fully in physical therapy, work hardening, functional capacity evaluations, and/or vocational rehabilitation to re-strengthen themselves and to increase the probability of their return to work.
Informing their medical provider of their willingness to participate in modified duty if the employer accommodates it, and closely following the medical provider's orders if it is allowed.

However, if barriers arise that adversely affect the employee's treatment or recovery, the same cooperative employees may feel:

Forgotten, as the employers and adjusters move on to other claims, replace them in the workplace, or move on to other priorities and responsibilities.
Frustrated, because they are doing all they were told to do without success. In some cases their own employers create barriers, such as refusing to accommodate modified duty.
Forlorn, the definition of which includes such words as unhappy, sad, and depressed. We have all seen employees who have become depressed over a period of time due to their inability to heal or their inability to work again, not to mention the financial stresses that occur as they are being paid benefits that may be much less than what they need.
De-motivated if the employer has programs that provide the disabled with net pay that is more than or close to the net pay that they received before the injury.

These same employees who have no intent to commit fraud may lose faith in the individuals directing their care and may finally give up. Then they get caught up in the process-oriented steps of going to the doctor, providing a disability note to their employers, etc. Inertia sets in and the claim continues along a line toward an unsuccessful outcome for everyone.

Special Reports /

Claims Fraud: Abusers, Opportunists & Forgotten Employees

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