In a workers' compensation claim, which action by the injured worker would be the most pertinent fraud indicator?

• A. Lifting a box
• B. Waiting to report
• C. Asking for referral
• D. Asking about check

Answer: (C)

In workers’ compensation fraud detection, red flags come from behaviors that suggest someone is altering the medical record or benefits to fit a false or exaggerated claim. Asking for a referral is a strong indicator because it can point to doctor shopping—seeking a new or different physician to obtain a diagnosis, treatment, or opinion that supports a larger payout or different benefits. This pattern of pursuing multiple providers or specific referrals to shape the claim is more suspicious than routine activities.

Lifting a box, waiting to report, or asking about a check can occur for legitimate reasons or routine administrative matters and are not as strongly tied to fraudulent intent.