When an employee is injured on the job, they can apply for worker’s compensation (usually referred to as workers’ comp). However, when the workers’ comp system is abused or used improperly, it may lead to criminal charges for the offense of workers’ compensation fraud.
A person or business commits workers’ compensation fraud when the person or business willfully makes false statements or withholds information for the purpose of receiving benefits or preventing someone from receiving benefits.
For a workers’ compensation fraud scheme to be successful, several people along the process must be involved in the fraud. This can include the employer, employee, medical and health care providers and representatives of the insurance company.
Workers’ compensation fraud takes place when either an employee, or an employer, knowingly and intentionally falsify, misrepresent or omit information related to a workers’ compensation claim. Workers’ compensation fraud can be considered to be a form of insurance fraud.
There are several examples to help understand workers’ comp fraud.
For example, if Eric works at a local big-box store and, while stocking some shelves, he falls from the ladder and hurts his leg. The injury is not that severe, but there were several witnesses to this tumble and he begins filling out an incident report. If he exaggerates his injury on the internal incident report, and most importantly, goes on to make the same exaggerations about the nature of his fall when filing documents in support of a workers’ comp claim, he would be committing a common form of workers’ comp fraud.
In a second example, Bill works at the same big-box retailer. Bill is busying himself in cleaning up the customer bathrooms when a long-neglected and loose light fixture falls from above, hitting him in the head. The fixture knocks Bill unconscious, and he falls, unsupported, to the floor. While filling out his incident report, management shows no open opposition to his statements. However, when processing his workers’ comp paperwork, management makes several (importantly, false) counterclaims in an attempt to have Bill’s legitimate application denied. The employer, in this example, would be committing workers’ comp fraud as well.
Workers’ comp fraud can be charged at the federal level and the state level depending on the context and severity of the offense. If you participate in a fraudulent workers’ comp claim while serving as a federal employee, you can be charged for workers comp fraud. This could mean a maximum sentence of up to five years imprisonment and steep fines if the sum of the fraud totals $1,000 or more, and a sentence of up to one year imprisonment and a lesser fine if the sum of the fraud totals less than $1,000.
At the state level, workers’ comp fraud typically results in a penalty of either up to one year in county jail, or between two and five years in state prison. The punishment for those convicted of the offense is often dependent on the gravity of the fraud. Fines are also possible.
Investigators (typically private investigators in cases not involving federal court or government employees) may utilize video surveillance, in-person surveillance and questioning associates and contacts to determine if a claim is valid. Showing up to a workers’ comp hearing in a wheelchair as a result of your worksite injuries and then being found in a social media post dancing while downtown, reveling, would be one example of how video evidence can be used in a workers’ comp claim.
Investigators can also work claims where the injured person is wrongfully denied. Evidence such as doctors’ notes, medical transcripts and testimony in support of the claimant is how the case might begin. The materials filed by the employer are examined to see if any misleading statements or material omissions might be in place.
If you feel you have been wrongfully denied a legitimate workers’ comp claim, it is certainly in your best interests to secure the services of skilled legal counsel. More than that, if you have been injured on the job in any way, it would be best to retain a lawyer specializing in workers’ compensation cases before making any material statements on the matter. Getting professional legal guidance before engaging in the workers’ comp process could mean a much more satisfying outcome for you.
Workers’ comp attorneys specialize in maximizing benefits due to their clients after they’ve suffered a workplace injury. These lawyers work to secure compensation for your medical bills, costs of missed work and the pain and suffering — past, present and future — incurred as a result of your workplace injury.
If you have been charged with workers’ compensation fraud or are being investigated for fraud, you may find the advice of an experienced workers’ compensation attorney helpful. A conviction for workers’ compensation fraud is punishable by imprisonment and fines. Your liberty and finances are at risk.
You can ask questions like these listed below and work with the attorney to devise a legal strategy for your defense.