Top Jefferson, NY Workers' Compensation Fraud Lawyers Near You
200 Great Oaks Blvd, Suite 228, Albany, NY 12203
321 Great Oaks Blvd, Albany, NY 12203
677 Broadway, 10th Floor, Albany, NY 12207
1234 Main, Schenectady, NY 12345
200 Harborside Dr, Suite 300, Schenectady, NY 12305
8 Southwoods Blvd, Suite 300, Albany, NY 12211
6 Tower Place, Albany, NY 12203
174 Washington Ave, Albany, NY 12210
125 High Rock Ave, Suite 215-H, Saratoga Springs, NY 12866
240 Washington Ave Extension, Ste 504, Albany, NY 12203
670 Franklin St., Schenectady, NY 12305
270 Mount Hope Drive, Albany, NY 12202
41 State St, Suite M100, Albany, NY 12207
26 Century Hill Drive, Suite 206, Latham, NY 12110
21 Everett Road Extension, Albany, NY 12205
20 Corporate Woods Blvd, Suite 501, Albany, NY 12211
159 Wolf Rd, Ste 305, Albany, NY 12205
677 Broadway, Suite 1205, Albany, NY 12207-2996
125 Adams Street, Delmar, NY 12054-2416
54 State Street, Sixth Floor, Albany, NY 12207-2524
677 Broadway, 7th Floor, Albany, NY 12207
125 Wolf Rd, Suite 316, Albany, NY 12205
12 Sheridan Ave, Suite 3, Albany, NY 12207
11 N Pearl St, Suite 1700, Albany, NY 12207
210 Washington Ave Ext, Suite 102, Albany, NY 12203
Jefferson Workers' Compensation Fraud Information
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What Is Workers’ Compensation?
Workers’ compensation provides benefits for workers who are injured on the job or suffer a work-related illness. Most employers are required to provide workers’ comp insurance for employees. When an employee is injured in the workplace, a workers’ comp claim provides medical coverage and partial wage replacement while the employee is unable to work.
The workers’ compensation process is generally a no-fault system. The employee is supposed to be covered for any work-related accident or occupational diseases. The worker does not have to show the employer was negligent. In return, the employer is protected from most personal injury lawsuits related to the accident and the compensation claims are limited to wage benefits, medical care, and disability benefits.
If employers or workers comp insurance carriers suspect the employee is committing fraud, they may investigate the claim to deny coverage or report the employee for fraud. If criminal fraud is suspected, law enforcement agencies may work with the insurance provider and employer to investigate the worker and could prosecute the worker for criminal charges.
What Qualifies as Workers’ Comp Fraud in New York?
Workers’ comp fraud involves fraud or misrepresentation in a workplace injury claim. Fraud may involve the worker trying to claim benefits for a non-covered injury or claim benefits when they are still able to work. Some examples of workers’ comp fraud include:
- Claiming a non-workplace injury happened on the job
- Claiming to be disabled when the worker can still perform their job functions
- Intentionally causing an accident or injury to get benefits
- Working another job under the table while receiving benefits
- Advising other workers on how to fraudulently claim workers’ comp benefits
- Filing multiple claims for the same injury
Fraud in workers’ comp claims can also involve health care providers. Doctors, medical service providers, and chiropractors may work together to defraud the workers’ comp system. Workers’ compensation insurance fraud rings may recruit workers to claim workplace injuries, with a medical provider making a false diagnosis of an injury, and doctors fraudulently treating the injured employees or billing for medical procedures that were never provided.
What Investigators Look For in Workers’ Comp Fraud
Some insurance providers or employers look for “red flags” that may indicate possible fraud. This may be a clue to further investigate the claim, talk to other employees, or use a private investigator to monitor the injured worker. Some possible red flags of workers’ compensation fraud may include:
- No witnesses to the accident
- Employee refusing treatment or examination
- Worker is difficult to contact after filing a claim for workers’ comp
- Injury occurred right before or after a planned vacation
- Injury occurred shortly before the employee was to leave the job
- Employee reported the injury after a poor performance review or workplace incident
- Treatment is inconsistent with the alleged injury
- Extent of injury and accident time frame do not match up
Is Workers’ Comp Fraud a Felony?
Workers’ compensation fraud can be charged as a misdemeanor or a felony, depending on the situation. As a misdemeanor, a conviction for fraud could result in up to a year in county jail and a fine. If fraud is charged as a felony, penalties can include more than a year in prison, fines, and restitution.
Some incidents of workers’ comp fraud can include additional criminal charges. The defendant may face related charges for:
- Identity theft
- Insurance fraud
- Health care fraud
Investigating Workers’ Comp Fraud
Insurance companies and the employer may investigate employees even without indications of claimant fraud. The insurance company and employer have a financial interest in denying workplace injury claims. As a result, they may wrongly deny a legitimate claim for an injured worker. Many employees do not go through the process to appeal the denial, and end up going without the benefits they deserve.
Do Private Investigators Follow Workers After a Claim?
A private investigator may follow the worker with video surveillance. Investigators may also talk to co-workers or neighbors about the worker’s activities. Social media accounts may also be reviewed for evidence that could hurt the worker’s claim. Some of the things investigators look for when an employee makes a workers’ comp claim include:
- Participating in sports or leisure activities
- Doing yard work, home improvement projects, or heavy lifting
- Going on vacation after making a claim
- Social media post showing the cause of the injury that is unrelated to work
- Medical bills for appointments the worker never attended