What is workers compensation fraud?
Workers’ compensation fraud laws make it a felony for anyone to file a false or fraudulent statement or to submit a false report or any other document for the purpose of obtaining or denying workers’ compensation benefits. Anyone caught performing these illegal acts will be prosecuted. If convicted, the person can face up to 5 years in prison and/or up to a $150,000 fine.
Workers’ compensation fraud occurs when someone willfully makes a false statement or conceals information in order to receive workers’ compensation benefits or prevents someone from receiving benefits they may be entitled to. If you think someone may be committing workers’ compensation fraud but are not sure, contact the Fraud Section for assistance.
Depending on who is talking about it, workers’ comp fraud is either an epidemic or an overblown rarity which lets insurance companies lobby for changes to the laws. Big business and insurance companies complain that most injured workers aren’t really injured, that they could go back to work, and that they just enjoy watching daytime television. We can count on one hand the number of clients who fit that description. We’re told that an Industrial Commission study done a few years ago found that about 1% of injured workers’ committed fraud, about 1% of insurance companies committed fraud, and about 7% of employers committed fraud. As far as injured workers go, instances of fraud such as working while drawing weekly checks are pretty rare. At least in our firm cases of people staging an accident to make “big bucks” is almost unheard of. Workers’ comp just isn’t that lucrative an area of the law. Insurance company fraud is most often exhibited in direct lying about what benefits are availa
Workers’ compensation fraud occurs when someone willfully makes a false statement or conceals information in order to receive workers’ compensation benefits or prevents someone from receiving benefits to which they might be entitled. Below are a just few examples of how workers’ compensation fraud can be committed. If, after reading these indicators, you feel you know someone who may be committing fraud, contact the Office of Workers’ Compensation’s Fraud Division at 1-800-201-3362 or by clicking here to report fraud. Claimant Fraud Malingering or exaggeration of symptoms Working while allegedly disabled and not reporting income Claiming a job-related injury that never occurred Claiming a non-work related injury as a work-related injury Falsifying mileage reports Employer Fraud Underreporting payroll or misclassifying employees for lower insurance premiums Deducting premium dollars from employee’s wages Employer knowingly fails to have necessary workers’ compensation coverage Medical o
Fraud usually involves six elements: • False information given by an insured employer, an injured worker, a witness, another person involved in a claim, an insurance company or a claims adjuster working for an insurance company. • The false information is spoken or put in writing. • The person who gives the information knows it’s false. • The false information is meant to prove, validate, affirm or deny a claim for injury or loss payment, or to obtain insurance coverage. • The false information must be given with intent to defraud. • The false information must relate to the case (i.e., change the way the claim was handled, investigated, evaluated or settled).
