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Workers Compensation Fraud

Written by lisaspitzer. Posted in Injured Worker News

If any type of fraud is suspected on behalf of any of parties involved in the workers compensation claim, the victim has the right to seek corrective action and compensation for the losses they have suffered as a result. The victim can be the employer or employee. Workers compensation investigations are handled by the appropriate local, state or federal government agency that governs workers compensation laws. The federal government and most state departments have an appeals board who hears the evidence gathered in workers compensation investigations. The victims of fraud have the right to legal representation in these proceedings. Legal representation can be greatly beneficial for victims of workers compensation fraud because these experts have the knowledge and experience to maximize and protect a victims legal interests.
Workers compensation investigations of fraudulent activity can result in strict penalties for those who violate workers compensation regulations. Workers compensation fraud adversely affects the economy, tax payer dollars, public agency resources, and those individual victims of fraud. Therefore, workers compensation investigations can lead to misdemeanor and felony charges brought against the fraudulent or negligent liable party.

It is important to note that an employer commits workers compensation fraud if they unlawfully manipulate the facts in order to lower their workers compensation premium. This deceitful manipulation of the factors relevant to a workers compensation premium can include any falsification of facts, including the number of employees that are to be covered or the nature of their work. Paying a workers compensation premium is considered part of the cost of running a business, and is therefore considered wholly the responsibility of employers. Employers can be held legally liable for any breech of this requirement.

Workers' compensation insurance fraud occurs in simple to complex schemes that often require difficult and lengthy investigations.  For example, an employee either inflates the extent of his/her injuries, or simply fabricates injuries altogether.  At the other end of the spectrum, white-collar criminals, including doctors and lawyers, entice, pay, and conspire with other indiviuals in cheating the system through fraudulent activity and insurance companies "pick up the tab," passing the cost onto policyholders, taxpayers and the general public.

If you report workers compensation fraud by an employer, you may be eligible to receive compensation under the QUi TAM law.

But what is workers’ compensation fraud? 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,
Claimant Fraud

  • Malingering
  • Exageration 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
  • False Milage 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 or Health Care Provider Fraud

  • Providing unnecessary testing or treatment of injured workers to reap financial benefit
  • Billing for services or treatment never performed
  • Billing the workers’ compensation insurer and the workers’ health insurer for the same services

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