What Happens If You're Alleged To Have Committed Workers' Comp Fraud?

Posted on: 6 July 2017

If you're injured at work, you're likely entitled to workers' compensation benefits. These benefits are paid by your employer through an insurance policy designed to ensure injured workers won't face foreclosure or other financial problems due to an on-the-job injury. However, those who try to pass off non-workplace injuries as workers' comp-eligible ones can face some stiff civil and criminal penalties. As one Montana state employee recently learned after being charged with a felony for passing off a motorcycle injury as one he sustained while jumping from a box truck, public employees who engage in this type of fraud can be penalized even more severely.

Read on to learn more about the potential penalties for falsifying a workers' compensation claim, as well as some of the types of facts you'll need to prove to protect your workers' compensation claim from a fraud audit.

What penalties may you face if charged with committing workers' compensation fraud?

The penalties for workers' comp fraud can vary from state to state, but often mirror those for other types of insurance fraud. Because workers' compensation claims can involve such a high dollar amount of payment, with some extensive injuries generating tens or even hundreds of thousands of dollars in benefits, this is often sufficient to push the severity of alleged fraud from the misdemeanor to the felony level in states where the charges are based on the amount of the fraud.

In addition to facing time in jail or prison upon conviction of workers' compensation fraud, those alleged to have committed fraud can be required to pay restitution to the insurance company (or employer) who paid out funds, as well as other civil fines and penalties. This combination of civil and criminal penalties can mean that those who commit workers' compensation fraud create a tremendous amount of risk for themselves, and with states enacting anonymous tip lines for reports of fraud, it can be harder and harder to avoid being caught.

However, innocent workers can sometimes be accused of fraud even where none exists, with the workers' compensation insurer demanding additional documentation before a claim will be processed. If this is the case, you may need the assistance of an attorney to ensure you're able to receive all the funds rightfully owed. 

What will you need to show to support your workers' compensation claim?

If you've been alleged to have committed workers' compensation fraud--or your file has just been selected for a more in-depth treatment--you may be wondering what you can do to ensure your benefits continue uninterrupted and you aren't falsely accused of attempting to defraud an insurance company. 

Your first step should be to get all relevant documents created on (or around) the date of your injury, including medical records from your initial evaluation, any prescriptions, and potentially even written statements from coworkers who witnessed your accident or injury. One of the first ways an audit investigator can begin to poke holes in an injury story is by interviewing coworkers who don't remember your injury (or worse, who remember you talking about engaging in a dangerous activity over the weekend), so having signed witness statements from those who can vouch for you can go a long way toward resolving this allegation in your favor.

You may also want to jot down some notes of your own to ensure your memory remains accurate with regard to the events surrounding your injury. The last thing you want is to find yourself being tripped up by a minor detail that winds up creating a hole in your case, so getting your version down as quickly as you can may be able to refresh your recollection when the time comes. For more information or assistance, contact companies like Wolter, Beeman, Lynch & Londrigan LLP.


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