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What is Workers’ Compensation Fraud? —Useful Advice from a Workers’ Comp Attorney in NY

Erwin, McCane & Daly | Tuesday, June 21, 2016

Workers’ compensation insurance was designed to protect employees that are injured on the job. This insurance is meant to compensate an employee for lost wages, medical costs and other expenses while they recover from their work-related injury. While the majority of workers’ compensation claims filed in NY are legitimate, there are some that are not. Workers’ compensation fraud is a growing concern and the more fraudulent cases approved, the harder it will be for legitimate cases to receive the compensation they deserve.

What is Workers’ Comp Fraud?

Workers’ compensation fraud occurs when individuals willfully make a false statement or purposely hide information to receive workers’ compensation benefits, when they are not actually eligible to collect them.

Examples of Workers’ Comp Fraud

There are numerous ways an individual may commit workers’ compensation fraud. If you are about to file your own claim, make sure that you are not deemed as committing fraud:

  • Submitting Bogus Claims- Bogus claims are among the most common types of workers’ compensation fraud. This is when an employee makes knowingly false claims regarding work injuries to receive compensation. This can include filing for workers’ comp for an injury that happened off the job; inflating injuries to seem more serious than they actually are; faking injuries altogether, such as soft tissue damage; using old injuries to claim workers’ compensation; and, staying at home longer and pretending to be disabled longer than medically necessary.
  • Employer Fraud - Sometimes it is not an employee making fraudulent claims; it is the employer. Some examples of employer fraud can include deducting a premium from an employee’s wage; underreporting payroll to lower workers’ compensation premiums; and, knowingly not carrying adequate workers’ compensation insurance when it is required.
  • Medical or Physician Fraud - Physicians or healthcare providers may take advantage of workers’ compensation to pad their billing. Some examples of medical fraud can include providing unnecessary testing or treatment for an injury; billing for treatments or services not rendered; and, billing workers’ compensation and the health insurance company for the same services (double billing).

What Happens if You Are Caught?

Filing fraudulent workers’ compensation claims is a crime. You may face jail time for fraud, fines and penalties, and the insurance company will likely sue for repayment of the fraudulent compensation they paid out.

If you have a legitimate workers’ compensation claim, contact an attorney who will ensure you represent the facts of your case accurately and avoid any chances of fraud. A workers’ comp attorney at Erwin, McCane & Daly can assist you with filing a proper workers’ compensation claim.

Call us today at 518-449-2245 to discuss workers’ compensation claims or contact us online to schedule your free consultation.