Why Am I Being Accused of Workers’ Compensation Fraud?

Workers who develop occupational illnesses or suffer workplace injuries usually expect that their workers’ compensation claims will be approved. They assume that since their injury is genuine, their medical expenses and lost wages will be reimbursed. However, some employees get the shock of their lives when their claim is denied and they’re accused of fraud. This may happen to an innocent person but some workers do try to trick the system.

If you’ve been accused of workers’ comp fraud, you need to take it seriously since there can be criminal penalties attached. Therefore, you need to contact a Florida workers’ compensation attorney for advice on how you should proceed. For now, let’s look at what workers’ comp fraud is and how you can avoid being accused of it.

What Is Workers’ Compensation Fraud?

Workers’ comp fraud is basically when an employer, employee, or healthcare provider lies in an effort to get money they don’t deserve. Fraud can be very costly to employers since it can lead to higher insurance premiums and other penalties. The most common types of fraud that employers engage in are:

  • Faking their illness or injury. A worker may claim they have a problem they don’t actually have so they can claim benefits.
  • Exaggerating their illness or injury. Some workers really are unwell but they make their condition seem worse than it really is so they can get more time off.
  • Double dipping. This is when an employee claims temporary disability benefits but continues to work, especially in an organization that’s different from the one where they got injured. This happens despite a doctor mandating that they not work or not do a specific type of work. Double dipping is different from when a physician recommends that an employee take on modified duties.
  • Claiming their injury occurred at work when it really happened during their personal time.

How Is Workers’ Compensation Fraud Detected?

Workers’ comp insurance providers often have investigators who look into suspicious cases in an effort to identify possible fraud. Florida also has a Bureau of Workers’ Compensation Fraud which is staffed by detectives. While it can be difficult to prove that a worker isn’t being truthful about their injury or illness, there are lots of signs that can indicate fraud. These include:

  • Reporting your injury late
  • Missing doctor’s appointments
  • Refusing treatment for your illness or injury
  • Not having any witnesses if you suffered an accident
  • Filing a claim after you were terminated
  • Having a history of workers’ comp claims
  • Being a disgruntled employee
  • Experiencing financial difficulties at home

Workers’ comp fraud is a criminal offense. If you’re found guilty of this crime, you could face both criminal and civil penalties including jail time, fines, and restitution.

What to Do If You’re Accused of Fraud

It is not unheard of for an employer or insurer to claim there’s fraud when a claim is actually valid. If this happens to you, you need to validate your claim. You’ll need to gather all the evidence you have to prove that you really did suffer a work-related injury or illness. It’s also a good idea to contact a Florida workers’ compensation attorney for help. They can help you to put together all the relevant evidence, communicate with your employer’s insurer, or file a lawsuit if necessary.

How to Prevent Accusations of Fraud

While it’s not necessary to hire a workers’ comp lawyer when you file a claim, it can help you to avoid accusations of fraud. There are a number of other things you can do including:

  • Keeping records of all the details surrounding your injury
  • Keeping evidence of doctor’s appointments, your diagnosis and prognosis, bills, and other relevant documents
  • Encouraging witnesses to go on record when their memories are fresh
  • Taking photos of visible injuries and taking updated ones as you recover

You may also want to watch what you post online while you recover. If you seem to be physically exerting yourself or enjoying life too much, you may attract suspicion.

Hire an Experienced Workers’ Comp Attorney

There’s a lot at stake and you don’t have any time to waste if your employer or their insurer is accusing you of fraud. In addition to losing out on benefits, you could be facing criminal charges. If you want to get the benefits you deserve, you need to hire a workers’ comp attorney in Florida. The attorneys at Work Injury Rights have lots of experience in representing workers who are struggling to get the benefits they deserve. Contact us today to schedule a consultation.

Share on facebook
Share on twitter
Share on linkedin
Share on reddit

Read More Related Articles