Worker compensation is a type of insurance designed to replace wages and cover medical bills for company employees who have been injured on the job. Generally, in exchange for insurance coverage, the employee gives up the right to sue for negligence. The employee can still file a lawsuit against their employer or another party if errors such as:
- -Defective products;
- -Exposure to toxins;
- -Wrongful conduct on the part of your employer;
- -Injuries at work; me
- -Failure to carry adequate worker’s compensation insurance
What is workers’ compensation fraud?
Workers’ compensation fraud occurs when an employee intentionally makes a false statement, withholds information to obtain workers’ compensation benefits from their employer, or prevents someone from receiving benefits to which they may be entitle. It is important to know that both employees and employers can be hold liable for workers’ compensation fraud.
Employers can be held liable for workers’ compensation fraud, when an employer intentionally misrepresents facts about its employees in order to obtain workers’ compensation coverage for less than the employer would actually have to pay the insurance company for all the present events.
What are some examples of workers’ compensation fraud?
Some examples of workers’ compensation include the following:
- -Applicant/Claimant Fraud: Occurs when the injured employee cheats or falsifies documents by exaggerating their injury in order to receive workers’ compensation benefits.
- -Adjuster Fraud: Occurs when the insurance adjuster manipulates evidence to support or deny a claim and fails to pay the claimant for their injuries. The insurance adjuster usually works for the insurance company.
- -Premium Fraud: Occurs when the claimant gives false information to the insurance company to obtain a workers’ compensation policy at a discounted rate.
- -Employer Fraud: Occurs when the employer does not want to pay workers’ compensation and makes false or intentionally misrepresentations about the claim.
What are the elements of workers’ compensation insurance fraud?
In order for the prosecutor to convict and dismiss the defense’s arguments for workers’ compensation insurance fraud, the following elements must be meet:
- -The defendant knowingly made a false statement;
- -The statement is related to a claim or payment made or to be made from an insurance company; Y
- -The declaration is a key part for the payment of the insurance or claim.
How often does workers’ compensation fraud occur?
Although it is impossible to determine an exact number, studies have indicated that fraud only occurs in 1-2% of claims. According to statistics taken from the US Bureau of Labor, more than 3 million non-fatal workplace accidents occur annually. If 1 to 2% of those are fraudulent, that means approximately 30,000 to 60,000 fraud cases per year would occur.
In a system costing more than $90 billion a year, the dollar amount of that fraud can add up quickly. For example, in a very recent period, the state of California estimate that more than 5,000 arrests were make for workers’ compensation fraud, representing more than $300,000,000 dollars to the insurance company in potential losses.
Who can commit workers’ compensation fraud?
While many assume that only employees commit this type of fraud, employers and providers can also commit workers’ compensation fraud:
- -Employees: Employees can commit fraud by overstating claims. Claiming an injury that never occur, working while a disability claim is being evaluate and not reporting wages. Or claiming a non-work relate injury as a work injury.
- -Employers: An employer commits fraud by misclassifying employees. Deducting insurance premiums from their employees’ paychecks, or misreporting their coverage.
- -Health care providers: Health care providers can also commit workers’ compensation fraud. This type of fraud occurs when the medical provider performs unnecessary tests. Bills for tests the provider never performed, or bills multiple times for a single treatment.
Should I seek legal advice? Hire the right attorney.
Workers’ compensation is designed to facilitate prompt treatment of injuries that occur on the job. Unfortunately, fraud can complicate this system and hurt those who have already suffered needlessly.
If you believe you have been the subject of workers’ compensation fraud, consulting with an employment attorney can help ensure your rights are protect. If you fear that an employee is abusing your workers’ compensation insurance, an experienced attorney can help you handle the situation.
