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At the Whitten Law Firm, our attorneys and professional staff are dedicated to getting our clients results. With over 40 years experience, we are confident that when it comes to Workers' Compensation, we're the solution.

Workers Compensation Fraud - Misrepresenting Workplace Injuries

Workplace compensation fraud is the process whereby someone intentionally hides, misrepresents and lies to either obtain or deny employee compensation benefits or insurance coverage. There is usually some form of financial gain to be derived from the fraud and it can be committed by the victim of the workplace accident, a co-worker, the employer, medical professional, etc.

Instances of workers compensation fraud involve an intentional deceit by an employer with regards to the cause of the injury i.e. making an insistence that the workerís injury wasnít suffered while in the course of performing his/her work duties. Other forms involve trying to halt benefit payments earlier than stipulated legally, manipulating medical reports and refusing benefit payments.

Whenever someone is charged with this kind of fraud, the most important thing is to obtain evidence that suggests that the misrepresentation of the injury was done intentionally. There are two main types of workers compensation fraud i.e. premium fraud and benefit fraud.

Employers are the main culprits behind premium fraud and it occurs when an employer attempts to undermine the pay grade of the employee or tries to lower the insurance premium payments by transferring workers to a business unit, regarded as low risk category by insurance companies.

An employee commits benefit fraud when he/she has a full time unreported job and derives benefits when he/she is incapacitated to work. Another instance of benefit fraud occurs when a worker lies about an injury or connives with a medical care professional or lawyer to exaggerate the extent of his or her injury in order to derive financial benefits from double billing or fake billing of services.

Workers compensation fraud is also committed by insurance agencies when documents regarding a workplace injury are intentionally faked in order to prevent or reduce payment of benefits to the victim.

Fraud indicators are used to reduce the frequency of workers compensation fraud. They do not assert that fraud has occurred but just raises red flags for a claim to be analyzed carefully. For example employee fraud indicators come into play when an injury claim is made at the workplace without any witnesses or an employee who is scheduled for retirement or layoff, gets injured.

If you think you are a victim to workers compensation fraud, the best move to make is to contact your attorneys for legal advice on the way forward.