Workers compensation fraud cases occur in situations where a person lies or keeps information hidden with the intention of attaining workers’ compensation benefits, or when someone retains information willfully in order to keep another person from receiving benefits. It is typically seen as a worker who greatly exaggerates his or her medical condition while collecting compensation through his employers’ worker compensation insurance, or working jobs outside his employer and collecting unreported wages while also collecting benefits. Workers compensation fraud can also be committed by employers by altering the numbers in their payrolls, thus receiving decreased premiums.
Investigating Workers Compensation Fraud
In most cases, workers’ compensation fraud allegations are investigated by the insurance company responsible for handling the original claim. However, some business owners or independent insurance agents may decide to investigate claims made by their employees in attempts to limit their loss of manpower or allow more funding to be available for genuine claims. They may choose to go with an independent professional insurance fraud investigator, but in most cases opt to attain the services of an independent private detective. These individuals can, and often do use tactics such as surveillance, background checks and personal interviews, and medical record checks, all in efforts to gather enough evidence to prove or disprove an allegation of fraud.
Different Penalties for Different Levels of Worker Compensation Fraud
Worker compensation fraud carries a wide array of penalties, varying from state to state, though in almost all cases the punishments are severe. Often the term of punishment is reactive to the amount of benefits the claimant has illegally received.
- In some states any amount taken by workers’ compensation fraud is considered a felony, and punishable by up to 30 years imprisonment.
- Some states vary punishments depending on the amount of benefits stolen through compensation fraud. This could mean that where the fraud amount is under $1,000 dollars, it may be considered a misdemeanor, while anything above that amount would be a felony.
- In most cases, restitution of the entire amount of the benefits given is required as part of the sentence.
- All workers’ compensation fraud cases are punishable by a fine ranging from $300 to $30,000 dollars.
- Results of a worker compensation fraud conviction often result in forfeiture of property, and long-term probation.
If You Think Someone You Know is Committing Compensation Fraud
If you suspect someone you know of committing worker compensation fraud you should report their misconduct to a worker compensation professional immediately.
If you have either been accused of workers compensation fraud or you believe you are the victim of fraud on the part of your employer or employees, consult with an experienced workers compensation attorney. He can review the situation to determine if fraud exists and assist in taking steps to remedy the problem.