The Costly Penalties of Workers’ Comp Fraud

Committing workers’ compensation fraud is a serious offense, and the penalties for it can be severe legally and financially. And in the long run, it can have a negative impact on your reputation.

When Employees Commit Fraud

An employee fraudulently claiming workers’ compensation benefits is subject to criminal prosecution. One can commit workers’ comp fraud in many ways, such as the following:

• exaggerating the effects of an injury (making it appear worse than it actually is)
• making a claim for an illness unrelated to the employee’s job
• failing to report income on other jobs
• misrepresenting an inability to work while receiving temporary disability benefits

When Employers and Health Care Providers Commit Fraud

In turn, an employer will be subject to criminal prosecution when committing acts such as these:

• obtaining workers’ compensation insurance by fraudulently underreporting payroll
• discouraging an injured worker from making a claim
• misclassifying employees as independent contractors to avoid paying insurance premiums
• engaging in other material misrepresentations

Health care providers can also commit workers’ comp fraud in order to support a false claim for benefits. For example, a hospital could bill for services that were not performed or for medical care that was not provided.

The Consequences of Workers’ Compensation Fraud

The penalties for workers’ comp fraud can vary depending on the jurisdiction and a wide range of other factors. Such factors include the severity of the offense and whether or not the accused is a repeat offender. The conviction may then be deemed either a misdemeanor or a felony. Either way, these are some of the possible penalties:

• a hefty fine (potentially double the amount of the fraud)
• restitution orders to repay all unlawfully obtained benefits
• years of jail time

Long-term effects of this would be a tarnished reputation and damaged credibility. This in turn can make it more difficult to secure future employment or obtain insurance coverage.

When individuals seek to exploit the workers’ compensation system dishonestly, they undermine the integrity of the system and compromise its effectiveness. This means that those who do have legitimate claims may consequently face greater scrutiny, making it harder for them to obtain their rightful benefits. A foundation of trust between employers, employees, health care providers, and insurance companies is important for workers’ compensation programs to run as effectively as possible.

How You Can Combat Workers’ Comp Fraud

The best way to protect your claim is by being truthful about the incident and your medical history. It is important to report work-related injuries and illnesses as soon as possible, then receive the medical evaluations and treatments prescribed by doctors and other professionals. Your claim will be strongest when you go through the proper channels and have a medical history that is similar to the injury or illness you’ve declared to have received from your job.

If you are accused of workers’ compensation fraud or feel your employer has failed to provide an appropriate workers’ compensation insurance plan, Rose Legal can help you through the ordeal. Call or text us with your questions today at 801-810-7673.