November 16, 2015

Workers’ Comp fraud is a very real thing. And it can result in very serious penalties. Just take a look at the recent local headlines out of Rochester and Lockport http://www.lockportjournal.com/news/local_news/funeral-home-president-arrested-for-alleged-fraud/article_caab5c7e-c1de-5415-a238-6db2f2df73e4.html. In addition to losing weekly benefit checks and medical coverage, insurance companies can also seek charges in criminal court.

The New York State Workers’ Compensation Law devotes an entire Section to the topic of fraud (§114-a). The Office of Inspector General (OIG) of the Workers’ Compensation Board defines fraud as “when someone knowingly and intentionally makes a false, material statement in order to obtain or deny a benefit for themselves or another.” They go on to describe different types of employee fraud:

  • Filing a claim for an injury that did not occur on, or has no relation to the job.
  • Lying about work status when questioned directly, such as at a deposition or a hearing, while receiving temporary disability benefits.
  • Misrepresenting the severity of a claimed injury.

What can you do to prevent a Workers’ Compensation fraud allegation? The most important thing is to report any work, or work-like activity, paid or unpaid, to your attorney. The insurance companies can and do hire investigators to perform surveillance on Workers’ Compensation claimants. If you are observed or recorded performing work or activities that can be construed as work-like, and it is not reported, the insurance company can allege fraud.

Some insurance companies will send out periodic questionnaires which they can use as evidence of fraud. Often times these questionnaires ask if you are working. The Lockport man in the story above was charged with seven felony accounts of filing a false instrument – likely questionnaires sent to him by the insurance company regarding his work status.

As a Workers’ Compensation claimant, if you are out of work and collecting Workers’ Compensation benefits, it is important to clearly understand any and all work restrictions set forth by your doctor and abide by those limitations in all daily activities.
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