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November 15, 2020 by PILLI Law

What Is Workers’ Compensation Fraud?

One of the challenges of filing a workers’ compensation claim is that if you don’t prepare your claim in the correct way, you may be accused of committing workers’ compensation fraud. As committing workers’ compensation fraud is a crime, this is an outcome best avoided. Thankfully, experienced workers’ compensation attorneys, like workers’ compensation attorneys in Queens NY from Polsky, Shouldice, & Rosen, P.C., understand how to approach the workers’ compensation process in such a way that a client’s request for benefits shouldn’t raise any red flags. This is just one of the many reasons (in addition to ensuring that the claim is fairly valued, isn’t rejected, etc.) why it is generally a good idea to work with an attorney as you’re preparing a claim, even if you could technically file it on your own.

Avoiding an Accusation of Workers’ Compensation Fraud

Workers’ compensation fraud occurs when an individual filing a claim either willfully submits false information or withholds significantly relevant information in an effort to claim workers’ compensation benefits. Because fighting an accusation of workers’ compensation fraud is tough and a fraud conviction could be life-changing in the worst possible way, it’s important to be proactive when trying to avoid an accusation that you’re committing fraud.

There are several signs that workers’ compensation benefits claims adjusters look for when attempting to spot fraud. It’s important to understand these signs, as many of them can be made by those submitting rightful and proper claims. When multiple potential red flags are raised in a claims scenario, a good law firm knows how to support a claim in such a way that it mitigates the likelihood that the claim will be perceived as fraudulent. For example, claims that occur first thing Monday morning or last thing Friday afternoon may be perceived as suspicious. Do accidents occur at these times? Absolutely. However, it’s important to guard against the perception that reporting such an accident may be perceived as fraudulent by properly supporting the claim with evidence and context.

Additionally, incidents in which no witnesses are present, accidents that occur immediately following a job termination or the end of seasonal employment, injuries that aren’t reported immediately, and certain behaviors and medical history can raise red flags. Again, it certainly isn’t impossible to successfully submit a legitimate claim if one or more fraud “signs” are present within that claim. However, it’s important to work with an experienced workers’ compensation attorney when a potentially suspicious claim is being filed to guard against accusations of fraud.

Legal Assistance Is Available

If you’ve suffered an injury at work and you want to file a workers’ compensation claim, call a law firm today for knowledgeable assistance. Your lawyer will do his or her utmost to ensure that your claim is paid promptly, is fairly valued, and is supported in ways that mitigate the risk that you’ll be accused of fraud during your claims process.

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