Workers’ compensation fraud occurs when someone willfully makes a false statement or conceals information in order to receive workers’ compensation benefits or prevents someone from receiving benefits to which they might be entitled.  The people who may be committing this fraud can be employers, employees, providers or anyone else involved in the system. Unfortunately, the people that commit workers’ compensation fraud are making your premiums higher, higher prices on goods and services and lost pay due to draining business profits. 

When employers commit workers’ compensation fraud, they are usually doing this to avoid paying workers’ compensation premiums.  Employers can use a variety of tricks to accomplish this goal such as using shell companies.  Shell companies are inactive companies without significant assets that can be used to disguise business ownership from law enforcement or the public. 

Here are a few examples of Workers’ Compensation Fraud

Claimant Fraud

  • Malingering or exaggeration of symptoms
  • Working while allegedly disabled and not reporting income
  • Claiming a job-related injury that never occurred
  • Claiming a non-work related injury as a work-related injury
  • Falsifying mileage reports

Employer Fraud

  • Underreporting payroll or misclassifying employees for lower insurance premiums
  • Deducting premium dollars from employee’s wages
  • Employer knowingly fails to have necessary workers’ compensation coverage

Medical or Health Care Provider Fraud

  • Providing unnecessary testing or treatment of injured workers to reap financial benefit
  • Billing for services or treatment never performed
  • Billing the workers’ compensation insurer and the workers’ health insurer for the same services

Workers compensation is a benefit to all employees.  The Office of Workers’ Compensation is there to protect injured workers and if you need help understanding your workers’ compensation rights call the attorneys at Losi & Gangi at 716-854-1446 to help give you all of the information you may need. 

Article adapted from: https://www.thebalancesmb.com/workers-compensation-fraud-examples-4101604