Workers’ Compensation Fraud in New York: What It Means for Workers

Workers’ compensation benefits give you a financial lifeline if you’re a victim of a workplace injury. While most people are honest about their injuries, 10% of workers’ compensation cases are fraudulent and can undermine the system’s integrity. If you’re suspected of workers’ comp fraud, you may have a tough time accessing benefits and possibly end up in trouble with the law. Learn about workers’ compensation fraud and how to prevent your claim from being flagged.

What Is Workers’ Compensation Fraud?

Workers’ comp fraud happens when someone tries to manipulate the system in their favor to reduce the benefits paid out or to get more compensation for themselves. Anyone can commit this crime, including:

• Employees
• Employers
• Healthcare providers
• Insurance companies

Fraudulent behavior might involve lying about an injury, misreporting payroll, inflating medical bills, or withholding information to avoid paying out benefits. Like in other states, New York takes fraud seriously and will punish those who are caught engaging in these dishonest practices.

Common Workers’ Comp Fraud

Fraud within the workers’ compensation system doesn’t only happen with workers. Here are some of the most common types of workers’ compensation fraud:

Employer Fraud

Employer fraud happens when employers misrepresent information to reduce the amount of their workers’ comp premiums. This includes:

• Misclassifying employees, especially high-risk ones, to reduce insurance costs.
• Underreporting the number of employees to pay lower premiums.
• Failing to report workplace injuries to prevent their insurance rates from increasing.
• Intimidating or harassing an employee for reporting a workers’ comp injury.

Insurance Carrier Fraud

Insurance companies can also be responsible for fraud by manipulating claims to reduce payouts. Common types of insurance fraud include:

• Denying valid workers’ compensation claims and forcing workers to appeal
• Intentionally delaying a claim’s payout and leaving workers without financial support.
• Downplaying the severity of an injury to reduce the amount of compensation paid out or cut off benefits sooner.

Health Care Provider Fraud

Healthcare providers can also be involved in fraudulent acts related to workers’ comp. This might include:

• Charging for treatments or services that never happened or overcharging for services
• Doing unnecessary procedures or prolonged treatments to boost insurance payout
• Faking medical reports to secure more benefits for themselves or their patients

Employee Fraud

Lastly, employee fraud involves workers lying about their injury or illness to qualify for benefits. Primary examples include:

• Faking an injury to get benefits
• Exaggerating the severity of a legitimate injury to prolong their benefits
• Secretly working at another job while collecting workers’ comp benefits
• Claiming injuries that aren’t related to their workplace

While employee fraud is one of the most widely known types, remember that most “suspicious” claims are 100% real. Always file your paperwork correctly and consult an experienced workers’ comp lawyer to avoid running into legal issues down the road.

Penalties For Workers’ Comp Fraud In New York

In New York, engaging in workers’ comp fraud is a Class E felony for first-time offenders and a Class D one for further instances after that. However, both carry severe civil and criminal penalties, including hefty fines, jail time, and being forced to pay restitution to the person affected.  For businesses, fraud could even lead to losing their license permanently.

How To Prevent Your Claim From Getting Flagged As Fraud

If you’re a worker filing a legitimate claim, you need to be on top of your paperwork to ensure it isn’t flagged as fraudulent. Here are a few tips to do this:

• Have consistent information: Be transparent and consistent with the details you provide to your employer, the insurance company, and your doctor. Any slight deviation could lead to suspicion.
• Provide thorough documentation: Keep records of your injury, including medical reports, treatment plans, and any communication with your employer or insurance carrier.
• Follow the rules: Always attend medical evaluations and follow your doctor’s treatment plan to the letter. Skipping appointments or treatments could result in your claim falling under scrutiny.
• Report your injury immediately: The earlier you report your accident, the earlier you can start getting treated and avoid raising concerns about the claim’s validity.

Our Attorneys Are Here To Help

Navigating the complexities of workers’ compensation can be challenging, especially if the board accuses you of fraud. Whether you’re filing a claim or facing allegations of fraud, our experienced workers’ compensation attorneys are here to help you secure the benefits you deserve. Please contact us online or at 855-338-1207 for a free consultation with one of our lawyers today.