Fraud in Workers Comp Cases

The Connecticut Worker’s compensation system entitles employees to certain financial assistance when they experience work-related injuries or illnesses. Some people, however, might try to game this system by falsifying information for personal gain or the benefit of their business.

While a Connecticut worker’s compensation lawyer can help you with your claim, it’s still vital that you understand the rules and be able to recognize when fraud might be an issue.

How Extensive is the Problem of Worker’s Compensation Fraud?

Fraud in the worker’s compensation system is a serious matter. It’s a common misconception that injured workers are the only parties who might commit wrongdoing, however. In fact, employers tend to commit nine times more fraud than employees if you look at nationwide figures for some of the largest cases.

When worker’s compensation fraud is committed by the employee or claimant, it might include such things as reporting false claims or exaggerating injuries. Some injured workers also fail to report additional earnings from other jobs or work a second job when they are claiming to be disabled.

Employers also commit workers compensation fraud when they do anything that might prevent an injured worker from collecting the benefits they deserve. This might include falsifying payroll records to pay less in insurance premiums than necessary, incorrectly classifying employees as independent contractors, or refusing to report legitimate work-related injuries or illnesses.

There have even been cases of worker’s compensation fraud that go beyond employees and employers. For example, a medical or other provider might bill for services that they didn’t provide or deliver services that are unnecessary. A claims adjuster may tamper with paperwork to deny a claim or take kickbacks from providers in exchange for service referrals.

Recent Worker’s Compensation Fraud Cases

In Connecticut, it is illegal to work a second job while you are also collecting certain worker’s compensation benefits. In September 2016, a Waterbury woman was arrested and charged with fraud for illegally collecting $21,000 in benefits. A 51-year old Certified Nursing Assistant at Saint Mary’s Hospital suffered a work-related injury in 2015 and was unable to work. She collected lost wages benefits but continued to work and receive pay as a live-in caretaker.

In March 2015, an employee of the state’s Department of Children and Families (DCF) was arrested and charged with worker’s compensation fraud. The 40-year-old employee had a 2014 work-related injury, leaving him unable to work, so he collected more than $11,800 in disability benefits. However, surveillance video showed him playing golf and doing yard work. The employee was charged with a Class B felony, which is punishable by fines up to $15,000 and/or a 20-year prison sentence.

Laws Related to Connecticut Worker’s Compensation Fraud

If you have a worker’s compensation claim in Connecticut and have been accused of fraud, it’s important that you speak with a qualified worker’s compensation attorney immediately. Even an innocent misunderstanding of the rules could lead to serious charges, fines, and jail time should you be found guilty. In some cases, a worker’s compensation fraud in Connecticut is treated as a felony. Some of our state’s laws that relate to fraud in the worker’s compensation system include:

  • Penalties for Fraudulent Claim or Receipt of Benefits (CGS § 31-290c). This rule states that any person or representative who receives or attempts to receive benefits by the intentional misrepresentation of facts or by failing to disclose information could be guilty of either a class B or C felony. Also, any employer or other person who assists in the making of false claims could be liable for the same civil and criminal penalties as the claimant.
  • Penalties for Health Insurance Fraud (CGS § 53-440 to 53-443). A person or other entity may be found guilty of health insurance fraud if they make false or misleading statements to obtain services or assist someone in obtaining unnecessary services. Each instance is a separate larceny offense that could be punishable by fines, imprisonment, or both.

Speak to a Qualified Connecticut Worker’s Compensation Attorney

If you have been injured or suffered an illness during the course of your employment, contact The APEX Law Firm, LLC to discuss your case. We take pride in our work on behalf of injured workers throughout Connecticut. The sooner you reach out to us, the quicker we can advise you of your rights and begin working on your case. Call us now at (860) 900-0900 or contact us online to schedule a free consultation.

How long does a Workers Compensation claim take?

Getting injured at work is never something anyone plans or wishes to happen, and chances are good that it will never happen to you.  However, if you are injured at work, there are certain responsibilities that you and your employer have. All employers in Connecticut must carry worker’s compensation insurance; it’s the law.  This insurance policy covers medical bills and lost wages while you recover. As the injured party, it is your responsibility to report the injury immediately and to get medical treatment as soon as possible.  Not doing so could jeopardize your claim for benefits.

Insurance companies are in the business of making money and are often reluctant to pay money out for any reason, including legitimate injuries.  This means a worker’s compensation claim can take considerable time to resolve.  Most insurance companies hire attorneys to forestall payments or have claimants settle for far less than deserved.  So, how long should a worker’s compensation claim take?

Unfortunately, there is no quick answer; the answer typically depends upon the injury.  Some claims can take a few weeks to resolve, while other claims can last for years.  Unless your injury is minimal and recovery is expected to be short, don’t assume your claim will resolve quickly.  In contrast, it is possible that an injury that appears to be minimal initially could cause persistent problems down the road.

Consider soft tissue and internal injuries: Such injuries can cause persistent pain and limited mobility for long periods of time.  Neck and back injuries are the most common, because there is no set diagnosis or hard evidence that can definitively prove an injury.  Pain and discomfort is not something that can be seen on an x-ray or CT scan.  Therefore, insurance companies often minimize these cases and contest payment for the medical bills and lost wages.

An experienced workers’ compensation attorney can often help expedite your claim by helping to get medical bills and lost wages paid.  After all, bills do not stop coming in because you are not working.  Never agree to sign anything from the insurance company or the employer.  Call one of our worker’s compensation attorneys in new britain as soon as possible.

Why do you need a Criminal Defense Attorney?

For some people, the threat of incarceration is enough to keep them on the straight and narrow, but there is the old adage of, “The wrong place at the wrong time.”  Hopefully, this does not happen to you, but should something happen, it is always best to find an experienced criminal defense attorney.

Under the law, defendants are presumed innocent until proven guilty.  The state has the burden to prove guilt beyond a reasonable doubt. They must prove each and every element of the alleged crime beyond a reasonable doubt or the jury must find the defendant not-guilty. It’s not an easy burden to prove.An experienced criminal defense attorney can help you protect the things most important to you: your freedom and civil rights.

A criminal defense attorney understands the legal process and will be able to advise you how to best handle your case.  Sometimes, situations can be resolved without the need for trial, and the state may have weaknesses could weigh in your favor.  An experienced criminal defense lawyer will have keen understanding of these weaknesses and will be able to use them.

If the evidence against you is overwhelmingly in the favor of the state, your attorney can assist you in pleading to a lesser charge which may lead to a shorter sentence or possibly probation.  Without representation from a criminal attorney, you may not be given this choice or you may not understand it completely.

All citizens are protected by the state and federal Constitutions.  Although most rights are guaranteed, unless you understand Constitutional law, you may not have the complete understanding necessary to keep your rights protected.  Contact our experienced criminal defense attorneys in New Britain and ask how we can help you with your case today!

Workers Compensation Claims: What to do when you are injured on the job

If you are injured while at work for any reason, you have the right to be compensated while you are recovering and the right for your medical bills to be paid under worker’s compensation insurance.  Employers are reluctant to file workers’ compensations claims because they often result in higher premiums.  Many insurance companies do not like to pay the expensive medical bills associated with claims because it subtracts from their bottom line.  Here are a few tips to protect yourself if you are injured.

  1. Immediately inform your supervisor.

Do not wait if you are injured.  Even a seemingly minor injury can cause serious problems in the long run. Letting a supervisor know what happened immediately is paramount to getting your workers compensation claim started.

  1. File an injury incident report and make a personal copy.

You should fill out a form stating what happened, when, how and the like.  You must retain a copy of this report.  Make sure this is done in your handwriting, if possible, detailing an accurate description of how the injury occurred.  List any witnesses to the injury.

  1. Seek medical attention.

Regardless of how minor your injury may seem, it is important to have it medically documented.  Employers are required to allow you to see a physician for your injuries, and only a physician can make a diagnosis for you.

  1. Keep detailed notes on everything.

Maintain a diary or journal detailing your injuries and treatment you received.  Problems begin when the employer contests your claim and you do not have proof it happened at work.  There exist occurrences when employers may “lose” claim reports or allow insurance to lapse. Don’t let this happen to you, and don’t rely on your memory.  The best offense you have is documented evidence from medical professionals.

  1. Do not settle until you speak to an attorney.

Insurance companies will want you to take a low settlement and close the claim.  The problem with an immediate settlement is you lose rights if the sustained injury becomes chronic.  Proper medical documentation can prove chronic injuries and you need a physician and attorney on your side. Don’t leave it to chance; contact a workers compensation attorney.

Getting injured at work is a great inconvenience and is never planned and you do have rights if you are hurt. Contact a workers compensation attorney and use these five helpful tips to protect yourself and your loved ones in the case of an on-the-job injury.

 

10 Reasons why you need a Workers Compensation Attorney

Injuries at work happen. While no one intends to get injured while at work, employees can suffer serious injuries that prevent them from performing their regular duties.  Some injuries are more serious than others, and some injuries are more painful than others. Regardless of how serious the injury is, knowing your rights under the law and how to protect them is vital to all work-related injuries.

Some employers are hesitant to allow workers to file claims of work-related injuries, and the insurance companies themselves are often loath to pay out on a claim. In some cases, the insurance company will dispatch an adjuster to the injured party with complicated forms and may make great promises to entice the injured employee to sign.  This is where the trouble begins. Always consult with a worker’s compensation attorney before signing anything. Here are ten good reasons why it is a good idea:

  1.  Medical benefits – Insurance companies do not like to pay physicians, emergency rooms, chiropractors and even necessary medications for you.  The less the company has to pay out, the higher their profits. Despite this, it is the responsibility of the employer’s insurance company to pay the medical expenses associated with a work-related injury.
  2. Insurance appointed nurses – Many companies employ case management nurses to assist with your case.  They may ask to attend physician appointments.  This is dangerously close to a HIPPA violation, and it is something that you have the right to decline.
  3. It didn’t happen – Not all injuries are physical. Insurance companies often contest work-related injuries. Their goal in stalling is to prevent payment of a claim or to force you to give up.
  4. WC claims never expire – A workers’ compensation claim lasts forever unless you settle the claim. They will never tell you this voluntarily and many people don’t know that they can continue to get benefits long after the initial claim has been opened.
  5. “Pre-existing” condition – This is the catch all for denying claims. The insurance company and their physicians may try to argue that there is no new injury. Your WC attorney can help you through this.
  6. No workers compensation insurance – If your employer does not carry WC insurance, not only is it a violation of the law in Connecticut, but you may be responsible for the medical bills, lost wages and more.
  7. No returned calls – The old saying about “Ignore it; it will go away.” applies in the insurance business.  Companies and adjusters may ignore you and your phone calls, but an having an attorney will get their attention.

These ten reasons should be enough to help you understand the importance of a workers compensation attorney.  The best rule of thumb in the case of an injury is two-fold:  1) sign nothing until you speak with an attorney, and 2) write down everything that happens from the injury until the claim is paid.

 

The more information you have at your side, the better your chances of winning. If you have any questions, call our workers compensation attorneys in connecticut today at (860) 900-0900.