Fraud in Workers' Compensation Claims - Apex Law Firm

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.