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What You Need To Know About Workers Comp Fraud

file folders for workers comp fraud investigation
file folders for workers comp fraud investigation

In Florida, most employers are required to carry workers’ compensation insurance. The purpose of this coverage is to reimburse employees for medical expenses and lost wages when they suffer work-related injuries, regardless of who was at fault. However, sometimes employees may game the system by faking an injury to receive benefits. While you might think that this is an unlikely scenario, the truth is that it does happen, and over 450 cases are prosecuted yearly in Florida for this and other types of workers’ comp fraud. Luckily, working with an experienced work injury lawyer in Florida can help you avoid the risks and penalties associated with workers comp fraud.

What is workers’ comp fraud?

Generally, workers’ comp fraud happens when an employer, employee, or health provider lies in order to receive money they do not deserve. Depending on the circumstances, workers’ comp fraud can be very costly, particularly to the employer, leading to penalties and higher insurance premiums. There are numerous red flags that can suggest workers comp fraud. Here are some of the most common types of workers’ comp that employees are likely to commit:

  • Faking illness or injury. A worker may falsely claim hearing issues or vision problems that are non-existent so they can stay home and rack up some money for nothing.
  • Exaggerated problems. This happens when a worker has a genuine workplace injury like a sprained hand but tries to argue it’s something much more severe such as a broken hand.
  • Weekend warriors. This happens when an employee suffers an injury in their personal time, maybe over the weekend, but claims it occurred within the scope of their employment.
  • Double dipping. Sometimes an injured employee may choose to continue working, particularly in another organization where they did not file the work comp claim, despite physician-mandated work restrictions. In other words, the employee is earning a paycheck elsewhere while still collecting temporary disability benefits from the company where they got injured.

How to identify workers’ compensation fraud?

Oftentimes, workers’ comp insurance companies have special investigative experts to investigate possible fraud, especially if there’s anything suspicious. Sadly, most of the workers’ comp fraud schemes are not easy to spot. They can even be more difficult to detect when the worker is sporting an actual injury that a physician can verify. Various signs for spotting workers’ comp fraud include:

  • Late reporting
  • Missed medical appointments
  • Employee refuses treatment
  • Lack of witnesses
  • The “Monday morning” claim
  • Conflicting injury details
  • History of claims
  • Post-termination claims
  • Financial hardship at home
  • Disgruntled employee

Consequences for workers’ compensation fraud

Committing workers’ comp fraud is a serious crime in Florida. That means if you’re accused of committing this offense, you’re likely to face severe civil and criminal penalties based on the court’s discretion. These may include fines, jail time, deportation for nonresidents, or even being forced to pay back whatever amount the employer lost.

How to validate your workers comp claim

injured worker who needs a lawyer to prevent workers comp fraud
To prevent accusations of workers comp fraud, report your injury immediately and collect evidence such as eyewitness testimony.

It’s not unusual for employers or their insurer to deem a valid claim as fraud. If that happens, you’ll need to validate the details of your workplace injury. That means you have a responsibility to preserve all the evidence you can by: 

  • Documenting all the details of your injury
  • Getting witnesses on the record to preserve evidence in case their memory lapses or to prevent them from changing their story
  • Taking photos of your injuries, and updating those photos as you recover
  • Recording all your medical appointments, care plan, bills, and prognosis

Even when you have all the evidence you need, it may not be possible to understand all the legal requirements and procedures that may invalidate your claim. For that reason, you need to hire a dependable work injury lawyer to help you file your claim. The right attorney will ensure that you gather the right evidence, calculate your claim value, deal with your employer’s insurer and even represent you in court if it comes to that.

Work with an experienced attorney to fight or avoid worker’s comp fraud

If you think your employer or their insurer has wrongfully misclassified your valid workers’ compensation claim as fraud, act fast and hire a skilled Florida workers’ comp lawyer near you. Our attorneys at Sternberg | Forsythe, P.A. have been helping injured Florida workers for decades and can help you collect what you deserve. Contact us online or give us a call at 561-687-5660 to learn more about the Florida workers’ comp process and your legal rights.

What to read next:

The Top Warning Signs Of Workers’ Compensation Insurance Fraud

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