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How to Avoid Being Accused of Workers’ Compensation Fraud

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Insurance carriers know that even accusing an injured worker of fraud will delay and perhaps damage a workers’ compensation claim, whether or not the accusation sticks in the end. This is why insurance carriers are quick to make the accusation, often with little or no proof, and especially when they know they will have to pay out a large sum of money otherwise.

Unfortunately, many injured workers do things during their cases that can trigger fraud accusations without ever truly intending to cheat the system, with the Board usually siding with the insurance carrier.

3 Ways to Avoid Being Wrongfully Accused of Fraud

Therefore, it is extremely important for all injured workers to be aware of and avoid doing certain things during a workers’ compensation case that could put them at risk of a fraud accusation later on. Here are 3 things in particular to avoid doing:

1. Denying or not disclosing prior injuries, illness, or medical treatment

There are many occasions during a workers’ compensation case when you will be asked about or expected to disclose whether you ever injured the same body part(s) or had the same illness you are claiming in your case before your accident:

  • When you complete your C-3 Employee Claim form, one of the questions asks if you have any prior injuries to the same body part(s) or prior similar illnesses.
  • If an attorney is helping you complete that form, your attorney should ask you about this. Regardless, you should tell any attorney who represents you, as soon as possible, about any prior accidents, injuries, or illnesses that in any way overlap with your current claim
  • When you go to any doctor, whether your own treating doctor or the insurance carrier’s doctor, you will likely be asked about such prior injuries and illnesses. If you are not asked, you will be expected to volunteer this information anyway.
  • When you are in court, the judge or the insurance carrier’s lawyer may ask you about prior injuries or illnesses.

Many injured workers may naturally assume that it is ok to not mention past injuries or illnesses that they think were not that serious or happened too long ago to matter anymore. That assumption is wrong, and it may cost you big time later on. Make sure you disclose each and every prior accident or illness that is similar to what you are claiming in your current workers’ compensation case, no matter how insignificant or old it is, in any of the above listed situations.

2. Working while collecting workers’ compensation benefits and not telling the insurance carrier

If you are out of work and collecting workers’ compensation benefits and then you start working again, you must immediately tell the insurance carrier or your attorney if you have one.

Whenever you are awarded money at a workers’ compensation hearing, the judge or the insurance carrier’s lawyer will ask you if you have done any work since your accident or since the last time you were in court. You should assume in this situation that “work” is defined as broadly as possible and means any of the following:

  • Work for the same employer where you got injured
  • Work for a different employer
  • Work that is paid off the books
  • Any kind of self-employment or freelance activity, whether profitable or not
  • Unpaid volunteer work
  • Helping friends or family with work or business, whether you are paid or not

If you answer “no” when asked if you have done any work, and the insurance carrier finds out that you have done any of the above things, it will likely accuse you of fraud. This is why it is so important to tell the carrier immediately whenever anything about your work status changes.

It is actually possible for an injured worker to legally collect workers’ compensation while working at lower wages than he or she earned at the time of injury. In fact, there are some circumstances in which you can legitimately collect more workers’ compensation money while working than you would be entitled to while not working.

3. Doing physical activities that your doctors say you are too disabled to do

Many injured workers who truly are too disabled to work their old job or even any job still have to perform basic tasks of daily living in public such as shopping, going to the doctor, or caring for children and other dependents. Insurance carriers know this and will often hire investigators to:

  • Follow injured workers around with a camera to try to catch them doing something with their bodies that is inconsistent with what their doctors are saying they can do and use these videos as supposed proof that the injured worker lied to his or her doctor about how disabled he or she is.
  • Monitor any social media postings you make that are publicly viewable to try to find instances of you doing things outside of your medical restrictions.

If your life situation forces you to perform certain activities of daily living that your doctors are saying you are physically unable to perform, you should discuss this with your doctors and ask your doctors if they think you can perform these activities at least on a limited basis, so that the things you absolutely have to do to survive remain consistent with your doctors’ restrictions.

If you were injured in a New York workplace accident, call Schotter Millican, LLP today at (718) 550-0610 or fill out our form online for a free consultation.

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