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What You Should Know About Workers’ Compensation Fraud

injured worker holding wrist

In New York, workers’ compensation fraud is both a civil matter within a workers’ compensation case itself that can result in disqualification from monetary benefits and potentially a criminal matter that can result in jail time.

Workers’ Compensation Fraud Under New York State Law

Workers’ Compensation Law Section 114 is a criminal statute that makes it a Class E felony for any person to knowingly and with the intent to defraud present a written statement that contains a false statement or omission. Within the workers’ compensation case, Workers’ Compensation Law Section 114-a(1) provides that an injured worker is guilty of fraud if he or she:

“for the purpose of [obtaining workers’ compensation money or influencing the Board’s decision regarding a monetary award], knowingly makes a false statement or representation as to a material fact.”

A “false statement or representation” can sometimes mean not disclosing information that is relevant to your case, such as a history of medical treatment before your accident for the same injury or work you have done after the accident.

Why it Matters

The Workers’ Compensation Board cares first and foremost about the dishonesty or the appearance of dishonesty behind statement or omission, and not so much whether you actually stood to gain anything (or the insurance carrier stood to lose anything) because of it.

If the Board finds that you violated Section 114-a(1), it will, in all cases, penalize you by disqualifying you from collecting monetary benefits that are “directly attributable to such false statement or representation.” If any of that is money you have already been paid, you will owe it back to the insurance carrier.

But the Board will also have the option, if it so chooses, of disqualifying you from collecting any money in your case ever again. Whether it does depends on how serious the Board considers the fraud to have been.

Does Being Accused of Fraud Prevent Me From Further Treatment?

It is important to know that no fraud finding against you will ever disqualify you from medical treatment that you are otherwise entitled to. It is also important to know that a fraud finding under Section 114-a(1) only affects the specific case in which it is made and does not affect any other workers’ compensation cases you may have.

Although it is rare in practice for injured workers accused of fraud under Section 114-a(1) to be referred to a district attorney for criminal prosecution under Section 114, it is still possible, and any injured worker accused of fraud should have an attorney who can advise them of their rights against self-incrimination.

What To Do if You Are Accused of Workers’ Compensation Fraud

Because workers’ compensation fraud must be raised by the insurance carrier on the record in a hearing, what you must do largely depends on whether you are represented by an attorney at that hearing.

If you are represented by an attorney and are accused of fraud at a hearing, insist on speaking to them in private before answering any questions.

If You Are Not Yet Represented by an Attorney

In the event that you are not represented by an attorney, immediately tell the judge that you wish to retain counsel. Be firm that you will not answer any questions or say anything further until you have hired a lawyer and contact a workers’ compensation lawyer as soon as you can after the hearing concludes. Do not put it off because you could inadvertently harm your case. For example, if any findings were made at the hearing that should be appealed, there is a firm 30 day deadline to file the appeal; otherwise the findings generally cannot be changed later.

You should not be surprised if an insurance carrier suddenly accuses you of fraud, no matter how innocent you are, as soon as it becomes clear to the carrier that they will soon have to pay you a lot of money. These frivolous accusations are simply the carrier’s desperate, last-ditch attempt to avoid paying you what it owes you.

Experienced Workers’ Compensation Attorneys in New York City

If you have been wrongfully accused of workers' compensation fraud, it is important to seek professional legal advice as soon as possible. Schotter Millican, LLP will be able to help you navigate the legal process and protect your rights. We will be able to gather evidence and conduct our own investigation as we work to secure your deserved compensation.

If you were injured in a workplace accident and are being denied workers’ compensation benefits, call us today at (718) 550-0610 or fill out our form online for a free consultation.

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