What is workers’ compensation fraud?
In accordance with the Workers' Compensation Act, an employee who, either suffers an accidental injury or occupational disease because of their employment, may file a claim through their employer to receive medical and or compensation benefits while they are out of work for the injury or illness because they are incapable or have a limited ability to work.
Pursuant to the Workers' Compensation Act, the fraudulent attempt or receipt of benefits, occurs where there is an intentional misrepresentation or non-disclosure of a material fact that affects the claim and is subject to criminal prosecution. For example, any person who fails to report income from other sources while receiving benefits, exceeds medically imposed restrictions, or misrepresents symptoms or circumstances related to the injury. In addition, any person who helps another to fraudulently receive, or attempt to receive benefits are also subject to the same penalty as the person receiving or attempting to receive such benefits.
Workers' compensation fraud is not limited to the wrongful collection of benefits. Other examples of workers’ compensation fraud include actions by healthcare providers who intentionally submit a false bill for a patient that was not examined, treated or for treatment unrelated to the work injury or illness. Other examples include duplicate billing or receiving payment from more than one insurance carrier for the same treatment -- and not making restitution.
Workers’ compensation fraud also includes the failure of any business to comply with the requirement to self-insure or carry workers’ compensation insurance or pay the proper assessments to the Second Injury Fund or provide misleading information to an insurance carrier to obtain lower cost insurance premiums.
Some individuals may not recognize that their actions are criminal. However, individuals should be aware that they may face jail time and fines for workers’ compensation fraud or noncompliance. For example, where the receipt or attempt to receive workers’ compensation benefits is obtained fraudulently and exceeds $2,000, the offense is a class B felony punishable by one to twenty years imprisonment and the court may impose fines up to $15,000. The fraudulent attempt or receipt of workers’ compensation benefits under $2,000 is a class C felony punishable by one to ten years imprisonment and the court may impose fines up to $10,000. Business owners or their corporate officers engaged in workers’ compensation fraud or noncompliance, may be guilty of a class D felony punishable by one to five years imprisonment and subject to a stop work order. A person found guilty of fraud shall also be subject to other civil penalties.