What Is Workers’ Compensation?
Workers’ compensation is a compulsory insurance system that ensures that employees receive benefits for workplace injuries. The employer is compelled by law to fund this insurance. The funds would then be applied towards the compensation of employees for financial losses resulting from workplace injuries such as medical care, lost wages, and permanent disability or even death.
What Is Workers’ Comp Fraud?
Workers’ compensation fraud is a serious offense that attracts harsh criminal penalties. If you suspect workers’ comp fraud, you might need a workers’ compensation lawyer.
Workers’ compensation fraud could involve any number of perpetrators, ranging from employees, employers, health care providers, and insurance companies.
For employees, it may involve providing fraudulent material/statements to obtain workers’ compensation benefits to which they are not entitled.
On the part of the employers, failing to provide the necessary workers’ comp insurance as required by law could also amount to workers’ compensation fraud.
Consequently, any action taken to receive undeserved benefits or cheat the established workers’ compensation system may likely amount to fraud.
Examples of Workers’ Comp Fraud
Workers’ compensation fraud is a complex concept that involves several issues. As such, it may sometimes be challenging to identify. However, some of its most common instances are highlighted below as follows:
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An injured worker may make false or fraudulent statements or knowingly present multiple claims using different identities to obtain benefits.
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An employee may also commit workers’ compensation fraud by making a claim for a non-work-related injury or by failing to report income on other jobs.
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Workers’ compensation insurance fraud also occurs when an employer misclassifies employees as independent contractors on purpose or when they pay their workers less than what they are entitled to.
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Health care providers may also be guilty of workers’ compensation insurance fraud if they make a fraudulent statement that they provided medical care when they did not, to support a false claim for benefits.
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Workers’ compensation fraud will also arise if an employer is shown to have discouraged an injured worker from making a workers’ compensation claim.
Duty of Employers to Provide Workers’ Compensation Insurance
Workers’ compensation is mandatory for business owners and organizations with five or more employees or one or more employees for those in the construction industry due to the inherent risk involved. Failure to have this may lead to harsh civil and criminal penalties. The employer may also face potential jail time depending on the frequency of the violation.
How to Identify Workers’ Compensation Fraud by Employees
It might not always be easy to detect workers’ compensation fraud cases. Nevertheless, you might have a reason to be suspicious in the following cases or similar circumstances:
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If the injured worker has a medical history that is similar to the alleged work injury
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The employee seems to lack a witness to the injury.
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The injured employee did not report the injury right away.
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If the injured workers refuse medical evaluation and insist on treatment services obtained from specific doctors or professionals.
The above could indicate workers’ comp fraud and should be investigated.
Again, if an employee frequently makes workers’ comp claims, the insurance company may investigate subsequent injuries to prevent insurance fraud since the employee has become familiar with the system.
Therefore if you notice any of the above signs as an employer, you should contact a workers’ compensation lawyer to advise you.
Workers’ Comp Fraud Penalties
Workers’ compensation fraud is a crime in the State of Missouri. However, the severity attached to the offense is based on several factors, including whether or not the accused is a repeat offender. Thus, workers’ comp fraud may be charged as either a misdemeanor or a felony.
Penalties for each class of the offense vary and range from jail time to fines up to thousands of dollars.
In the same vein, the sanctions for workers’ compensation fraud as prescribed under the law also vary depending on the personality of the perpetrator, whether as an employer, employee, health care,, or insurance provider, as follows:
1. Filing a Fraudulent Workers’ Comp Claim by Employees
According to the workers’ compensation law, penalties for a false or fraudulent claim include fines and jail time.
A misdemeanor conviction for workers’ compensation fraud can be punished by one year of jail time. The sentence may also include a fine of approximately $150,000 or double the amount of the fraud, whichever is greater, and compensation to the employer and insurance company victimized by the fraud.
Penalties for workers facing a conviction for comp fraud are punishable by two to five years of jail time for felonies. It may also include a fine of $150,000, or double the amount of the fraud, whichever is greater, and restitution to the employer and insurance company victimized by the fraud.
Filing a false or fraudulent statement to claim benefits is an unlawful act that can be charged as a Class E felony. Workers guilty of filing a fraudulent claim shall be made to pay a fine of up to $10,000 or double the amount of the fraudulent claim, depending on which sum is more.
Repeat offenders with previous convictions for this crime are guilty of a Class D felony. The defendant’s criminal history may also impact the penalties assigned by the court for workers’ compensation fraud.
2. Penalties Against an Employer who Fails to Provide a Workers’ Comp Insurance Plan
Generally, this offense is treated as a Class A misdemeanor. However, it attracts steep penalties, including paying an amount three times the original cost of the annual insurance premium, which the employer had failed to fund, or an amount up to $50,000.
A second or repeat offense is more serious. The offender may be found guilty of a Class E felony with or without additional fines.
Injured employees in such an instance may also bring a civil suit against their employer to recoup the cost of medical treatment. A top-rated workers’ compensation attorney can provide more insight and help injured workers get compensated in such circumstances.
3. Liability of Health Care and Insurance Providers for Workers’ Comp Fraud
Liability for workers’ compensation fraud is not limited to only employers or employees. Therefore, the law makes it a criminal offense to knowingly assist or conspire with an individual to recover insurance benefits or avoid payment of benefits without cause.
Consequently, medical care providers can also commit workers’ compensation fraud if they knowingly assist employees in bringing a false claim for benefits. This may be by giving a false or fraudulent statement or material representation of an injury that never occurred to get workers’ compensation benefits.
Insurance providers may also be guilty of workers’ comp fraud if they show an intent to defraud by failing to comply with the law or fulfill their obligation to compensate an injured worker with an indisputable claim.
Insurance companies in such instances may be found guilty of a Class E felony and may have to pay a fine of up $10,000.
Other third parties who aid the commission of workers’ comp fraud may be found guilty of a misdemeanor and may be liable to pay a fine of up to $10,000.
Defending a Workers’ Compensation Fraud Charge
If you are accused of workers’ comp fraud, you do not have to face it alone. Hiring an experienced workers’ comp lawyer is crucial to present your case and defend you. Your lawyer can advise you and provide you with a good defense strategy. They can also represent you during court hearings to ensure that you get the best possible outcome for your case.
Reporting Workers’ Compensation Fraud
Suppose you are in Missouri and you’d like to report a case or suspicion of workers’ compensation fraud by any person. In that case, contact the Fraud and Noncompliance Unit of the Missouri Department of Labor and Industrial Relations and make your complaint.
You could also contact a top-rated workers’ compensation attorney to give you more insight.
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