Fraud can be found in a number of factual situations, against a number of involved parties. The New York State Workers' Compensation Board has an Office of the Fraud Inspector General. This office investigates any allegation by any party against the workers' compensation system. These might include:
- Individuals who submit false claims, such as for injuries that occurred outside of work
- Any person who makes a false statement in order to assist a claimant in making a false claim
- Injured workers who misrepresent their condition, injury, or work status in their claim for benefits
- Claimants with established and legitimate cases who lie during a formal proceeding such as a deposition or hearing
- Employers who seek to dodge responsibility by misclassifying an employee
- Healthcare professionals who falsify records to inflate bills
- Legal professionals who encourage the filing of a false claim
- Insurance professionals who alter records or evidence to support denying benefits
Consequences of workers’ comp fraud
If a workers’ compensation law judge finds fraud was committed by a claimant, they must assess the mandatory penalty under the law, which is disqualification of the claimant’s monetary benefits directly associated with the fraud. Additionally, the judge may assess a discretionary penalty under the law, which disqualifies the claimant from all future monetary benefits.
The Office of the Fraud Inspector General will refer cases to the local district attorney for criminal prosecution. If found to have committed criminal fraud, an offender can be charged with a class E felony. Under state sentencing guidelines, penalties for a conviction can include a prison term up to four years.
How to get answers
When you are hurt at work, the goal is to get the benefits to which you are entitled. The last thing you want is to jeopardize your benefits by misrepresenting anything in the claim. If you have questions about applying for benefits, get answers from an experienced workers’ compensation attorney.