Workers’ compensation laws are designed to protect employers from lawsuits and provide employees with coverage should they be injured on the job. However, employers, employees, or workers’ compensation insurance agencies sometimes make false claims or statements. When false statements are made, it can amount to a workers’ comp fraud case.
Whether you are a business owner, manager, or employee, knowing how workers’ compensation fraud can impact you or your business is important.
What Is Insurance Fraud?
Insurance fraud is any case in which false claims are made in order to receive improper benefits. Insurance agencies and consumers alike can be victims of insurance fraud. An insurance agency is a victim if a consumer makes a false claim or exaggerates losses. A consumer is a victim if they purchase an illegitimate policy. Both cases are considered a felony.
Oklahoma’s insurance fraud laws prohibit making false claims or providing illegitimate evidence in order to receive payments for a perceived loss. They also prohibit drafting or subscribing to any legal documents intending to use them to support any false insurance claim. Penalties may include imprisonment for up to three years or a fine that may not exceed twice the loss.
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SPEAK TO AN ATTORNEY TODAYEmployers
A business needs to be careful about how it deals with its insurance policy. Insurance companies use job responsibilities to determine the risk of illness or injury. They use this information to determine insurance premiums, and sometimes businesses will lie about workplace safety in order to receive lower premiums.
Some businesses get into trouble by misclassifying employees. This might be the case if a business classifies its workers as independent contractors, but they are really employees.
Suppose a business is caught misclassifying employees or not counting all employees. In that case, the business may be subject to penalties for fraud and may need to pay back taxes and overtime wages. Additionally, business owners may face lawsuits or penalties if they are caught without workers’ compensation insurance.
Employees
Employees may be the likely culprit one thinks of in a workers’ compensation fraud case. An employee may commit workers’ compensation fraud in one or more of a few ways. The worker may make up an illness or injury or exaggerate an injury or illness that does not prevent him or her from working.
Additionally, an employee may claim that a non-work-related injury was the result of a workplace incident. In any case, the employee may be attempting to wrongfully receive the financial benefits or time off promised in a workers’ compensation claim.
Healthcare Providers
Sometimes, a healthcare provider may attempt to abuse the system in order to charge the insurance agency for more than what is necessary. The provider may make up injuries or illnesses or even insist on treatments that are not necessary.
Reporting Workers’ Compensation Fraud
Workers’ compensation fraud is not always easy to identify. If you suspect a claim may be fraudulent, you must report the claim to the state with as much information as possible.
If the fraudulent claim comes from an employee, you may need to verify with witnesses or check security cameras. The state will then perform an investigation and determine whether or not the claim is fraudulent.
Is a Denied Workers’ Compensation Claim Evidence of Fraud?
It is illegal to submit a claim for workers’ compensation that is inaccurate or misleading in any way. If you are submitting a claim for workers’ compensation in Oklahoma, it is critical that you have a skilled attorney by your side to help ensure it is fully accurate.
If you receive a denial of a claim you’ve submitted, that doesn’t mean you will be charged with fraud or are being accused. However, if you are denied compensation and you believe this is a mistake, you may be able to appeal that decision. The key to workers’ compensation claims is:
- Ensure you accurately describe what occurred
- Clearly demonstrate it occurred while working
- Show that you took the necessary steps to file a claim with your employer
- Received medical care
- Reported all of the financial losses (and other losses) you incurred as a result of the incident
Let Us Help
If your claim was denied, act now. Contact our workers’ compensation attorney in Oklahoma to help you navigate the legal options available to you. If you have been accused of fraud, contact us immediately for guidance on your legal options.
If you have any questions or suspect a fraudulent claim, contact Boettcher, Devinney, Ingle & Wicker to discuss your concerns today.
