Workers compensation comes in handy when you are injured at work and need time to heal. When other people commit workers compensation fraud, it can have a negative impact on the entire system. Workers comp is insurance that your employer purchases to protect you in case of a work-related injury or illness. It also protects the employer by preventing you from suing them. Fraud, on the other hand, hurts you, the employer, and the business.
The Many Faces of Workers Comp Fraud
Just as there are many types of injuries and illnesses that qualify for workers comp, there is a broad range of ways that people commit fraud.
When insurance providers commit workers compensation fraud, it is on a much larger scale than what an individual may do. Sometimes, professionals will work together to make claims or bill for work that was never performed. Each person involved in the process can commit fraud in a number of ways.
When Employees Commit Workers Comp Fraud
Sometimes employees make up injuries or illnesses that they really don’t have. They do this strictly to gain paid time off and enjoy the financial compensation from the insurance coverage. Injuries or illnesses that aren’t physically noticeable such as hearing loss or back pain might be the basis for their claim.
Another way that employees commit fraud is to embellish the details of their injury. They turn something minor into something more painful so that they appear unable to work. They submit a workers comp claim to their employer and go home with the hopes of collecting compensation.
Some employees try to pass off injuries or illnesses that occur away from work as having happened on the job. They might also use an old injury that resurfaces to validate that their injury occurred while at work.
Workers Comp Fraud by the Employer
Employers are legally obligated to carry workers compensation insurance to cover their employees. They must find an insurance provider and pay premiums for their coverage. Several factors determine how much premiums cost. One is the safety of the work environment. A workplace that takes every precaution to keep employees safe isn’t as likely to have workers comp claims. As a result, the employers’ insurance premiums are often significantly lower. That’s why employers sometimes lie about the safety of their work environment. This reduces their premiums and saves them money.
The employer can also commit fraud by misclassifying their employees. Sometimes they don’t even report the true number of employees working for them. Misclassifying means listing some employees as independent contractors so that the employer isn’t responsible for their insurance coverage. A good example of classification is with the share ride company, Uber. Uber insists that the people who drive for them are independent contractors and they don’t require workers comp coverage. Employers who get caught committing this type of workers compensation fraud could end up paying a higher price in workers compensation fines, back taxes, and overtime wages to the worker.
Sometimes employers just don’t purchase workers comp insurance. Almost every employer is required to protect their employees with insurance. They can end up paying significant penalties if they don’t.
When Healthcare Providers Commit Workers Compensation Fraud
We all know that healthcare professionals make some of the highest salaries of those in any industry. That doesn’t stop some of them from abusing the workers comp system. Sometimes the same professionals you entrust with your health use dishonest tactics to gain even higher profits than they already receive.
One way that providers abuse the system is by exaggerating an employees’ injury or illness. They might add more charges to the insurance report as a means to get repaid more for treatment.
Some dishonest providers go so far as to give the employee more treatments than they really need. They might even recommend treatments for an illness or injury that doesn’t exist. While most healthcare providers are honest, those who are willing to deceive their patients and put their health at risk do exist.
How Workers Compensation Fraud Impacts You
Workers comp fraud can have a lasting impact on everybody involved in the system. Employers often end up having to pay higher premiums because of the losses endured by the insurance companies. Depending on the method of fraud an employer uses, it can put the employee’s safety and financial security at risk. If they become injured and ill and are unable to work, their workers comp insurance might be the only financial resource they have. Without it, they may not be able to get the medical treatment they need to heal.
When to Talk to a Workers Comp Attorney
Sometimes there are clues that your employer might be guilty of workers comp fraud and you may want to look into consulting with a workers’ compensation lawyer. If you are injured on the job, your employer is required to provide you with a workers comp claim form. If that doesn’t happen or your employer asks you not to file a claim, it could be because he hasn’t gotten the insurance coverage required by law.
Your employer might offer you a lump sum settlement in return for not filing a workers comp claim. If you accept and your injury ends up costing more than expected to treat, you could end up with a pile of medical bills you can’t pay.
Don’t do as he asks. Instead, schedule an appointment with a work comp lawyer right away. You only have a certain amount of time to file a claim. An attorney can help you determine what steps to take to get compensation for your work-related illness or injury.
If your employer does not have workers compensation insurance, you may be able to sue him for a personal injury. Unlike workers comp, a personal injury claim may also include pain and suffering for the emotional distress caused by your injuries. Punitive damage might also be awarded to punish your employer for failing to follow the law.
If you suspect you’ve been a victim or workers compensation fraud, contact The House of Workers Comp. Our San Diego work injury lawyers will evaluate your case, help you understand your rights, and help you maximize your compensation.
