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  • Tori Jacobs Law

FRAUD; Workers' Compensation Fraud... what is it and how can I protect myself from these allegations

Workers' Compensation fraud is a very serious allegation that you should be aware of. Recently, in the last couple years more and more allegations of fraud have been raised against honest injured workers' and can imagine how scary this could be. Fraud, is found under Section 114 of the Workers' Compensation Law. The first way one can be proven guilty of fraud is by the obvious: claiming to be out of work and entitled to indemnity lost wage payments but yet working. The other though is not so obvious and the most hotly litigated issue currently. One can be proven guilty of fraud when they represent a disability more serious than what their disability is. Think of this; walking into your doctor's office with a cane and a limp so that they declare you as totally disabled, unable to work in any capacity due to your disability but then later in the day, perhaps right after that appointment, the cane and the limp disappear. Obviously if the doctor knew your true ability to perform tasks perhaps you wouldn't be found totally disabled and you could be found capable of a less strenuous job. This is often where injured workers have to defend themselves. I have handled so many claims and a couple points need to be pointed out: 1.) Always be truthful with your doctor about everything. Your past injuries and your current abilities. 2.) If you don't have to use a cane on a daily basis then be specific with your doctor on when you do so that they may have a understanding of what your abilities are. Do you only use it for long distances? When you go out due to the fear of uneven surfaces? 3.) Be aware of your surroundings. I often get a call that they know they are being followed. Please keep in mind that unless an investigator is breaking the law, they are allowed to surveillance you. Assume you are always under surveillance and never represent a disability over and beyond what you really have with any of your treating physicians, including the carrier's consultant if you are examined. 4.) Surveillance can be done anywhere, anytime. In my experience, the insurance carrier's investigators are getting trickier and may even place and "unmanned surveillance" unit outside of your house. This could be depicted as a traffic camera. If you have doubts, you can always clarify with your local city/town to see if there is one truly assigned to your area or if there is something to report. 5.) Your rights should never be violated. If you feel that you are being harassed or are in fear of a strange vehicle following you etc., you are encouraged to exercise your right to feel safe and secure in your environment and if necessary, call the authorities. I am here to help in all areas of your case, but when a fraud allegations arises, please note it is highly recommended that you are represented to defend these allegations. Your testimony will more than likely be taken, along with the possibility of your treating physicians. I understand what fears and what options may be available when this arises. A fraud allegation can be very serious and can result in a mandatory or discretionary forfeiture of your indemnity benefits. If you feel that you need help with a potential fraud allegation, I can help. Please call me at (716)204-5285 to discuss representation. *this blog is merely informational and not conclusive on the area of fraud. Every fraud allegation is different and this blog is merely meant to provide an overview of this issue. Further representation is highly recommended to discuss specific aspects of any Fraud Allegation in your case as this is a very serious finding in your case and can potentially, result in a criminal claim being filed against you for any benefits proven to be fraudulently taken.*

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