New York Workers' Compensation Fraud Claims

Fraudulent Workers’ Compensation claims needlessly burden employers/carriers by requiring payment to claimants that may be able to work. A fraud finding is appropriate if a claimant knowingly and intentionally misrepresents (or omits) a material fact about an injury for the purposes of obtaining workers' compensation benefits.  One of the most egregious forms of fraud is when claimants simultaneously receive workers’ compensation indemnity benefits while working and receiving wages. A fraud finding may also be made entered if a claimant does not disclose his/her work activities when questioned directly during a hearing. 

 

In addition, the Workers’ Compensation Board has also determined that a claimant’s failure to disclose a pre-existing or subsequent injury to the same body part constitutes fraud. A claimant has an obligation to disclose prior/subsequent accidents if the same body part is injured (i.e. motor vehicle, personal injury or workers’ compensation). When determining whether a material misrepresentation or omission has been made, it is imperative to review the medical reports submitted by treating physicians and IME physicians. 

 

A fraud finding may also be entered if the claimant exaggerates the severity of his/her injuries. In many cases, treating physicians will determine that a claimant is temporarily totally disabled from employment based on representations made by the claimant during the medical examination. However, if evidence (video surveillance/social media posts) of the claimant’s physical activity is obtained and the activity is inconsistent with a total disability, there may be a basis to raise fraud.

 

If a fraud finding is entered, a claimant may forfeit his/her right to any compensation that may be attributed to the material, false representation.  In addition, a claimant may be held criminally liable for fraud as determined by a criminal court upon prosecution at the request of the Inspector General.

 

For more information on workers' compensation fraud claims, please contact Usra Hussain at uhussain@bhlfirm.com