WHAT IS FRAUD IN A WORKERS’ COMPENSATION CLAIM?
A workers’ compensation claimant who commits fraud loses his or her right to benefits and can be sued by the Employer for reimbursement of any benefits paid. Fraud in a workers’ compensation claim is lying in an effort to receive benefits.
For example, if you are found to have lied about having an on-the-job accident. Most often it is you forgot something. If you hurt your back on-the-job and are asked in a recorded statement or asked by a doctor if you ever hurt your back before and you say no, even if you simply forgot about the prior injury, they are going to say you lied. If giving a recorded statement or when speaking to your doctor, be honest. Try and remember every prior accident and injury you have ever had. If you later remember, call the doctor or adjuster to tell them you remembered something. Best if you do that in writing.
Assume the Adjuster or the insurance company’s attorney will get every medical record you have ever had. Adjusters have access to a national database listing every insurance claim you have made whether workers’ compensation, auto accident or other. Assume they know of every prior injury, accident or claim no matter how long ago it occurred. For example, you hurt your back in high school playing football and were taken to the ER. Now, 20+ years later, you forgot about that. They are going to say you lied.
Contact an experienced workers’ compensation attorney early rather than later in your claim.