Under the Workers’ Compensation Law, fraud is defined as knowingly making a false statement or representation of a material fact, for the purpose of obtaining compensation or influencing a determination regarding a payment of compensation.
Fraud can be based upon an omission of a relevant fact, an exaggeration of symptoms to a physician, or a failure to disclose work or volunteer activities. A claim of fraud can occur as the result of a statement made to your employer or Workers’ Compensation carrier; your treating physician or the carrier’s examining doctor; or a statement made at a hearing. Fraud is commonly monitored through the use of questionnaires and alive and well checks.
Workers’ Compensation fraud often results when an injured worker fails to notify the carrier that they have returned to work. The carrier must be notified immediately if you expect to receive any wages, no matter how small, and even if for a short period of time. If you perform work but do not receive wages, you must still notify the carrier. If you operate an online business or perform online work, you must disclose that activity as well. If you are performing any activity that a reasonable person could expect to receive payment for, you are obligated to notify the carrier. This includes work performed in exchange for goods or services—for instance, to repay a debt or to receive a reduction in rent. The carrier must even be notified if you are performing volunteer work.
Fraud can also occur as the result of an activity performed by you. The carrier may hire an investigator to videotape you performing activities, such as yard work or grocery shopping and lifting bags of groceries. If you perform any activities that are inconsistent with the restrictions given to you by your doctor, this can be considered fraud. If you exaggerate your symptoms to a doctor, this can also be a basis for fraud. For example, if you do not normally use an assistive device such as a cane or a brace, do not use it when going to the doctor.
If a Workers’ Compensation Judge finds that you have committed fraud you could be disqualified from receiving compensation benefits for a period of time or for the remainder of your life. It is even possible that criminal charges could be pursued.
You can avoid these unfortunate results by calling your attorney before you return to work or perform any activities which could be construed as work. You should also contact your attorney before providing any information to the carrier, including completing questionnaires that you may receive in the mail. You can also avoid an allegation of Workers’ Compensation fraud by doing your best to follow the advice of your doctors and not doing any activities that are against your doctor’s recommendations. Being honest and asking questions before you act can help you avoid a fraud finding.
When in doubt, call your attorney. It is better to be safe than sorry.