Could My Employer Accuse Me of Workers’ Comp Fraud to Avoid Paying Benefits?

young woman upset reading a noticeAs an injured employee filing a workers’ comp claim for benefits, filing a fraudulent claim is something you clearly want to avoid. However, what can you do if your employer accuses you of fraud when you are innocent of the charges?

Greg Coleman Law looks at valid examples of workers’ comp fraud, why workers are sometimes wrongfully accused of fraud, and what you can do if you find yourself in this situation.

Our experienced workers’ compensation attorneys in Knoxville are ready to help when an injured employee has been wrongfully accused of workers’ compensation fraud. If you find yourself in this situation, it is important that you do not delay seeking legal help. We provide free initial consultations to discuss your situation.

FREE Case Review. (865) 247-0080

Valid Examples of Workers’ Compensation Fraud

Employers may sometimes falsely accuse injured employees of workers’ compensation fraud to try to delay or deny paying benefits. However, there are also some valid examples of when an employee is guilty of workers’ comp fraud, such as:

The Injury is Not Work-Related

For an employee to be eligible to receive workers’ compensation benefits, the injury must be work-related. Attempting to claim workers’ comp benefits for injuries that clearly occurred outside of work is fraudulent. Sometimes an employee who gets injured on the weekend, may try to pass it off as a work injury – which often happens on a Monday. When an employer or insurance carrier investigates the claim to get more details the truth often outs. 

The Injury Claims Are False

Claiming there was an injury when none occurred can also lead to charges of fraud.

Exaggerating the Extent of an Injury

An employee who did get injured, but who exaggerates the extent or severity of his or her injury to try to get more benefits is committing fraud and may face heavy penalties and other legal charges.

Falsifying Records of a Valid Claim

It is fraudulent for an injured employee with a valid claim to falsify records to claim more benefits than what is deemed reasonable or necessary. One example of this type of fraud is an injured worker who creates false transportation records to claim more gas expense benefits.

Working a Second Job While Injured

Some workers may be tempted to get a second light-duty job to help supplement workers’ compensation benefits while recovering from an injury. However, even “innocently” doing light-duty work without the knowledge and approval through the workers’ comp system is a bad idea. Worse still, it can get you accused of fraud for attempting to hide that additional income while continuing to receive full workers’ comp benefits.

How Wrongful Accusations of Workers’ Comp Fraud May Happen

It is important to note that not all accusations of fraud are valid. Can an employer wrongfully accuse you of workers’ comp fraud? In short – yes, it can and does happen. However, there are some actions that injured employees may do that could land them in that position unintentionally:

  • You did not file an accident report or seek immediate medical attention: Injuries you sustain while performing your job duties may be considered work-related and qualify you for workers’ comp benefits. This includes any off-site work for an employer, such as delivery work or driving between different sites. However, if you do not file an accident report or seek medical attention right away, you have no evidence to link your injuries to the incident that caused you harm.
  • It may appear you are exaggerating your injury: One common example may be if you suffered a soft tissue injury, such as to your neck, back or shoulder. Soft tissue injuries are hard to diagnose from an MRI or X-ray. Even though your injuries may be exactly as you say, it can be easy for an employer to argue that you are exaggerating how badly you were hurt. Following up with your doctor’s appointments, including any physical therapy, and documenting your pain – including how it is interrupting your ability to do daily tasks – can help provide support for your claim.
  • Posting on social media: Even innocent activities, such as having a friend over to visit while you are recovering, can look a whole lot different when posted on social media. Insurance companies focus on making a profit and will therefore look hard for a way to discredit your claims of injury – even when valid. For this reason, it is a good idea to avoid posting anything on social media while you are recovering from your injuries.

How to Protect Yourself and Your Claim

There are multiple steps you can take after being injured at work to protect your claim and to avoid being wrongfully accused of workers’ compensation fraud, such as:

  • Following your employer’s rules and procedures for seeking workers’ compensation
  • Filing your accident report right away and before leaving the premises
  • Getting contact details of co-workers or eyewitnesses
  • Taking pictures of the accident scene and any visible injuries
  • Seeking medical care immediately and describe what happened to your treating physician
  • Following your physician’s plan of care – including showing up for appointments
  • Documenting your injuries and their progress carefully
  • Seeking legal help without delay

Our Attorneys Are Ready to Protect Your Rights

If you suffer a work-related injury and your employer has wrongfully accused you of filing a fraudulent claim, we strongly recommend that you contact one of our knowledgeable and qualified attorneys as soon as possible.

We have been advocating for injured workers in Tennessee for decades, recovering millions in compensation for our clients. Our proven track record speaks volumes of how hard we are prepared to work to help you obtain the benefits you need.

Call today to schedule your free consultation with one of our qualified attorneys. There is no risk or obligation to you. If we represent you, there are no upfront costs to pay while we work on your case.

Millions Recovered. Ph: (865) 247-0080