There's a lot of media hype about not-so-injured employees who try to cheat the workers' comp system and collect benefits to which they aren't entitled. One widely repeated statistic even claimed that about 25% of all employee claims were fraudulent! (In reality, it's closer to 1%.) The real fraud, however, is more likely to come from employers, who stand to gain a great deal by skirting the rules. Learn more about how to recognize when your employer is lying to workers' comp (and what to do about it).
Premium Fraud
One common way that employers try to defraud the workers' comp system is through premium fraud. Workers' comp premiums are expensive, and the costs get higher as the jobs get more dangerous. In order to avoid paying the high premiums, employers have been known to do several things:
- They will classify non-clerical employees as clerical. It's far cheaper to insure six office workers than it is to insure that same half dozen as part of a construction crew.
- They may try to hide the value of their operations. For example, instead of accurately reporting their gross income (which affects the cost of their workers' comp premiums), they claim $1 for every $2 that they take in and pay some employees off the books.
- They will hire workers as "independent contractors" instead of actual employees. Employers aren't required to carry workers' comp for independent contractors, but they cannot simply designate an employee's status any way they want. There are specific rules that define an independent contractor.
All of these methods cheat the insurance companies out of the premiums that are necessary to pay the claims of injured workers down the line and put a strain on the entire system.
Employee Coercion
One tactic employers sometimes take is to ask employees to lie about their job duties and title and lie about the way the accident happened. If you're part of a landscaping team, for example, and your employer asks you to list your occupation as "clerical" and claim that your back injury occurred due to a slip and fall in the office, that's a sure sign that some sort of fraud is happening.
Another tactic that some employers take is to coerce employees to lie and tell their doctors that they were injured at home or off-duty. That way, employees can put their medical bills through their regular insurance, instead of having workers' comp cover them. Employers might even offer to pay any copayments, in order to convince an employee that they have nothing to lose.
In reality, workers' comp not only provides full coverage for your injuries, it entitles you to a partial replacement income if you have to miss work and also provides you with things like vocational rehabilitation. An employee who goes along with his employer's scheme risks losing out on future benefits if he or she fails to heal and risks being involved in legal action if the employer is caught trying to defraud the insurance company.
If you think that your employer is committing workers' comp fraud, you can contact your state's insurance oversight commission. If you're injured and your employer is pushing you to lie about where or how the accident occurred, your job title and duties, or tells you that you can't file for compensation because you're an independent contractor, talk to an attorney right away in order to protect yourself.
For more information, contact Law Offices Jonathan Teperson or a similar firm.
