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Avoiding Workers’ Compensation Fraud


The law is clear: It is illegal to knowingly make a false or misleading statement in order to collect workers’ compensation benefits. That’s nothing new; in almost all areas of law, purposefully committing fraud or misrepresenting facts can prevent recovery, or worse, lead to criminal prosecution.

But what is fraud in the workers’ compensation context? How do people get themselves in trouble?

The Language of the Workers’ Compensation Statute

The language of the law is the guidepost that judges use to determine if fraud was committed as follows: (1) whether or not a false statement was made, and (2) whether the false statement was made knowingly for the purpose of securing workers’ compensation benefits.

People who may just have bad memories, who may misunderstand something asked of them, or who may just innocently be incorrect may escape the intentional aspect of workers’ compensation fraud.

False statements don’t have to be under oath or in an official court proceeding; they may be stated to doctors or insurance agents. False statements may be made orally or in writing.

Innocent vs. Purposeful Misrepresentations

When and how do lies or fraud in workers’ compensation occur? Certainly, there are outright liars. These are the people who say an accident happened when it did not, who fake accidents, or who lie about how an accident happened or who lie about the nature and extent of his/her injuries.

But most of the time, there is not a complex web of lies that are carefully orchestrated by a scheming claimant that ends up constituting fraud. Many times, fraud occurs when people misstate the nature, scope or extent of pre-existing injuries or concurrent pre-existing diseases that end up being questioned by insurance company lawyers.

False statements are unintentionally easy to make, because people may not remember their prior medical history, or they may not understand their own medical history. They may not understand questions asked of them. For example, someone who is asked “have you ever had an accident that lead to a back injury?” may not consider the time he/she suffered disc damage lifting weights 15 years ago to be an “accident.”

Intentional Misrepresentation

That’s why the second part—whether the misrepresentation was intentionally made to obtain benefits—is so important. Judges will commonly ask whether a reasonable person would have made the error that the claimant did (for example, whether a reasonable person would have forgotten to report an injury, or misunderstood a question, or mischaracterized the severity of a prior injury).

Judges are tasked with evaluating claimants’ credibility. Someone who remembers every conversation that occurred 15 years ago is more likely to be intentionally lying when he says he didn’t remember being in a car accident 5 years ago.

Having an attorney with you when you have a workers’ compensation claim can help you avoid accidentally getting into trouble. Contact us today at the Celeste Law Firm in West Palm Beach for a free consultation about getting the workers’ compensation that you deserve.




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