NYC Disability Insurance Fraud Lawyers

New York is one of many states that provides benefits to individuals who may suddenly be unable to work due to a disability. As such employers are required to carry disability insurance to cover such an event, so the needs of the employee will be met. The law applies to employees in every business, regardless of the type of work they do and the benefits provided by each employer must be comparable to those outlined in the New York State Disability Benefits Law.

As with any type of insurance, there are specific providers who can ensure employers are covered. In New York, the state identifies those insurance companies authorized to offer disability insurance and employers in the state must obtain coverage from one of those providers. This makes it easier for the employer to know where to obtain coverage, while also helping to provide a uniform system across the state. In some circumstances, an employer may request the ability to insure itself, but authorization must be granted by the New York State Workers’ Compensation Board (NYSWCB).

Disability Insurance Fraud is a Crime
Unfortunately, this system of disability compensation has created an opportunity for dishonest individuals to cheat their employers. They may provide untrue or misleading facts about their state of health in an effort to receive disability benefits that they don’t really deserve or for which they wouldn’t really qualify.

There are two main types of disability fraud. An individual may either file a completely false claim to receive benefits, where a disability doesn’t exist, or he may falsify information on a claim to get more benefits than he really deserves. Where facts about a disability are falsified, it’s done with the intent of getting more benefits or for extending benefits for a longer time period. Similarly, those already receiving disability may not truthfully report income they received, fearing that it will cause their disability payments to be decreased. For similar reasons, individuals may also not report improvements to their condition. When one’s condition improves, benefits may be reduced or discontinued altogether and some individuals may try to delay this eventuality for longer.

Investigating Disability Fraud
Both law enforcement and insurance companies have special professionals who are tasked with differentiating between legitimate claims and instances of fraud. Even though these individuals are highly trained and many have years of experience, identifying fraudulent claims is never easy. Someone with a disability isn’t easily recognized, because not all use devices that identify themselves as disabled. They may have physical disabilities that are not outwardly recognizable or they may suffer from mental or psychological disabilities.

However, investigators are very thorough and will gather evidence of fraud, before proceeding with charges. The charges ultimately filed against an individual will vary, depending on the exact circumstances of their case. Charges will vary, based on the type of scheme attempted, the active role taken in committing fraud, and the total amount of money involved.

Fifth Degree Disability Fraud – This crime is a class A misdemeanor and it involves fraud of a value under $1,000. If found guilty, you may be required to pay up to $1,000 in fines and may be sentenced to up to one year in jail.

Fourth Degree Disability Fraud – In this classification, the individual must have committed fraud with a value of between $1,000 and $3,000. As a class E non-violent felony, the penalty is a prison term of one and a third years up to four years. Probation will not be considered as an alternative.

Third Degree Disability Fraud – The third classification of disability fraud involves sums ranging from $3,000 up to $50,000 and is a class D felony under New York law. It carries a penalty of up to seven years of imprisonment.

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Legal Scenario: What Would You Do?

Scenario

After recovering from a back injury, you returned to work part-time but continued collecting full disability benefits because your employer never updated your status with the insurance carrier. An investigator recently contacted you, and now you're worried that what started as an administrative oversight could be treated as intentional disability insurance fraud.

Can I really be charged with fraud if I didn't actively lie on any forms but just kept accepting the payments?

Attorney's Answer

Under New York Penal Law § 176.30 (Insurance Fraud in the Fifth Degree), knowingly receiving insurance benefits you are not entitled to can be charged as a class A misdemeanor, and more serious charges under §§ 176.35 through 176.40 apply when the amount exceeds certain thresholds. Prosecutors do not need to prove you filled out a false claim — continuing to accept payments you know you are no longer entitled to can establish the requisite intent. The fact that your employer failed to update your status may support a defense, but it does not automatically absolve you if evidence shows you were aware the payments should have stopped. An experienced disability fraud defense attorney can examine the communications between you, your employer, and the carrier to build a strong defense before charges escalate.

This is general information only. Contact us for advice specific to your situation.

Second Degree Disability Fraud – Here, the level of fraud carries a value of between $50,000 up to $1 million. As a class C felony, you may serve up to 15 years in prison, if found guilty.

First Degree Disability Fraud – Any fraudulent act with a value greater than $1 million falls under this category and is a class B non-violent felony. As such, a conviction carries a maximum prison term of up to 25 years.
As the above penalty schedule indicates, New York takes disability insurance fraud very seriously and will actively investigate any suspected incidences. For this reason, it may be in your best interests to consult an attorney as soon as possible, if you suspect you’re under investigation. Even where you may not have knowingly committed any wrongdoing, an attorney experienced in this area of law can help ensure your rights are protected. Additionally, your legal advocate can help make certain you continue to receive benefits for which you’re legally entitled. As is true of most legal matters, disability insurance fraud charges aren’t something you should attempt to handle on your own.