Defending Against Allegations of Workers Compensation Fraud by Employees

Defending Against Allegations of Workers Compensation Fraud by Employees

Being accused of workers’ compensation fraud can be scary and overwhelming. But with the right legal defense, you can protect your rights and avoid harsh penalties. This article will explain what workers’ comp fraud is, potential penalties, and most importantly – your defense options if wrongly accused.

What is Workers Compensation Fraud?

Workers’ compensation fraud refers to intentionally deceiving an insurance company or employer in order to collect workers’ comp benefits. There are laws against this to prevent people from unlawfully taking money they don’t deserve. But sometimes mistakes happen or people are wrongly accused.

In California, the main workers’ comp fraud law is California Insurance Code 1871.4. It says it’s illegal to:

• Knowingly make a false or fraudulent statement to get workers’ comp benefits
• Knowingly submit a false or fraudulent report to get workers’ comp benefits
• Knowingly cause someone else to make a false statement or report

Common examples of alleged workers’ comp fraud by employees include:

• Claiming an injury occurred at work when it really happened elsewhere
• Exaggerating the severity of an injury
• Saying you can’t work when you actually can

But not every questionable claim is fraud – mistakes happen. And dishonest insurance adjusters sometimes wrongly accuse people who have legitimate claims. So don’t panic if accused – just call an attorney.

Penalties for Workers Compensation Fraud

If convicted of workers’ comp fraud, you could face:

• Up to 5 years in jail and/or a fine up to $150,000
• Restitution to pay back money
• Loss of future workers’ comp benefits
• Permanent criminal record

That’s why it’s critical to hire an attorney immediately if accused. An experienced lawyer understands these complex cases and the strategies that work best for defending innocent people.

Defending Against Fraud Allegations

There are several legal defenses your attorney may use to fight the charges, such as:

You Didn’t Act “Knowingly”

To be guilty under California Insurance Code 1871.4, you must have acted “knowingly.” This means you knew the statement or claim was false. If it was an honest mistake, you aren’t guilty of fraud.

Lack of Evidence

Prosecutors must prove their case “beyond a reasonable doubt.” If they lack solid evidence you intended to defraud, the charges should be dismissed.

Statement Wasn’t Material

The allegedly fraudulent statement must have been important or “material” to the workers’ comp claim. Minor inaccuracies aren’t enough to prove fraud.

You Relied on a Doctor’s Advice

If a doctor told you that you can’t work or need certain treatment, it’s not fraud to follow their advice – even if it turns out to be wrong.

Violation of Your Rights

If investigators violated your rights, such as by using deception or refusing your request for an attorney, evidence may be suppressed.

Finding the Right Fraud Defense Attorney

Don’t leave your defense to just any lawyer. Look for an attorney with specific experience defending workers’ comp fraud cases. Ask prospective lawyers:

• How many fraud cases have you defended?
• What are some cases you’ve won?
• Are you familiar with the fraud investigators and prosecutors I’m up against?

A knowledgeable lawyer will thoroughly examine your case, build the strongest defense, and fight to get your charges dismissed. With so much at stake, it’s critical to have the right legal champion on your side.