When you work hard and contribute to a company, you expect your employer to take care of you, especially if something goes wrong in life. Unfortunately, employers try to cut costs or avoid their responsibilities by committing fraud, leaving workers without the benefits they’re entitled to. If you’ve paid into workers’ compensation insurance only to have your benefits denied or delayed, here’s what you need to know to protect your rights.
Recognizing Employer Fraud
How can you tell if your employer is engaging in fraudulent behavior? Watch for these red flags:
Misclassifying employees: Employers might classify workers as independent contractors to avoid paying workers’ compensation premiums. This practice leaves employees without the benefits they are owed, as independent contractors are not covered by workers’ compensation insurance.
Underreporting payroll: Employers may report lower wages than actually earned to reduce the amount of workers’ compensation premiums they pay. This could also affect the compensation you’re entitled to should you file a claim.
Failure to report a work-related injury: If your employer downplays or misreports the details of a work-related injury, it could be a sign of workers’ compensation fraud. In some cases, employers may even discourage employees from filing claims in the first place.
Denying or delaying benefits: If you face unexplained delays or outright denials of your workers’ compensation benefits, particularly when all the paperwork is in order, it could be due to fraudulent actions by your employer.
Consequences of Employer Fraud
The impact of employer fraud is far-reaching. Employees may find themselves without benefits they need for medical treatment, lost wages, and recovery. Employers found guilty of fraud may face substantial fines, criminal charges, and an increase in workers’ compensation premiums. Additionally, the employer’s reputation can suffer irreparable damage, making it difficult to maintain trust within the community or attract new employees.
Reporting Employer Fraud
If you suspect employer fraud, take these steps to protect yourself:
Document everything: Keep a record of all communications, such as emails, letters, and witness statements, that support your case. This evidence will be crucial if you decide to report the fraud.
Report the fraud: Contact your insurance company and your state’s workers’ compensation agency. They can investigate the situation further and take appropriate action against your employer.
Cooperate with the investigation: Be honest and transparent with the investigating parties. Provide any additional information they request to help resolve the issue.
Pursue civil action: In some cases, it may be necessary to pursue civil action against your employer. A legal professional can help you navigate this process.
Protecting Yourself from Retaliation
Remember, reporting employer fraud is legally protected. Employers cannot retaliate against employees for reporting fraudulent activities. If your employer retaliates by demoting you, firing you, or taking disciplinary action, contact your state’s labor department to file a complaint.
Understanding Workers’ Compensation Fraud
What is Workers’ Compensation Fraud?
Workers’ compensation fraud occurs when an employer deliberately misrepresents or hides information to deny benefits to an injured worker. This can include various actions such as misclassifying employees as independent contractors, underreporting payroll, or failing to accurately report details of a work-related injury.
Such fraudulent activities don’t just affect individual employees—they also distort the fairness of the workers’ compensation system. Employers who engage in fraud risk severe penalties, including fines, increased premiums, or even criminal charges. On the other hand, injured workers are left without the support they need to recover.
Workers’ Compensation Insurance
Workers’ compensation insurance is a state-mandated program that provides benefits to employees injured on the job. It protects both employees and employers by offering financial support to workers unable to work due to a work-related injury or illness. Employers must purchase workers’ compensation insurance, with premiums based on the size and risk profile of their workforce. Fraudulent actions, such as falsifying employee classification or underreporting payroll, can lower workers’ compensation premiums but unfairly deny injured workers the benefits they rightfully deserve.
Filing a Valid Workers’ Compensation Claim
Overview of the Claims Process
If you’ve been injured on the job and are seeking workers’ compensation benefits, here’s what you need to do:
Notify your employer: As soon as possible, inform your employer about your work-related injury. This step is critical for initiating your claim.
Complete the claim form: You’ll need to fill out a workers’ compensation claim form, which your employer will typically provide. Make sure all information is accurate.
Provide medical documentation: Be prepared to submit medical records that detail your injury and treatment. This documentation will help substantiate your claim.
Cooperate with the investigation: Your insurance company may investigate the claim. Make sure to provide any requested information promptly.
Common Mistakes to Avoid
Avoid these common mistakes when filing your claim:
Failing to report the injury promptly: Don’t wait to report your injury. Delays can harm your case and potentially result in denial of benefits.
Not providing accurate details: Ensure that all the information you provide is accurate and complete. Misstatements can weaken your claim.
Not cooperating with the investigation: If your insurance company requests additional information or documentation, comply as soon as possible to keep your claim moving forward.
Delaying medical treatment: Failing to seek medical attention promptly can lead to complications in both your health and your claim.
Defending Your Rights
Understanding Your Rights
As an injured worker, you have the right to:
File a workers’ compensation claim: If you’ve been injured on the job, you are entitled to file a claim for benefits.
Receive benefits: You are entitled to workers’ compensation benefits, which may include medical expenses and lost wages.
Appeal a denied claim: If your claim is denied, you have the right to appeal the decision.
Seek legal action: If your employer denies you your rights, you can pursue legal action to protect your interests.
Seeking Professional Help
Filing a workers’ compensation claim and navigating the system can be overwhelming. A skilled attorney specializing in workers’ compensation at Bourassa Law Group can help you understand your rights and defend your case. An attorney can also help you pursue civil action if needed, ensuring that your employer is held accountable for fraudulent behavior.
Consequences of Employer Fraud Allegations
Penalties for Employer Fraud
Employers who engage in workers’ compensation fraud face serious consequences, including:
Fines and criminal charges: Employers found guilty of fraud can be fined and, in some cases, face criminal prosecution.
Increased premiums: Insurance companies may raise the employer’s premiums, making it more expensive to maintain workers’ compensation coverage.
Reputational damage: Employers caught committing fraud may suffer damage to their reputation, leading to loss of trust with employees, clients, and the community.
Civil Consequences
In addition to criminal penalties, employers who engage in fraud may face civil consequences, including:
Punitive damages: Injured workers may be entitled to additional compensation for the harm caused by the fraud.
Attorney’s fees: Employers may be required to pay for the injured worker’s legal fees if the case goes to court.
Implementation of corrective measures: Employers may be required to adopt new policies and procedures to prevent future fraudulent activities.
FAQ
Part I
1. What is premium fraud in workers’ compensation?
Premium fraud occurs when an employer intentionally misrepresents their payroll, employee classification, or other details to reduce their workers’ compensation premiums. This can lead to financial disadvantages for injured workers who may not receive the benefits they’re entitled to.
2. How do I know if my employer is involved in fraudulent claims?
If your employer is misclassifying workers, underreporting payroll, or withholding information about a work-related injury, these are clear red flags. If you are aware of these activities, they may be an example of fraudulent claims or premium fraud.
3. Can I report fraudulent activities related to workers’ compensation?
Yes. Reporting fraud is essential to protect workers’ rights. If you suspect that your employer is involved in fraudulent activities, you should document your concerns and report them to the insurance company or relevant state agency. It is against company policy and the law to retaliate against you for reporting fraud.
4. What are the consequences for employers involved in workers’ compensation fraud?
Employers involved in workers’ compensation fraud can face criminal charges, penalties, and civil action. They may also see increased workers’ compensation premiums, and the reputation of their business could suffer. In extreme cases, they could face fines and even imprisonment.
Part II
5. Can I be denied workers’ compensation benefits due to fraudulent claims?
Yes. Employers who engage in fraudulent claims may deny you the benefits you rightfully deserve. This includes coverage for lost wages, medical expenses, or rehabilitation due to a work-related injury. If you suspect fraud, take immediate action to protect your rights.
6. How does fraud affect the workplace?
Fraudulent activities undermine the integrity of the workplace, create an unfair environment, and harm injured employees unable to work. Employees might face delays in receiving workers’ compensation benefits, and the business could face legal consequences, leading to financial losses.
7. Can I benefit from reporting fraud?
Reporting fraud ensures that more money flows into the proper insurance system to help injured employees. It also holds the employer accountable and could potentially prevent future fraudulent activities. In some cases, whistleblowers may be eligible for rewards for their role in uncovering fraud.
8. What should I do if I’m unsure whether I’m aware of fraudulent activity at my job?
If you’re unsure, start by observing any irregularities in payroll, injury reporting, or workers’ compensation processes. Something seems off? Don’t hesitate to ask questions. Consult with an attorney or an insurance professional to guide you in identifying potential fraud.
Contacting a Law Firm
At Bourassa Law Group, we’re dedicated to protecting your future by providing compassionate support and expert legal guidance. If you believe your employer is committing fraud, contact us today.
We can guide you through the process, investigate the situation thoroughly, and represent you in legal action if necessary. Don’t let fraudulent practices undermine the system designed to protect you—take action now.
1-800-870-8910