Category Archives: Fraud

Explainer: Fraud as a Defense in New York Workers’ Compensation Claims.

How does New York define “Fraud”?

Any person who knowingly and intending to defraud the workers’ compensation system by presenting (or assisting in presenting) an application for benefits, which contains a misrepresentation of a material fact. The penalty: Class E Felony charges. In addition to a Class E Felony conviction, the claimant who is convicted loses the right to all past and future compensation benefits. Fraudsters have to return any money they got through their fraud. WCL § 114. This is contrary to the general rule of law that claimants do not have to pay back money fraudulently obtained.

Greg LoisA claimant who applies for workers’ compensation benefits is required to provide accurate records and truthful statements to the WCB, the insurance carrier, and the employer. However, the law does not require the claimant to give a truthful account of their condition to their medical care provider. The prohibition on false representations appears to only apply to false statements made to get a monetary benefit – it does not appear to apply to medical awards or benefits, since the prohibition on lying applies only to WCL § 15 (indemnity awards) and not expressly to § 13 (medical benefits) or § 16 (death benefits).

An employer has the right to report suspected workers’ compensation fraud to the Fraud Inspector General. However, fraud will actually be inspected by the office of the Workers’ Compensation Fraud Inspector General which is actually staffed by WCB employees. The Fraud Inspector does not prosecute cases – rather, it refers cases to local authorities for prosecution. Continue reading Explainer: Fraud as a Defense in New York Workers’ Compensation Claims.

New York State Workers’ Compensation Fraud: Stereotypes versus Reality.

The Stereotype

The common image of workers’ compensation fraud most likely looks like this: An employee claims to be totally disabled and therefore cannot work at all yet he or she actively makes improvements to their homes, enjoys recreational sporting activities, engages in yard work, or perhaps takes glorious vacations, all while accepting healthy indemnity benefits for months at a time.

The above scenario may be true in some circumstances, but in truth, New York workers’ compensation fraud may take many forms and result in a myriad of consequences.  New York Workers’ Compensation Law (WCL) section 114(a) governs fraud and describes significant penalties for those who are caught committing fraud such as a permanent ban on their eligibility to receive indemnity benefits and/or a permanency award. Continue reading New York State Workers’ Compensation Fraud: Stereotypes versus Reality.