Workers’ compensation laws are designed to protect employers from lawsuits and to provide employees with coverage should they be injured on the job. However, sometimes false claims or statements are made by employers, employees, or the workers’ compensation insurance agency. When false statements are made, it can amount to a workers’ comp fraud case. Whether you are a business owner, manager, or employee, it is important to know how workers’ compensation fraud can impact you and/or your business.
What is Insurance Fraud?
Insurance fraud is any case in which false claims are made in order to receive improper benefits. Insurance agencies and consumers alike can be victims of insurance fraud. An insurance agency is the victim if a consumer makes a false claim or exaggerates losses. A consumer is the victim if he or she purchases an illegitimate policy. Both cases are considered a felony.
Oklahoma’s insurance fraud laws prohibit making false claims or providing illegitimate evidence in order to receive payments for a perceived loss. They also prohibit drafting or subscribing to any legal documents with the intent of using it to support any false insurance claim.
Penalties may include imprisonment for up to three years or a fine that may not exceed twice the loss.
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A business needs to be careful about how it deals with its insurance policy. Insurance companies use job responsibilities to determine the risk of illness or injury. They use this information to determine insurance premiums. Sometimes businesses will lie about workplace safety in order to receive lower premiums.
Some businesses get into trouble by misclassifying employees. This might be the case if a business classifies its workers as independent contractors, but they are really employees. If a business is caught misclassifying employees or not counting all employees, the business may be subject to penalties for fraud and may need to pay back taxes and overtime wages.
Additionally, business owners may face lawsuits or penalties if they are caught without workers’ compensation insurance.
Employees may be the likely culprit one thinks of in a workers’ compensation fraud case. An employee may commit workers’ compensation fraud in one or more of a few ways. The worker may make up an illness or injury or may exaggerate an injury or illness that does not really prevent him or her from working. Additionally, an employee may claim that a non-work-related injury was the result of a workplace incident . In any case, the employee may be attempting to wrongfully receive the financial benefits or time off promised in a workers’ compensation claim.
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Health Care Providers
Sometimes, a health care provider may attempt to abuse the system in order to charge the insurance agency for more than what is necessary. The provider may make up injuries or illnesses or even insist on treatments that are not necessary.
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Reporting Workers’ Compensation Fraud
Workers’ compensation fraud is not always easy to identify. If you suspect that a claim may be fraudulent, you must report the claim to the state with as much information as you can. If the fraudulent claim comes from an employee, you may need to verify with witnesses or check security cameras. The state will then perform an investigation and determine whether or not the claim is fraudulent.
If you have any questions or suspect a fraudulent claim, contact Boettcher, Devinney, Ingle & Wicker to discuss your concerns today.
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