Workers’ compensation fraud is a criminal offense—one that can put you away for years. If the state accuses you of this crime, contact My Rights Law‘sfinancial crimes lawyers for unparalleled legal representation at (888) 702-8882 or by filling out our secure web form for a free consultation.
Workers’ Compensation claims happen daily throughout the state. In 2020, there were 3.4 work-related deaths for every 100,00 full-time employees. Even more egregious, 2.8 injuries or illnesses arose from work-related conditions for every full-time employee. Therefore, it’s no wonder why countless employees and surviving relatives file workers’ compensation claim every year. Unfortunately, insurance agencies don’t always want to pay you what you’re owed. Insurance agents will even raise accusations of fraud against you in some cases.
There are several types of fraud in the workers compensation system. Workers’ compensation fraud is a particular insurance fraud type that relates to work-related injuries and sicknesses. Most employers carry workers’ compensation insurance. In California, all employers with at least one employee must buy this insurance. This insurance means that any employee who gets hurt on the job will get monetary benefits to compensate them for the dangerous or negligent work environment and their inability or limited ability to work and earn wages. The employer and insurance company often communicate with each other to ensure that these benefits are properly administered.
You commit workers’ compensation fraud when you knowingly make false statements or induce another to make false statements on your benefits so that you can make insurance claims that you aren’t legally entitled to receive. Illegally obtaining workers’ compensation benefits is a form of fraud. This is the law regardless of whether you’re employed at a firm, partnership, limited liability company, association, nonprofit, corporation, or a different business entity, according to Penal Code 549.
A judge may impose various jail sentences if a jury finds you guilty of fraud. Typically, you could spend up to one year in county jail.
However, you could face more time under subdivision (h) of Section 1170—particularly if this is not your first workers’ comp conviction. This statute allows judges to increase your sentence for rehabilitation, restorative justice, or deterrence. Should a judge choose to enhance your punishment, you can be sentenced to sixteen months, two years, or three years. The court may also order you to pay a maximum of $50,000 in fines or double the compensation amount you fraudulently obtained. The court tends to make you pay whichever amount is higher. Furthermore, a mandatory punishment of paying restitution on any medical evaluation you’ve undergone to defraud the state will be imposed.
Post-incarceration effects can include:
Suspension or loss of certain licenses and certifications
Difficulty in getting a new job after incarceration
Depression and embarrassment
You are innocent until the state proves your guilt. However, you must maintain your innocence by crafting well-thought-out defenses. For a uniquely tailored defense, contact us for legal counsel. Some defenses may apply to your case.
As with all crimes, the prosecutors must prove you are guilty beyond a reasonable doubt. The more doubt you raise, the less likely jurors will find you guilty. There are several ways in which to plant doubt in jurors’ minds. One way is to point out when there is insufficient evidence to convict you. Examples of insufficient evidence cases could be:
Lack of proof you submitted false documents
Lack of your signature on the false documents
Lack of proof the documents are knowingly false
Proof that your injuries did occur from work
Proof that your illness did or could stem from your work environment
No Fraudulent Intent
Typically, you have a defense if you can prove you lacked the required intent to defraud the system. For example, suppose you got hurt at work and immediately saw a doctor. That doctor switched your x-ray with another patient who’d been hurt in the same area but had a more severe injury. You didn’t know about the mix-up and submitted the switched medical report to your employer for benefits. In this case, you had no reason to question what the medical experts told you, and you acted honestly.
The state may charge you with other crimes that coincide with workers’ compensation insurance fraud. These crimes could be healthcare fraud and insurance fraud. Healthcare fraud occurs when you aid, abet, solicit or conspire with someone to knowingly submit or make fake injury claims or documents to get healthcare benefits, according to Penal Code 550(a). You commit insurance fraud under Penal Code 550(a)(5) when you knowingly submit any false claim you prepared, intending for you or someone else to use it to support a fraudulent claim. Penal Code 550(b)(5) also penalizes knowingly concealing information that could prevent a legitimately injured person from receiving insurance benefits.
A conviction for these other charges can lead to increased punishment, such as a longer sentence and heftier fines.
Workers’ Comp Fraud As A Federal Offense
Workers’ compensation is a federal offense when you are federally employed. 18 U.S. Code § 1920 governs this crime. It penalizes you for knowingly and willfully falsifying or hiding material facts contrary to your work-related injury or illness and making false statements to support claims of work-related injury or illness.
Examples of false statements include but are not limited to:
Verbal statements to your employer, medical provider, or other interested parties
Bills for your medical or therapeutic injuries that stem from dishonesty
Bills for aide or caretaker services that stem from dishonesty
What Are The Penalties For Workers’ Comp Fraud?
A conviction of federal workers’ compensation insurance fraud is perjury. A judge may order you to serve a maximum of five years in prison upon conviction. However, if the amount you defrauded the government out of isn’t more than $1,000, a judge can’t order you to serve more than one year. Of course, a more severe penalty could be that a conviction of this sort prevents you from ever being federally employed again. Although nothing on the books says you can’t work in a federal capacity post-conviction, the reality is that federal employers, who’ll conduct a thorough background check, may be reluctant to take a chance on you.
What Are The Defenses For Workers’ Comp Fraud?
Aside from the defenses that you might use for state-level fraud defenses, you can argue that the statements weren’t material or that the police violated your Fourth Amendment rights. Remember that the false statements must be material (that is, of consequence to the result). Suppose you embellish or exaggerate your injuries in a way that wouldn’t have made a difference in the outcome. (you said you’d been showing symptoms of asbestos poisoning for two weeks when it’d actually been for ten days). In this case, such an immaterial lie shouldn’t be considered criminal. Moreover, if the police violated your rights to obtain evidence, the judge must deny its admittance in court unless an exception states otherwise.
Contact A Knowledgeable Workers’ Comp Defense Team
The first step you should take once handcuffs are slapped on you is to lawyer up. Don’t answer any questions without a lawyer present. Even if you think your statements are harmless, the investigators may twist your words, trip you up, and make you out to be a liar when you’re an honest person. If you have questions, call us at (888) 702-8882 or reach us through our secure web form.
Call My Rights Law’s Workers’ Compensation Fraud Attorney Today
At My Rights Law Our skilled fraud defense lawyers know our way around criminal charges. Thus, we’re not easily intimidated by the judicial system or opposing attorneys. Due to our ample experience, we have great instincts about which defenses make the most sense for your case and which results are most likely to happen. Of course, you can also trust us to continually seek a route where you don’t get anything on your record and won’t have to spend any time behind bars where possible. Still, there is no guarantee because it matters whether the evidence we discover makes that a plausible option.
Sometimes, we understand that getting you into a mental or drug treatment program is better than having you plead guilty or going to trial. After all, there’s no conviction record if you’re in a treatment program, and employers and society alike are more prone to be sympathetic if you get help for your condition than if you serve time. Other times, we’ll pursue getting the prosecution to drop some of the charges or reduce your felony to a misdemeanor when applicable and possible. This pursuit results in a lighter sentence, making it more likely that you may get probation instead of imprisonment.
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