Workers’ compensation plays a vital role in the lives of all Americans. It offers a path to medical treatment and the recovery of lost wages for all work-related injuries and illnesses—without requiring proof that the injury or illness was caused by another’s negligence or wrongdoing. This no-fault system was created to help injured workers get the assistance they need, but it does not always live up to its purpose. Fraud and noncompliance turn workers’ compensation claims into nightmares for injured workers and their families.
What is workers’ compensation fraud? This is described in Georgia Code § 34-9-19 as intentionally making “any false or misleading statement or representation for the purpose of obtaining or denying any benefit or payment” related to workers’ compensation. Workers’ comp fraud is a misdemeanor, punishable by up to 12 months in jail and/or a fine of $1,000 to $10,000.
An employer or an employee may commit workers’ compensation fraud and face severe penalties as a result. A worker may face criminal charges and lose their right to workers’ comp benefits. An employer may face criminal charges and may be held liable for an injured workers’ treatment, expenses, and even punitive damages.
Types of Workers’ Compensation Fraud by Employers
When an employee is injured on the job and receives workers’ compensation benefits, their employer and the workers’ comp insurance company end up paying more than the injured worker’s salary alone. They may also face penalties from the Occupational Safety and Health Administration (OSHA) if safety violations led to the incident. The perceived financial losses associated with work-related injuries may entice some employers to find creative (and unethical, if not outright illegal) ways to avoid paying workers’ comp claims.
Employers may commit workers’ compensation fraud or other wrongdoings, such as:
- Employee misclassification. In Georgia, employers with three or more employees are required to carry workers’ compensation insurance. Some employers intentionally misclassify employees as independent contractors or others who are ineligible for workers’ comp benefits.
- Denial of medical coverage. Employers and their workers’ compensation insurance companies may try to downplay a worker’s injuries or minimize their coverage to keep medical costs low. Workers’ comp should cover all medical treatment for a work-related injury or illness, from medication and medical supplies to hospitalization and specialist appointments. When employers and insurance providers try to deny medical coverage, this may be a form of fraud.
- Employer retaliation. Although not technically a type of workers’ comp fraud, retaliation is illegal and is another way an injured worker may be wronged by their employer after a work accident. Georgia employers are not allowed to fire, demote, or otherwise penalize workers for reporting work injuries or pursuing workers’ compensation benefits. Employees who are retaliated against can sue their employers, recoup their losses, and get their jobs back.
If you think your employer is committing fraud or any wrongful act related to workers’ compensation, you can report this to the Georgia State Board of Workers’ Compensation. You can also talk to an Atlanta workers’ comp lawyer about your rights and options in pursuing the benefits you deserve, plus additional damages.
Workers’ Comp Fraud by Employees
Sometimes employees are accused of committing workers’ comp fraud. This can jeopardize their right to benefits and can even result in criminal charges. If you’ve been accused of fraud, you should act fast and talk to a lawyer. You deserve to be protected.
A worker may be accused of doing the following to try to get workers’ comp benefits:
- Exaggerating an illness or injury
- Falsely claiming that an injury is work-related
- Claiming a fake injury or illness
- Intentionally harming oneself
- Working while receiving benefits, without reporting wages earned
- Falsifying medical expenses
Talk to an Atlanta Workers’ Compensation Attorney
If you believe your employer or their insurance company is committing workers’ compensation fraud, or if you have been accused of filing a fraudulent claim, you deserve the chance to present your side of the story. To do this, you need a powerhouse fighting for your right to benefits. It begins with talking to an attorney about your case and what has occurred. As an Atlanta workers’ comp lawyer who has served clients throughout Northern Georgia for over 30 years, Douglas F. Kaleita is here to offer the help you need. His experience and commitment to righting the wrongs caused by workers’ compensation fraud help him secure outstanding results for clients from all walks of life.
Call (888) 665-7699 today to find out how our firm can help you.