Being accused of workers’ compensation fraud can leave you shaken and wondering what to do next. Unfortunately, errors like overlooking an important detail on a form or forgetting to report side work can be mistaken for intentional deception. At Nappa, Monterosso & Poznansky, LLP, our Staten Island workers’ compensation lawyers help you understand what separates an honest mistake from actual fraud. We can also guide you through resolving an overpayment in NY before it puts your benefits at risk.
Key Takeaways
- Workers’ compensation fraud penalties in NY range from disqualification of benefits to serious felony charges.
- Many fraud allegations start as innocent errors, like failing to report your work injury right away or forgetting to mention a preexisting condition.
- An overpayment finding is different from workers’ compensation fraud, but both can affect your benefits and should be addressed as soon as possible.
- Our Staten Island workers’ compensation law firm takes quick action to help you correct honest mistakes before they escalate into fraud allegations.
What Counts as Workers’ Compensation Fraud in NY?
Generally, workers’ compensation fraud in NY involves knowingly making a false statement or misrepresenting a material fact to obtain benefits you aren’t entitled to receive. However, if an insurer or the Workers’ Compensation Board (WCB) accuses you of fraud, they must prove intent, not just inconsistencies in your paperwork or other mistakes.
Errors That Can Look Like Fraud
Many circumstances the WCB investigates as potential fraud happen due to carelessness or confusion, especially for workers navigating the system while recovering from an injury.
Inconsistent Descriptions of the Incident
An injured worker may give slightly different accounts of what occurred, often due to shock or confusion after an injury. It can look suspicious when an adjuster compares separate statements given to supervisors, coworkers, and doctors. Writing down what happened as soon as you can helps you stay consistent.
Waiting to Report Your Injury
Unfortunately, some workers wait to report their injury to a supervisor because they think it’s minor or worry about how their employer will react. If you wait days or weeks to inform them of your injury, an insurance adjuster may be skeptical, especially if it’s on a Monday morning or right before a layoff or termination. Generally, in New York you are required to report a work injury to your employer in writing within 30 days. If you’re hurt at work, always notify a supervisor promptly and seek medical care as soon as possible.
Surveillance and Social Media Activity
Insurance companies routinely use surveillance and scour your social media accounts for evidence that can be used to refute your workers’ compensation claim. Always follow your doctor’s restrictions exactly so your actions can’t be misconstrued.
Seemingly innocent photos of a family event or a check-in at an amusement park can make it appear that your injury isn’t as serious as you claim. Deactivate your social media accounts or avoid posting anything, leaving comments, or checking in at public places. Our workers’ compensation lawyers advise clients not to use social media at all until their claim is resolved.
Working While Receiving Benefits
Doing side jobs or earning any unreported income while collecting benefits is taken very seriously by the Workers’ Compensation Board. Failing to update the WCB when you return to work even part-time or light duty can also create the appearance of a false statement, even if it’s unintentional.
Medical Inconsistencies or Documentation Errors
Switching doctors frequently or giving inconsistent accounts about your medical history and condition to different providers can seem suspect to insurance adjusters. The insurance company may require you to attend an Independent Medical Examination (IME) with a doctor of their choosing. If what you tell the IME doctor doesn’t match your treating physician’s records, it can undermine your credibility and look like fraud. Your workers’ compensation attorney can prepare you for your IME and advise you on the specific language to use with all healthcare providers.
In addition, clerical errors like a missing signature, outdated paperwork, or forms incorrectly filled out by your doctor may look similar to submitting false medical documentation. Our team works closely with your treating physicians to ensure everything stays up-to-date and accurate.
Workers’ Compensation Fraud Penalties in NY
New York State takes all types of insurance fraud very seriously. Workers’ compensation fraud penalties can be quite harsh and the consequences may follow you long after your case is closed.
Loss of Benefits
Committing workers’ compensation fraud typically results in the immediate termination of your benefits, even if you have an ongoing injury. Under New York workers’ compensation law, this means that medical treatment and wage replacement benefits related to your workplace injury may no longer be covered. In some cases, you may never be allowed to collect any cash benefits again, even for a new work injury.
Criminal Penalties
Depending on the circumstances, workers’ compensation fraud can be charged as a misdemeanor or a felony in New York. Fraudulent workers’ compensation claims are often prosecuted as a Class E felony. If you’re convicted of a similar offense again within ten years, the charge may be elevated to a Class D felony.
A Class E felony can result in up to four years in prison, while a Class D felony carries up to seven. You may face fines of to $5,000 and may have to pay restitution for the benefits you already received. Depending on the total monetary value of the defrauded benefits, you may be charged under broader, New York insurance laws, which carry even longer prison sentences. Having a felony record can also significantly hinder your ability to find a job in the future.
Whether you’re facing a fraud investigation or criminal charges, an experienced Staten Island workers’ compensation attorney can push back against allegations that don’t reflect what actually happened and fight to protect your future.
Workers’ Compensation Overpayment in NY
Although overpayment isn’t the same as fraud, it is daunting to get a letter saying you have to repay thousands of dollars in benefits. Overpayment may happen due to a change in your condition, a retroactive award adjustment, or an insurance company error.
If you receive an overpayment notice, do not ignore it. In many cases, the WCB allows you to repay the insurer by reducing future benefit payments instead of a lump sum repayment. Our workers’ compensation lawyers can review your overpayment notice to determine whether the amount is accurate and negotiate a repayment plan that doesn’t jeopardize your ongoing benefits.
How to Protect Yourself From Fraud Allegations
Being accurate and proactive is the best defense against workers’ compensation fraud allegations.
Stay consistent — Give the same account of your injury and limitations to your employer, all healthcare providers, and the WCB every time.
Keep your information current — Report any change in your employment status, address, or medical condition to the WCB as soon as possible.
Double-check your paperwork — Missing signatures, outdated forms, and other errors can look like a false statement, so review everything carefully before it’s submitted.
Assume you’re being watched — Even innocent photos or updates be used against you, so avoid posting on social media. Be mindful of how you behave when you’re out and about, as insurance investigators may use surveillance to see whether your daily activities line up with your limitations.
Seek legal guidance— Although it’s important to respond promptly if you receive a letter about a fraud investigation or overpayment in NY, it’s vital to speak to a lawyer before taking any action. A workers’ compensation attorney can review your case and advise you on the best way to move forward.
Why Choose Our Staten Island Workers’ Compensation Lawyers?
We fight for you— Facing a fraud allegation is frightening, especially when you’ve made an honest mistake. We stand beside you and help you counter accusations with solid evidence and sound legal arguments.
Decades of local experience— As the largest workers’ compensation law firm in Staten Island, we care about our communities and the people we serve. Our firm focuses solely on workers’ compensation and Social Security Disability claims. We’ve spent more than thirty years cultivating professional relationships with the WCB, judges, court staff, and insurance adjusters including cases involving fraud and overpayment disputes.
Legal counsel for Spanish-speaking clients — Attorney and Partner Rolando Cubela handles cases involving Spanish-speaking clients directly so they clearly understand their rights and options.
Contingency fee structure— We take workers’ compensation and Social Security Disability cases on contingency. This means you won’t incur any upfront costs and we only get paid if we win your case.
Find a Staten Island Workers’ Compensation Fraud Attorney Today
If you’ve received a notice about a fraud investigation or overpayment in NY, Nappa, Monterosso & Poznansky, LLP, is here for you. To schedule a free consultation with a workers’ comp fraud lawyer near you in Staten Island, contact us or call 718-273-9000. We serve clients throughout the greater New York City area.
