Fraud in Workers’ Compensation and How to Avoid Such

“I’m not a fraud like all those other injured workers!”. That’s what many clients say to me. Well, the truth is that, while it does exist, employee fraud is not that great. Most employees are honest, hard working people who did not ask to be injured.

Studies have shown that most of the fraud in the work comp system is employer fraud. Insurance companies have used effective propaganda to brainwash everyone and they will do anything to avoid paying benefits. Every injured worker should understand that “fraud” in the worker’s comp system is not the kind of fraud most people are familiar with. That’s because the work comp law is written very broadly to include simple “misrepresentations”.

The most common traps that employees unwittingly fall into are:

  1. Submitting inaccurate mileage for reimbursement;
  2. Exaggerating their pain symptom;
  3. Exaggerating their physical restrictions or disability;
  4. Failing to report cash jobs or unemployment benefits while receiving disability benefits;
  5. Denying or forgetting about prior injuries.

Therefore, make sure you protect yourself and follow these simple rules:

  • Use Google Maps or a similar internet service to determine your mileage to and from medical appointments and attach a copy to the mileage form.
  • Don’t try to impress the doctor with how much pain you are experiencing. Be honest, but avoid saying that the pain is “10 out of 10″, “I can’t do anything”, or “I can never use my arm.”
  • Make sure that you inform the doctor about all prior injuries, both on the initial intake form, as well as during the interview. If you deny a previous injury, or simply forget, the insurance company will find out and may claim that you intentionally denied it and cut off your benefits for “fraud”. They will also meet with the doctor and convince him that you lied. So be prepared.


If you need help with a workers’ compensation case or have questions please contact The Law Professionals for more information.

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