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Workers’ Compensation Fraud


Workers’ compensation is a safety net provided to workers who experience workplace injuries that compromise or eliminate their ability to earn a living. When fraud occurs, it has far-reaching effects. If you have been impacted by workers’ compensation fraud, an attorney who specializes in the area may be helpful.

What is Workers’ Compensation Fraud? 

Any purposeful misrepresentation or concealment of information put forth in order to get workers’ compensation benefits, or to prevent a legitimate benefits claim, could be considered fraud. Employers, employees, and health care providers may each be culpable of fraud if they engage in deceitful activities.

Employee Fraud 

Employees who attempt to obtain unwarranted benefits may engage in particular fraudulent actions:

  • Exaggerating symptoms or malingering issues that are not legitimate;
  • Failing to report income gained while working when purportedly disabled;
  • Claiming a work-related injury that did not really occur;
  • Claiming an injury occurred at work when it occurred elsewhere;
  • Providing false mileage reports.

Employer Fraud 

Employers, too, may engage in fraudulent behavior in an attempt to reduce their risk. Examples include:

  • Underreporting company payroll;
  • Misclassifying employees in order to get a lower insurance premium;
  • Knowingly failing to provide necessary coverage;
  • Deducting premiums from employee wages.

Health Care Provider Fraud 

Health care providers may engage in fraudulent behaviors in order to increase their profits:

  • Providing unnecessary tests or treatments;
  • Billing for services that were not delivered;
  • Double billing the health insurer and the workers’ compensation insurer for the same procedures.

Consequences of Workers’ Compensation Fraud

Fraudulent activities reportedly cost industry and Florida citizens billions of dollars every year. It puts employers and insurance providers out of business and raises premiums and health care costs for everyone. It’s no wonder, then, that penalties have increased in the state.

The Bureau of Workers’ Compensation Fraud is comprised of 4 supervisors and 21 detectives, who investigate across the state. They work in tandem with the Florida Department of Business and Professional Regulation (DBPR) and local law enforcement agencies statewide. In the 2015-16 fiscal year, they prosecuted nearly 1,600 cases.

Depending on the amount of money involved, an individual accused of workers’ compensation fraud may be charged with a first-degree felony. Additionally, the statute of limitations has been increased to 5 years from the time the crime was discovered.

Businesses involved with fraud may lose their coverage and be unable to secure another provider. That means the state could close down the business all together. The insurer may also file civil charges, in addition to the criminal charges outlined above.

If You Suspect Workers’ Compensation Fraud 

If you are an employee, employer or health care provider who believes you are being taken advantage of due to fraudulent actions, our experienced workers’ compensation team at Barbas, Nunez, Sanders, Butler & Hovsepian can help. Contact our Tampa office today for a free, confidential consultation.


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