A simple definition of workers’ compensation fraud is any activity that prohibits the fair payment of valid claims for workplace injuries or illnesses. However, it is important to understand that fraud can be used to collect undeserved benefits as well.
Anyone connected with a workers’ compensation claim can potentially participate in fraudulent activities. The state of New Jersey Department of Labor and Workforce Development cites the following examples of WC fraud:
Workers who misrepresent their job status while collecting temporary disability, file claims for injuries not related to their jobs, misrepresent their condition to obtain benefits or misrepresent previous trauma or treatment
Employers who misrepresent employee payroll amounts or classifications or fail to purchase required workers’ compensation insurance coverage
Healthcare providers or attorneys who assist individuals in fraudulent schemes
These are all examples of practices that can result in criminal penalties to anyone found guilty. Notice, however, that one practice is not mentioned on this list — unfair denial of claims by employers or insurers. Although unfair claims processing is not necessarily considered fraud, the law does provide a legal means for pursuing the benefits workers deserve.
If your employer or its insurance company unfairly deny a valid claim, you need to take additional action to pursue the compensation you need for your injuries. In some cases, an experienced NJ workers’ compensation lawyer can informally negotiate on your behalf to get your claim back on track. If necessary, your attorney can represent you in a formal appeals process to put the matter in front of a workers’ compensation judge.