Employee Fraud in Workers’ Compensation


Thinking about committing fraud is hopefully and most likely the last thing on a claimant’s mind when navigating the frustratingly tricky waters of workers’ compensation in New York. However, even someone with a legitimate and meritorious claim for benefits can unknowingly commit fraud due to the complexity of a system that has only grown more and more burdensome over the past decade.

Workers’ compensation fraud under N.Y. Workers’ Compensation Law Section 114-a occurs when a person knowingly and intentionally makes a false, “material” statement regarding a claim. Whether a statement is “material” is a question for a Law Judge to decide, but it essentially means that the statement would be considered important in making a determination regarding a claim. Unfortunately, a claimant can do this in a number of ways.

Most obviously, lying about being hurt, either at work, or at all, is a simple case of fraud. It is also fraudulent to return to work without notifying the insurance carrier of your status; collecting benefits from workers’ compensation and collecting checks from your employer is fraud. While those may be obvious example, there are also more subtle missteps that claimants may make.

For example, failing to report a prior injury to your now injured body part in your initial claim for benefits can be considered fraudulent. Omissions of fact may be considered material to your claim. Remember: the insurance carrier may be investigating you and monitoring your activities to check on whether you are truly injured and/or working. It is important to have a truthful mindset and to act under the assumption that the insurance carrier and the Workers’ Compensation Board will find out if you attempt to lie.

More than ever, insurance carriers are raising fraud on claimants. While often times a charge of fraud can be deterred by an effective attorney, it is important to note that workers’ compensation fraud is a class E felony, meaning conviction could result in both fines and jail time. It is imperative that you consult with an attorney if the insurance carrier raises fraud against you. A proactive approach to avoiding fraud is answering all questions and forms honestly and openly, preferably with the help of an attorney. In order to most effectively avoid a finding of fraud against you, retaining an experienced and knowledgeable workers’ compensation attorney before fraud is ever raised is certainly your best course of action.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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