Fraud — or as we call it in legal terms, misrepresentation — hikes already-high costs of workers’ compensation insurance for Florida business owners. It also has made the process of filing a claim more complicated for workers with legitimate, authentic cases.
The state Bureau of Workers’ Compensation Fraud — made up of 21 detectives, with squads in Miami, West Palm Beach, Orlando and Tampa — reports prosecuting 335 cases of misrepresentation in FY 2017-2018.
What is fraud?
Fraud is a false, incomplete or misleading statement made in pursuit of workers’ compensation benefits. It can involve lying during a deposition about one’s past relevant medical history. Another example of fraud is giving testimony that is false, incomplete or misleading in regard to one’s current functional ability, or in regard to one’s past medical history, either to a court or workers’ compensation physician.
The main question in these cases: Was there intent to deceive?
It is a very different scenario, for example, if you forget to disclose a prior, non-permanent injury to the same part of your body that is now in question and you are now 70 years old, with that other accident having occurred in your 20s. It’s another matter altogether if you had a car accident two years ago resulting in neck surgery, and are now filing a workman’s compensation claim on your neck, but didn’t disclose that prior injury to a doctor or in deposition. It is clear to see that that misrepresentation may not bode well with a judge.
If a judge determines that a misrepresentation in pursuit of benefits has been made, all workers’ compensation benefits will be denied and the injured worker will likely be prosecuted by the state and if successfully prosecuted, found guilty of a third-degree felony.
Unfortunately, some injured workers make their injuries out to be worse than they actually are in an effort to receive a larger monetary settlement.
Having said that, insurance companies are hesitant to deny all benefits based on misrepresentation unless it is a clear case of fraud. The reason for this is that if benefits are denied based on misrepresentation and the claimant overcomes that defense, attorney’s fees and costs will be owed to the injured worker’s attorney, even if no benefits are awarded to the injured worker.
Not just an employee issue
Workers’ compensation fraud on the employers’ side, meanwhile, often involves misclassifying workers, paying employees “under the table” in cash, or underreporting payroll. All are efforts to achieve lower mandated workman’s compensation premium costs. This provides unfair competition for companies in the marketplace, with some paying their fair share and some cheating the system to achieve lower costs.
Workman’s compensation fraud, either on the side of the worker or the employer, is never OK. It hurts our economy and legal system overall.
If you suspect misrepresentation in a workers’ compensation case by a Florida employer or employee, call the state’s hotline at 800-378-0445, or file your complaint here.