Is it Workers’ Comp Fraud if Your Workplace Injury Does Not Turn Out to Be Serious?
Last year, the Daily Republic in California reported a story of a man who simply bumped his knee and is now facing prison time for grand theft in addition fraudulent workers’ compensation claims. These events came to be known as “the bumped knee massacre.”
When an assembly worker with no criminal history bumped his knee on a support pole in the workshop on a fateful day in October, he had no idea he would be facing three felony charges as a result. So, he did what anyone in pain would do. He borrowed some crutches and hobbled into his local occupational health center to get his injury checked out.
During his medical visit, a physician’s assistant (rather than a doctor) assessed the worker’s injury and came to the conclusion it was merely a bruised knee. The physician’s assistant went on to inform the patient that in his very “professional” medical opinion, the worker was faking any pain associated with his injury. With that said, the worker shuffled home with his $102 medical bill.
This is where things take a turn. The worker decided not to return to his follow up medical visits (who can blame him?), nor did he return to his assembly job due to car issues. Another employee let the employer know that he was experiencing pain that day (likely as an explanation for his absence), so the employer contacted the workers’ compensation insurance company, just in case the worker filed a workers’ comp claim.
As it so happens, the worker never filed a claim, nor did he receive any compensation whatsoever upon leaving his assembly job. However, this meant nothing to the insurance company, so an investigation was launched anyway. Later that week, the insurance company arranged for a person with a video camera to camp outside of the worker’s apartment building. The recording showed the worker playfully running with a child in front of the building and then up his flight of stairs. This endearing scene was all the insurance company needed.
The very next day, the insurance company contacted the local District Attorney’s Office to report possible insurance fraud. A year later, the fraud charges were filed and the worker was finally notified of the allegations against him. He immediately called his old employer, outraged. After all, he hadn’t worked for the assembly line for a year. Moreover, he never filed a claim in the first place, nor had he actually received any benefits from the injury. The worker even stated he wanted the claim dropped completely.
The insurance company wasn’t having any of it. On top of fraud charges, the worker was charged with grand theft. This charge was not filed for any actual money the worker received for his injury, as that grand total was zero. Rather, the insurance company considered all the money put towards medical reviews, in-house reviews, investigative costs, billing for the hours put into the investigation by insurance company employees, all of which totaled more than $5,000. Essentially, the worker was being charged for grand theft for the money put into the investigation, for a claim he did not file, for a job he no longer worked at.
What’s the worst part about this misfortune? A judge found him guilty.
How Can I Protect Myself Against Fraud Charges?
If you are injured on-the-job, the last thing you want is a five-year prison sentence on top of the pain you may be experiencing. Employers and their insurance company may try to make allegations in order to avoid giving their injured workers benefits while they recover. To avoid any false allegations, you have to make sure all of your “i’s” are dotted and your “t’s” are crossed. Report your injury immediately to your employer, preferably in writing. Your employer may have a required proscribed list of designated doctors for you to go to when you have your injury assessed. Be sure you comply with this list. In some cases, it may be beneficial to consult your own physician for a second opinion, however, the visit may not be covered by your employer. Keep all of your medical records covering your doctor visits.
Once you’ve reported your injury and have received medical attention, contact a lawyer immediately. Filing for workers’ compensation can be a complicated process and you do not want to give your employer or their insurance company any reason to deny your claim, or worse.
Larrimer & Larrimer, LLC is a workers’ compensation law firm that assists injured workers in Ohio.