Workers' compensation is supposed to provide for workers who are injured on the job. This includes providing wage replacement and medical bills for their workplace injuries. Unfortunately, some insurance companies and employers looking to save money will report an innocent worker for workers' comp fraud, cutting off benefits and exposing them to potential criminal charges.

If you have been accused of workers' compensation fraud in Charlottesville, talk to an experienced criminal defense lawyer to understand your rights and defenses.

Workers' Comp Fraud Laws in Virginia

Most employers in Virginia are required to provide workers' compensation coverage for employees, generally through workers' comp insurance. When an employee is injured at work or because of work-related tasks, the employee may be able to receive medical treatment and wage replacement for the time he or she is unable to work. In exchange, the employee is generally limited from filing a personal injury claim against the employer.  

Under Virginia Code § 65.2-312, it is “unlawful for any person to knowingly make, file or use any writing or document knowing the same to contain any materially false, fictitious or fraudulent statement or entry,” in connection with a workers' compensation award.

This applies not only to the “injured worker,” but to any person in relation to a workers' comp case. Workers' comp fraud can also involve:

• Employers,
• Co-workers,
• Doctors,
• Chiropractors, or
• Other healthcare professionals.

Types of Workers' Comp Fraud

Workers' comp fraud from employees often involves making false claims about an injury in order to get workers' comp coverage. This can include claiming an injury that occurred off-the-job as a work-related injury, exaggerating the injury or disability, or an agreement between a doctor and patient to claim a serious injury so the worker gets compensation and the doctor can bill for treatment.

Alternatively, employers may attempt to commit workers' comp fraud through fraudulently trying to deny a workers' injury claim, falsify records to get reduced workers' comp insurance, or misclassifying employees to avoid workers' comp coverage.

Penalties for Workers' Comp Fraud in Virginia

Under Virginia workers' comp fraud laws, filing a false or fraudulent workers' comp claim is a Class 6 felony. The penalties for a class 6 felony conviction can include up to 5 years in prison. However, at the discretion of the jury or court, a class 6 felony conviction can include sentencing to confinement in jail for not more than 12 months and a fine of up to $2,500.

Any doctor or licensed health care worker who is convicted of workers' comp fraud may have his or her license suspended or revoked.

In addition to criminal penalties, the defendant may also be ordered to return any workers compensation payments and costs of medical care.  

Related penalties can include obtaining a signature by false pretense, larceny, or identity theft. These related charges can result in multiple charges and increased penalties, up to 20 years in jail.

Workers' Comp Fraud Investigations

Workers' compensation fraud investigations are handled by the Virginia State Police. However, employers and insurance companies may investigate suspected workers' comp fraud and then report the fraud to the police for criminal charges.

What Investigators Look for in Workers' Comp Fraud

Workers' comp insurance companies have a financial interest in saving money on workers' comp claims. The insurance companies can be vigilant in investigating suspected fraud so they will not have to pay out for medical coverage and payments. Some signs of potential fraud that investigators look for can include:

• There were no witnesses to the injury;
• The worker waited a long time to report the injury;
• The worker has a history of workplace injury claims;
• The injury occurred shortly after a reprimand, demotion, or notice of termination;
• The injury claim is suspicious or inconsistent; or
• The worker pushes for a fast settlement.

Unfortunately, insurance company investigations can report innocent activities as evidence of fraud. For example, when recovering from a back injury, a doctor may encourage the patient to get exercise. The insurance company may then take pictures of the injury victim swimming, jogging, or playing tennis and report this as evidence that the worker is exaggerating the injury.

An insurance company or employer may deny a workers' claim for compensation. The injury victim may want to challenge the denial but worry about the insurance company reporting the injured worker for criminal fraud charges. The threat of criminal fraud charges can prevent an injured worker from getting compensation after a valid injury.

Charlottesville Workers' Comp Fraud Defense Lawyer

A conviction for workers' compensation fraud can include jail time and fines. It can also put the individual on the hook for all the compensation received and require repayment of medical treatment costs. A criminal fraud conviction can also harm your future job opportunities. If you are accused of workers' compensation fraud in Charlottesville, talk to an experienced criminal defense attorney about how to fight criminal charges and avoid a criminal record. Contact me today for a free consultation.