Workers’ compensation fraud is grounds for employers and insurance companies to deny employees’ claims for benefits. It is also a fourth-degree crime under New Jersey law. Unfortunately, while some employees will attempt to fraudulently obtain benefits, false and unsubstantiated allegations of fraud are often used as tactics to avoid paying injured workers. In some cases, well-intentioned employees will make mistakes that can be interpreted as intentional fraud.

What Is Workers’ Compensation Fraud?

Section 34:15-57.4 of the New Jersey Revised Statutes defines workers’ compensation fraud as follows:

“A person shall be guilty of [workers’ compensation fraud] if the person purposely or knowingly . . . [m]akes, when making a claim for benefits . . . a false or misleading statement, representation or submission concerning any fact that is material to that claim for the purpose of wrongfully obtaining the benefits.”

There are a couple of key terms in Section 35:15-57.4 that are particularly important to understand. First, in order to commit workers’ compensation fraud, an employee must act “purposely or knowingly.” In other words, if you do not know what you are doing, you might not be setting yourself up for success, but you are not necessarily engaging in fraud.

Second, in order to be considered fraudulent, any false or misleading statement must be “material” to your claim for benefits. This means that it must be relevant to your eligibility or the amount of benefits to which you are entitled. If a misstatement is “immaterial” (e.g., if you said that you tripped and fell at 2:00 when you really fell at 2:30), then it does not justify denying your claim on the basis of workers’ compensation fraud.

What Are Some Examples of Workers’ Compensation Fraud?

When might a misrepresentation made in connection with a claim for workers’ compensation benefits be considered material? The New Jersey Department of Labor and Workforce Development gives these examples:

  • “[M]isrepresenting . . . job status while collecting temporary disability benefits.” If you misrepresent that you are not working while you are on temporary disability, this may constitute workers’ compensation fraud.
  • “[F]iling a claim for an injury that did not occur on or has no relation to the job.” In order to be eligible for workers’ compensation, an injury must occur within the scope of employment. If you mischaracterize an injury that occurred outside of work as occurring in the course and scope of your employment, that may be considered workers’ compensation fraud.
  • “[K]nowingly misrepresenting . . . physical condition to obtain [workers’ compensation] benefits.” Faking an injury or pretending that an injury is worse than it really is could lead to allegations of workers’ compensation fraud as well.
  • “[M]isrepresenting previous trauma or treatment.” Similar to seeking benefits for a non-job-related injury, seeking benefits for a chronic condition that is unrelated to your work could constitute workers’ compensation fraud.

How Can I Overcome False Allegations of Workers’ Compensation Fraud?

If your employer or its workers’ compensation insurance company has denied your claim on the basis of fraud, there are a number of potential ways to overcome these allegations and begin collecting benefits. While each individual situation will require its own legal analysis, some potential strategies for overcoming workers’ compensation fraud allegations include:

  • Obtaining the necessary medical records to prove that your injury occurred on the job.
  • Relying on your accident report, surveillance video footage, coworker statements, and other evidence to prove that you got hurt at work.
  • Proving that you are suffering from a WEAR and TEAR injury that qualifies for workers’ compensation coverage.
  • Seeking a second opinion from a qualified doctor who will provide an independent assessment of the cause and extent of your injury.

In some cases, employers and their insurance companies will have legitimate questions about whether a worker is entitled to benefits. In other cases, companies may falsely accuse injured workers of fraud in an attempt to avoid liability. Determining whether a denial is being made in good faith will be an important first step toward deciding on the best path forward.

What If I Accidentally Submitted Inaccurate Information with My Claim?

If you accidentally submitted inaccurate information with your workers’ compensation claim, you are not guilty of fraud, but you will need to correct your mistakes in order to collect benefits. To ensure that you receive the benefits to which you are legally entitled, you should promptly discuss your situation with an attorney.

Speak with a Workers’ Compensation Attorney in Confidence

At Petro Cohen, P.C., we understand that filing for a workers’ compensation claim can be intimidating, especially if it is your first time being injured at work, or if for any reason your claim is being questioned as to the legitimacy.  By law, you are entitled to workers’ compensation as soon as you being a job, so it is absolutely your right to file a claim should you be injured at work.

To make sure you receive the benefits and compensation to which you are rightfully entitled, speak with an experienced workers’ compensation attorney. Our workers’ comp attorneys have a combined 100 years of experience handling all type of work injury claims, and you can rest assured that they will work hard on your behalf.

Petro Cohen, P.C. has been consistently recognized as one of New Jersey’s leading firms in the area of workers’ comp. The firm received the highest rating by Martindale-Hubbell – the world’s foremost authority on law firm credentials – in Professional Excellence and Ethical Standards and Legal Ability.

In addition to the firm’s stellar reputation, the department head, Frank Petro, is respected locally, regionally, and nationally as a leading attorney in this specialized field. He has been recognized as an outstanding attorney by Best Lawyers® every year since 1995 and by Super Lawyers® every year since 2005. Moreover, he has achieved a rating of “Superb” on the leading lawyer-review website, Avvo®, the highest achievable rating.

Together with Suzanne Holz Meola, Terri Hiles, and Daniel Rosenthal, our New Jersey workers’ comp attorneys having successfully handled thousands of litigated workers’ comp cases throughout New Jersey. This experience and winning track record means that you are going to have a skilled New Jersey work injury lawyer who will work for you.

For more information about dealing with allegations of workers’ compensation fraud, contact us to schedule a free, no-obligation consultation. To speak with one of our experienced lawyers in confidence, call 888-675-7607 or inquire online now.