Workers’ Compensation Fraud in Georgia

Workers’ Compensation Fraud in Georgia

Learn the signs of workers’ comp fraud in your workplace

An employee or employer may try to commit workers’ comp fraud to improve their financial situation. Protect yourself against fraudulent situations by learning to spot the signs.

Fraud is a crime that involves lying. In most fraudulent situations, people lie to get money or to avoid making payments. With that in mind, it’s no surprise that fraud occurs in many workers’ compensation claims. Both the employee and the employer may lie in order to receive a settlement that’s in their favor. This article identifies what you need to know about workers’ comp fraud in Georgia.

Georgia’s law on workers’ comp fraud

Georgia takes workers’ compensation fraud very seriously. The law punishes both workers and employers for committing fraud with heavy fines and possible jail time.

Georgia statute §34-9-19 reads:

Any person, firm, or corporation who willfully makes any false or misleading statement or representation for the purpose of obtaining or denying any benefit or payment under this chapter shall be guilty of a misdemeanor of a high and aggravated nature and, upon conviction thereof, shall be punished by a fine of not less than $1,000.00 or more than $10,000.00 or by imprisonment not to exceed one year, or by both such fine and imprisonment. Additionally, any person, firm, or corporation who violates this Code section may also be assessed the cost of investigation or prosecution, or both, in accordance with Chapter 11 of Title 17, relating to the assessment and payment of costs of criminal proceedings.

As you can tell by reading the above law, both the employee and the employer have a lot to lose by committing fraud.

Workers’ fraud committed by an employee

An employee may have many reasons to commit fraud other than simply having a criminal intent. Times may be tough and money may be tight. Nevertheless, fraud is still considered a crime and should never be attempted.

Employee fraud typically involves lying about an injury or the accident itself. Specific examples include:

  • Exaggerating or faking symptoms of an injury

  • Working while technically out on disability and not reporting wages earned

  • Reporting a workplace accident that never happened

  • Claiming a non-work related injury as a work-related injury

  • Lying about a pre-existing condition

  • Intentionally harming oneself in order to blame a workplace accident as the cause

  • Pretending to receive treatment and falsifying medical expenses

The possibilities for fraud are endless. As a result, employers have become more suspicious of accident claims. In fact, hiring a private investigator to track the employee is a becoming more common in workers’ comp cases.

Employers are also more aware of fact patterns connected to workers’ comp fraud. Here are some situations where, even if you’re innocent, your employer may be worried about a fraudulent claim.

  • The employee missed a lot of work prior to the injury

  • The accident occurred on a Monday morning or immediately after a vacation or holiday

  • The accident occurred in a place where the employee wasn’t assigned to be

  • The accident happened while the employee was completing a task not part of typical job responsibilities

  • There were no witnesses or the only witness is the employee’s friend

  • The employee refuses to sign authorizations, delays medical treatments or refuses alternative work options allowing for a lightened workload

  • The treatment doesn’t match what’s typically associated with the injury

The above scenarios could be connected to a non-fraudulent claim. In order for you to protect yourself from a false accusation of workers’ comp fraud, it’s important to let an experienced workers’ comp attorney handle your case. Your attorney will look for the possible holes in your case and provide your best defense against claims of fraud.

Your attorney will provide you the best legal advice, but you can also take steps to protect yourself with the use of two of our accident victim resources. Use the resources below to document your pain, symptoms and day to day activities with our post-accident journal, and keep track of your medical treatment and expenses with our damages and expenses worksheet.

Post-Accident Journal Form
Sample accident journal/diary to help you document the effect on your daily life
Download in PDF format

Damages/Expenses Worksheet
Damages worksheet to track expenses for your injury claim (medical treatment, property damage, lost wages, prescriptions)
Download in PDF format

Workers’ comp fraud by employers and insurers

Employees may commit workers’ comp fraud in the hope of earning more money and time off from work. In reality, workers’ comp fraud by employees is more rare than people may expect. Instead, it’s more common for an employer or insurance company to commit workers’ comp fraud.

Whenever an employee receives a workers’ comp settlement, an employer and the insurance company pay more to the injured employee than the employee’s salary. There also may be penalties from OSHA if an accident occurred and related expenses to correct whatever hazard caused the accident.

As a result of the possibly heavy expenses, an employer may commit fraud to minimize an injured worker’s accident and/or injuries. Examples of fraudulent acts by an employer or insurer include:

Employee misclassification

Georgia law requires that workers’ compensation insurance be purchased by all businesses with 3 or more employees. An employer who lacks the proper insurance coverage is considered non-compliant with Georgia’s State Board of Workers’ Compensation.

If an employer lacks the proper coverage, your boss may simply deny your claim or present your role in the company as that of an independent contractor or other employee who isn’t entitled to workers’ comp benefits. If this happens, a Georgia workers’ comp attorney can help identify your role within the company and demonstrate your need for coverage.

Enjuris tip: Georgia’s State Board of Workers’ Compensation has a form on their website for you to report fraud and noncompliance with the insurance requirement.

Refusal of medical coverage

Georgia allows injured workers to receive compensation for all necessary and reasonable medical care, prescriptions, diagnostic testing, specialist appointments, etc. Your employer or the insurance company, however, may try to deny you proper care in order to keep costs down.

If you believe your claim is being minimized unfairly or that you’re being denied proper medical treatment, don’t sign any settlement documentation. Instead, contact a Georgia workers’ compensation attorney in order to help you gather the appropriate evidence for a workers’ comp hearing or other legal proceeding.

Fraud by a medical provider

Georgia businesses typically provide a list of approved physicians for when a workplace accident occurs. Though doctors take oaths to tell the truth about their patients’ health, it’s always possible that a doctor may receive bribery to minimize a worker’s injuries. In order to prevent this act of fraud, it’s encouraged that you receive a secondary opinion from your family doctor regarding your diagnosis. Doctors can disagree about patient care, but drastically different medical diagnosis and treatment could be a sign of fraud.

Employer retaliation

Perhaps the most serious act of wrongdoing is when an employer tries to fire a employee for filing a workers’ comp claim in order to avoid a payout. In these situations, wrongdoing is cast on the employee before the claim is processed and the person is “let go.” Not only is this fraud, but this behavior is discrimination and illegal.

If you believe you were fired due to your workplace accident claim, then you need to speak with a top Georgia personal injury attorney who can file a civil suit that could award you substantial damages. The attorney will also help you report your employer’s bad behavior to the appropriate department of law enforcement.

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