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How Does Employer Fraud Affect My Workers’ Compensation Claim?

Legal18

The huge insurance company industry promotes the myth that many workers’ compensation claims involve employee fraud. Some people may remember the case from a few years back, in which an injured postal worker on workers’ comp because of an alleged serious back injury spun the Big Wheel on the Price is Right. Statistically, however, employee fraud only affects about 1 percent of workers’ compensation claims in Florida.

Employer fraud is a much more serious problem. The legal and economic environment encourages employer fraud. Most states, including Florida, don’t aggressively pursue employer fraud cases. Even if the employer gets caught, the punishment is generally a fine which, in many cases, barely exceeds the amount of money the company saved by not paying insurance premiums.

So, to many employers, fraud is worth the risk. If a worker gets hurt and the insurance company uncovers the fraud, it will most likely deny coverage. However, a Tampa workers’ compensation attorney can still obtain compensation for these victims, as outlined below. Victims need this money to pay work accident-related bills, like medical bills. They deserve it as well. Compensation doesn’t change the accident or injury, but it helps victims move on with their lives.

Types of Fraud

Partnering with unscrupulous companies and making false statements on insurance forms are the two most common kinds of employer workers’ compensation fraud.

As mentioned, most regulators don’t look very closely into employer workers’ compensation coverage. A simple declaration page is usually enough to satisfy them. So, many employers buy “insurance” from undercapitalized or shady companies, so they get a piece of paper that satisfies regulators. If the insurance company isn’t financially sound, it’s like the employer has no insurance at all.

Misclassification and miscategorization are the most common false statements. Misclassification is classifying employees as independent contractors or other non-employees. Every year, millions of employees are intentionally misclassified in this way. Miscategorization is changing workers from high-risk to low-risk jobs. For example, a roofing company might categorize its roofers as secretaries.

On a related note, some employers lie about payroll size, to artificially reduce their premiums. Insurance companies usually deny coverage when they uncover these lies.

Negligence Claims

If the workers’ compensation insurance company denies coverage, or cannot pay benefits, a Tampa workers’ compensation attorney may file an injury claim in civil court. Compensation is available if the victim/plaintiff proves negligence, or a lack of care, by a preponderance of the evidence, or more likely than not.

Employers have a legal duty to provide safe work environments. They also have a duty to instruct workers about basic safety measures and stress the importance of these measures. For example, if Ralph falls because the safety rail was loose, his employer was negligent.

Evidence in a work accident claim often includes eyewitness statements, including the victim’s own testimony and medical records. A preponderance of evidence is one of the lowest standards of proof in Florida. So, a little evidence goes a long way.

Typically, Florida law keeps employers from using comparative fault, assumption of the risk, and some other “silver bullet” defenses in nonsubscriber claims. Without these defenses, it’s very difficult for employers to refute injury claims. Therefore, these claims often settle early and on victim-friendly terms.

 Count on a Diligent Hillsborough County Attorney

Injury victims are entitled to important financial benefits. For a free consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. Injured workers have the right to choose their own doctors in Florida.

Source:

pbs.org/wgbh/pages/frontline/shows/workplace/etc/fraud.html

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