If you’re dealing with a workers’ compensation claim, the last thing you want to hear is the word “fraud.” But the reality is that even honest injured workers can end up facing fraud accusations because of small mistakes or inconsistencies in their case.
Yes. In workers’ compensation cases, fraud accusations aren’t limited to people who fake injuries. Even if your injury is real, you can still face fraud allegations if the insurance company believes you made an inaccurate statement or left out important information.
Many fraud claims start because of inconsistencies, like something you told your doctor not matching what you said to the insurance company, or failing to mention a prior injury. Even small details can raise red flags if the insurer thinks they affected your benefits.
Insurance companies may review your medical records, compare what different doctors say about your injury, and look at any prior claims or medical history.
They also sometimes use surveillance, check social media, and talk to coworkers, neighbors, or other potential witnesses. In the end, they’re usually looking for inconsistencies between what you say about your injury and what the evidence appears to show.
Most workers’ comp fraud accusations start with simple mistakes, not intentional wrongdoing. The most common mistakes are:
Even small inaccuracies can give the insurance company an opportunity to question your credibility.
Three points in a workers’ comp case tend to create the biggest risk for fraud accusations:
Because these moments become part of the official record, anything said or done during them can later be used to argue there are inconsistencies in your case.
The best way to protect yourself is to keep your case consistent from start to finish. Be upfront with your lawyer and doctors about prior injuries, work activity, or anything else that might come up later.
It’s also important to follow your doctor’s restrictions and avoid guessing when answering questions about your case. When in doubt, stick to the facts and keep your answers simple and accurate.
If you’re dealing with a workers’ compensation claim and want to talk through your situation, I’m always happy to have a conversation. Feel free to give me, Rex Zachofsky, a call anytime. Every case is different, and sometimes a quick discussion can help you understand what’s going on and what your options might be.
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