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What to Do if You are Accused of Fraud

Webster & Carlton

What Do You Do if You are Accused of Fraud?

Employers and insurance companies can be skeptical of workers’ compensation claims - often, needlessly and frustratingly so. However, in some situations, the investigation into the validity of a claim can raise suspicions of workers’ compensation fraud. This can be a serious matter if not handled properly and may even lead to criminal charges. If you are accused of fraud regarding a workers’ compensation claim, your first call should be to an experienced attorney.

Possible Penalties for Fraud

Missouri law specifically criminalizes fraudulent use of the workers’ compensation system by both employers and employees. Some acts by employees that can be considered fraudulent include:

  • Knowingly filing a false claim for the payments of benefits
  • Filing multiple claims for the same injury
  • Making false statements in regard to the severity of injuries
  • Providing false supporting documentation
  • Filing a claim for health benefits to be used by another person

If you are convicted of workers’ compensation fraud, you can face Class E felony charges. If convicted, you may have to pay a fine of $10,000 or twice the amount of the fraud value, whichever is greater. A second offense is a Class D felony, and aiding someone in a fraud scheme is a Class A misdemeanor. As you can see, there are very real and serious penalties for workers’ compensation fraud, including a felony record. You want to defend against such accusations as aggressively as possible.

Why are Claimants Accused of Fraud?

Some fraud schemes may be seamless and never discovered. However, employers and insurance companies have certain red flags they use to identify possible fraud, such as:

  • The employee has a pattern of filing multiple workers’ compensation claims
  • The claim coincides with a change to their employment status
  • The employee failed to report the accident or injury to their employer right away
  • The employee can provide no witnesses to the accident or injury
  • The employee posted photos or information on social media that contradicts their injury claims

What if an employee works in a high-risk position that commonly results in multiple injuries? What if the change in employment status was merely a coincidence? It is important to remember that many employers and insurers may accuse workers of fraud to prevent having to pay benefits. Just because you are accused of fraud does not mean that you cannot fight to prove the validity of your claim and avoid criminal charges. The right attorney can review your claim to determine why your employer or the insurer believes it is fraudulent. They can then help you take the necessary steps to provide evidence of your workplace injury so you can receive the benefits you deserve under the law.

Contact a Missouri Workers’ Compensation Law Firm You Can Trust

While workers’ compensation fraud accusations are rare, they do happen, and you should always contact a Missouri workers’ compensation attorney as soon as this happens to you. Call the Springfield office of Webster & Carlton at (417) 545-3775, our Joplin office at (417) 545-3775, or contact us online to discuss your situation today.

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