Workers’ Compensation Fraud Lawyers in Springfield, MO
Insurance fraud is a serious problem in the workers' compensation system. Employers and employees alike can commit fraud.
Workers who are victims of fraud may be unable to recover the benefits to which they are legally entitled. Employers and insurers who suffer fraud may become skeptical of claims, often needlessly and frustratingly so. They may then create unnecessary obstacles and challenges to your right to secure benefits. As a result, distrust becomes part of the system.
If you are an injured worker who believes your employer has committed some type of workers’ compensation fraud or you have been accused of fraud and denied benefits, Webster & Carlton can help. Our skilled litigators have devoted their careers to resolving all issues related to the Missouri workers’ compensation system, including fraud.
Workers’ Compensation Insurance Fraud
Employers and their insurance carriers can commit fraud within the workers’ compensation system in various ways as follows.
Misclassifying is one of the most common types of workers' compensation fraud that employers intentionally commit in order to avoid paying premiums.
Because employers with more than four employees must carry workers' compensation insurance under Missouri law, an employer may try to shirk their duty to purchase workers' compensation by classifying employees as independent contractors.
When an employer does this, they are denying workers the benefits to which they are rightfully entitled and could be subject to an investigation and criminal penalties.
Making Fraudulent Statements with Intent to Deny Benefits
According to the Missouri Department of Labor and Industrial Relations, another type of workers' compensation fraud occurs when an employer makes fraudulent statements with the intent to deny the benefits or discourage the injured worker from filing a claim.
Doing so is a class A misdemeanor and is punishable by a fine of up to $10,000. An employer may also come under investigation and be found guilty of insurance fraud if they fail to fulfill their legal duty to report a worker's injury to the state's division of workers' compensation within 30 days.
Noncompliance, Insurer Fraud & Employee Fraud
Employers may commit workers' compensation noncompliance to save money, knowingly failing to insure workers' compensation liability. This can be punished by up to $50,000, or three times the annual premium that the employer would have paid had the employer carried insurance.
Insurer fraud, on the other hand, occurs when an insurance company intentionally and knowingly refuses to comply with workers' compensation requirements.
Employees can also be found guilty of fraud. An employee commits workers' compensation fraud when they make a claim for workers' compensation benefits while knowing that they are not actually entitled to such benefits. Examples include filing a false claim or multiple claims for the same injury or illness or providing false documentation to support the claim.
Workers’ who are found guilty of fraud can be convicted of Class E felonies punishable by fines of $10,000 or twice the amount of the claim’s value. Second offenses are bumped up to Class D felonies. Helping another commit workers’ comp fraud is charged as a Class A misdemeanor.
Schedule a no-fee consultation with a Springfield workers’ compensation fraud attorney by contacting us online or at (417) 545-3775.
Why Do I Need a Missouri Workers’ Compensation Attorney?A workers’ compensation claim can take several months, even years, to resolve, especially if you continue to suffer from the effects of your work-related injury. Your employer and its insurance company will be represented by highly skilled attorneys who know how to exploit an injured employee. You need to level the playing field by hiring a Missouri workers’ compensation lawyer who will fight on your behalf.
What Happens If My Employer Denies Me Workers’ Compensation Benefits?In many cases, your employer or their insurance company will promptly pay any workers’ compensation benefits. But if they deny benefits–or stop paying them before you receive what you believe you are entitled to under the law–then you have the right to file a claim with the Missouri Division of Workers’ Compensation. An administrative law judge appointed by the Division will review your claim and either conduct mediation between you and your employer, or alternatively hold a formal hearing to determine your right to compensation.
What Kinds of Injuries Are Covered?
Under Missouri law, workers’ compensation only covers injuries that arise “out of and in the course of employment.” This includes accidents that occur during your work shift. It also includes “occupational diseases” contracted at work, provided workplace exposure was the “prevailing” cause.
Workers’ compensation is not necessarily limited to injuries suffered at your normal workplace. If your job requires you to travel–i.e., make deliveries or conduct on-site work with clients–you may be compensated for injuries sustained in the course of such travel. However, Missouri workers’ compensation law specifically excludes injuries sustained while commuting from home to work and back, even if you use a company-owned car.
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