Workers’ compensation fraud happens when someone lies about a work-related injury or accident to get money or benefits. This is a serious crime in New York State, and people who commit it can face big fines or even go to jail.
What does workers’ comp fraud look like?
Consider an employee who injures their back playing basketball over the weekend. On Monday, they report to their employer that the injury happened while lifting boxes at work and proceed to file a workers’ compensation claim. This constitutes fraud.
Another example involves an employee who sustains a workplace injury but exaggerates the severity to receive additional time off or increased compensation. This is also fraudulent behavior.
The New York State Workers’ Compensation Board mandates proof of Accident, Notice, and Causal Relationship (ANCR) for a claim to be valid. If these elements are absent, they may deny the claim.
The “no accident” defense
In some cases, employers may use the “no accident” defense to challenge fraudulent claims. This defense argues that no work-related incident occurred, or that the alleged injury does not meet the legal definition of a compensable injury under New York law.
For example, if a worker claims to have injured their back while lifting at work, but no witnesses can confirm the incident or medical experts cannot find evidence supporting the worker’s story, the claim might be disputed.
Seeking legal advice
Navigating workers’ compensation claims in New York can be complex. It is advisable to seek legal assistance from experienced attorneys in workers’ compensation defense. Legal professionals can provide advice, gather necessary evidence, and effectively represent employers’ interests.
Workers’ compensation fraud is a significant challenge that affects everyone. By understanding the different forms of fraud and utilizing defenses like the “no accident” defense, employers and the legal system can work together to combat false claims.