Little White Lies, Part 2 – Insurance Fraud Goes to Work

Posted September 22nd, 2015 by .

Categories: Workers Compensation.

Workers' Compensation Insurance Fraud Anthony CarboneThe Affordable Care Act  (also known as Obamacare) was created so that those who needed medical care would have the ability to obtain medical treatment.  Unfortunately, not all consumers have followed the government’s directives to secure medical insurance.  Thus, one of the reasons that insurance fraud goes to work.

The Employer and Insurance Fraud

What do we mean exactly?  Insurance fraud in the workers’ compensation arena can come from both ends.  Take the example of Simple Contracting, owned by Joe Simple.  Joe is aware that New Jersey laws require him to have workers’ compensation insurance in place.    However, the cost of insurance is based on the size of Simple Contracting’s payroll, the company’s claim history and the nature of Simple Contracting’s business.  Joe wants to keep his costs down and pays a number of his employees off the books.  Not only is Joe defrauding the government out of tax money, he is also lying to the workers’ compensation carrier.  His not so simple plan to save money can cost more than he expects.  And, if Joe decides to forego workers compensation insurance altogether, the price tag will go even higher.

Workers’ Compensation and Medical Treatment

We mentioned before that Obamacare was designed to make health benefits available to more people.  However, this does not mean that everyone is eligible for the coverage.  For example, undocumented workers are not eligible for the program.  Those without medical insurance may invent a workers’ compensation claim to obtain treatment.

This is the case of Kevin Smith.  Kevin has worked assembly line jobs his entire life.  His employer does not provide health benefits.  Kevin did not bother to look at the premiums for healthcare, as he has a hard time even making the rent.  One night, Kevin trips over one of his children’s toys.  When he awakens, Kevin came barely move.  Back spasms have him doubled over in pain.

Kevin’s wife is extremely concerned about her husband.  She knows they cannot afford an emergency room or doctor’s visit.  Her cousin just got hurt at work and even received money for his injuries.  Kevin’s wife suggests that her husband feign a fall at work.  Kevin follows his wife’s directives and reports the accident.  The only problem is that Kevin forgets his own lies.  When he visits the workers’ compensation doctor, Kevin mentions the fall at home.  Not only could Kevin’s claim get denied, but he could also be in big trouble for insurance fraud.

Contact Us

Insurance fraud hurt on many levels.  It raises prices and is sometimes a result of desperation.  If you have concerns about this area of the law, contact us.  We will gladly provide you with legal advice concerning your situation.

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