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Workers' Comp Fraud by Employers, Health Care Providers, Hurts

There are many levels to the workers' compensation system in New York, and fraud is a possibility at any one of them. Most commonly, workers' comp fraud is thought of as a worker issue; an employee may file a claim for an injury that did not occur at work, misrepresent his or her work status when questioned about it directly or otherwise knowingly lie about a fact related to their claim.

However, fraud committed by players other than employees in the workers' compensation arena - namely employers and health care providers - is just as common as employee fraud. What's more, many injured workers do not realize that fraud at the hands of their employer or medical provider can cost them the benefits they need.

So what does employer fraud look like? Most employer fraud is committed in order to keep workers' comp insurance premiums low, or to maintain a workers' comp insurance policy that may otherwise be revoked. For example, an employer may misrepresent the truth about an incident in order to deny compensation to an injured employee, or may lie to an employee about his or her entitlement to workers' comp benefits in order to discourage the employee from filing a claim.

Employers may also misrepresent the level of risk they are facing to insurers by under-reporting payroll, misclassifying payroll, or lying about company ownership to avoid a higher experience modification (an adjustment of the annual premium based on the rate of workers' comp payouts for an employer over the last several years).

Health care provider fraud typically involves overbilling. Doctors, rehab counselors, pharmacists, chiropractors or any other health care provider may bill for exams that never took place or treatment that was never provided. Sometimes, given the complicated web of insurers that can be involved in a workers' comp case, medical providers mistakenly receive duplicate payment from different insurance carriers - if the excess payment is kept, the provider is guilty of fraud.

If you have been injured on the job, it may not be a bad idea to keep an eye on your employer and your health care providers. Seeking the help of an experienced workers' compensation attorney will help ensure that you receive the benefits you are entitled to. Fraud hurts everyone in the system, and it may be up to you and your attorney to expose employer or health care provider misrepresentation before it damages your claim.

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