Workers' Comp Fraud Lawyer Serving Dallas

Types of Workers' Compensation Fraud

There are strict laws regulating workers' compensation in the state of Texas. There is a very specific set of rules and regulations that employers, employees and the workers' compensation insurance companies must follow when filing and processing a claim. There is always the possibility of fraud that can occur from any one of these areas, which is closely monitored by the Texas Department of Insurance. Below are listed various ways in which fraud can occur, from the employee to the employer, and even including health providers and attorneys. To ensure you are following the correct procedure for filing and pursuing your claim, consult with a workers' compensation attorney from the Malaise Law Firm. Our office will keep you fully informed on what is needed every step of the way through the processing of your claim.

Fraud by Employers

Employers can be involved in some type of fraud as regards to attempting to obtain workers' compensation insurance at a lower cost by cclassifying their employees as a different category in order to lower their insurance premiums. They can also attempt to do this by misreporting their payroll figure, changing it from year to year, or reporting a much lower figure than the actual amount. Frequent cancellation and changes of coverage can also indicate some type of fraud.

Fraud by Health Care Providers

Health care providers can sometimes work with unscrupulous attorneys to create bogus medical reports indicating treatment to employees that didn't occur. Some indicators of this can occur when it is seen that a person was treated on a holiday or weekends when there was no medical emergency and the health care office isn't even open. Some also bill fictitious types of treatments, or an unreasonable amount of treatment in one day.

Medical reports that seem to be mere copies of generic type medical reports

Employee Fraud

An employee can attempt to obtain workers' compensation benefits fraudulently by faking an injury or working at another job while on benefits from another employer. The employee may also be working with a health care provider in setting up bogus billings for treatment never received or not needed.

Some indicators that a claim might be fraudulent include an employee's reporting an injury when none actually occurred, especially when there are no witnesses to the injury, or it occurred late on a Friday or early on a Monday. Or the employee does not report his injury right away, but days after it supposedly occurred.

Some other indicators that there might be fraud include:

• Employee history of workers' comp claims
• Injury that is inconsistent with normal job duties
• Employee observed in activities in consistent with the reported injury
• Employer disciplinary action on the employee followed by a workers' comp claim
• Injury occurring before a strike or holiday, or in anticipation of termination
• Injury occurring in a location where the employee would not normally work
• Conflicting diagnoses from subsequent treating providers

Filing a workers' compensation claim must be done responsibly and ethically. If you are injured at work, you have every right to file a claim, even if some of the indicators of fraud appear in your claim. Not everyone who fails to report an injury right away or files a claim on a Friday or Monday is committing fraud, but there could be cause for concern by your employer and workers' compensation insurance company when it comes to handling your claim. If you feel there is some indication by your employer that your claim is suspect, it becomes more important to obtain a workers' compensation lawyer who can provide you the legal support you need to ensure you obtain the benefits you deserve. At the Malaise Law Firm we are ready to assist you with whatever legal help you need when it comes to your workers' compensation benefits.

Find out more about any workers' comp fraud you might have questions about by calling the Malaise Law Firm.