Oklahoma Workers’ Compensation is designed to provide support to employees injured on the job, but unfortunately, the system can sometimes be vulnerable to fraudulent claims. Understanding what constitutes Workers’ Compensation fraud, its consequences, and how to protect yourself is vital for both employees and employers. The Armstrong Law Firm, PLC, in Tulsa, shares more about Workers’ Compensation fraud and how employees can protect themselves against charges of claims fraud.
Understanding Workers’ Compensation Fraud
Workers’ Compensation Insurance Fraud is defined under 85A O.S. 6(A)(1)(a) as:
“Any person or entity who makes any material false statement or representation, who willfully and knowingly omits or conceals any material information, or who employs any device, scheme, or artifice, or who aids and abets any person for the purpose of: (1) obtaining any benefit or payment, (2) increasing any claim for benefit or payment, or (3) obtaining workers’ compensation coverage under this act, shall be guilty of a felony punishable pursuant to Section 1663 of Title 21 of the Oklahoma Statutes.”
Section (b) defines a material false statement or representation as including, but not limited to, “attempting to obtain treatment or compensation for body parts that were not injured in the course and scope of employment.”
The Oklahoma Workers’ Compensation and Insurance Fraud Unit (WCIFU) considers any “material misstatements, misrepresentations, or knowingly concealing material information” with respect to attempts to the following as fraud:
- A claim for payment or other benefits from an insurance policy.
- Obtaining Workers’ Compensation coverage under the Administrative Worker’s Compensation Act.
- Failure to report income to an employer, insurance carrier, or Third-Party Administrator while receiving Temporary Total Disability (TTD) benefits.
- Presenting an altered or falsified certificate of Workers’ Compensation Coverage.
Who Can Commit Workers’ Compensation Fraud?
Both employers and employees can be guilty of committing Workers’ Compensation fraud. Here are some common ways this is attempted.
Employer Fraud
Employers may commit fraud by denying legitimate claims, misclassifying employees to reduce premiums, failing to maintain proper insurance, or asking employees to obtain needed medical treatment through their private health coverage instead of filing a Workers’ Compensation claim.
Employee Fraud
Employees may attempt to defraud Workers’ Compensation by:
- False Injury Claims: An employee might fabricate an injury that never occurred or exaggerate the severity of an actual injury to receive benefits improperly.
- Failure to Report Previous Injuries: An employee may fail to disclose previous injuries and claim a new injury occurred while on the job, effectively seeking compensation for an ongoing issue.
- Misrepresentation of Job Duties: Employees might claim they were injured while performing their job duties when, in fact, the injury happened elsewhere or during personal activities.
Employers or employees who commit Workers’ Compensation fraud may be subject to serious consequences, including legal penalties (Workers’ Compensation fraud is a felony), loss of benefits, increased premiums, and denial of coverage.
Protect Yourself Against Workers’ Compensation Fraud
Protect yourself by following the rules if you sustain an injury at work. The Armstrong Law Firm, PLC, recommends the following:
- Be Honest About Your Injury: Always provide truthful information about your injury and its circumstances. Transparency is crucial in maintaining the integrity of your claim.
- Document Everything: Keep detailed records of your injury, medical treatments, and communications with your employer and insurance company. This documentation can help validate your claim and prevent misunderstandings.
- Seek Legal Advice: If you’re unsure about any aspect of your claim or feel pressured to exaggerate your injury, consult with our Workers’ Compensation attorneys for legal guidance.
Report Workers’ Compensation Fraud in Oklahoma
Workers’ Compensation fraud undermines the system designed to protect injured workers and can have severe repercussions for all parties involved. The Oklahoma Workers’ Compensation and Insurance Fraud Unit (WCIFU) allows anonymous reporting via their hotline at (877) 800-8764 or by submitting a Workers’ Compensation Fraud Complaint Form through the mail or email.
If you suspect fraud or need assistance with a claim, contact The Armstrong Law Firm, PLC, in Tulsa, for help protecting your rights and understanding your responsibilities. We can work with you to ensure a fair and just Workers’ Compensation process so you receive everything you deserve under the law.