If you’re an employer in California, you must purchase workers’ compensation insurance. Doing so provides employees with a means of seeking financial compensation for their medical bills and related losses if they’re ever injured on the job.
You may be a reasonable employer who genuinely wants your workers to receive the compensation they deserve when they’ve legitimately been injured in workplace accidents. However, you might also know that some employees attempt to take advantage of the workers’ compensation system by committing fraud.
The specific ways in which an employee may do so can vary. For example, an employee might injure themselves in hopes of a payout. Or, they might fabricate a workplace accident so they can pursue workers’ compensation benefits for an injury that was actually sustained outside of work. Additionally, some workers who’ve truly been injured in some capacity will nevertheless exaggerate the severity of their injuries in an attempt to recover more compensation than they’re owed.
You don’t have to honor all workers’ compensation claims. You could attempt to deny a claim if you have strong reason to believe an employee is committing workers’ compensation fraud.
That said, if you deny a claim on these grounds, you should be prepared to back up your denial with evidence showing fraud has been committed. Ways to do so include the following:
Pay close attention to the way in which an employee describes a workplace accident throughout the claims process. When an employee first reports an accident, ask if they’d be willing to draft a narrative of it so you can refer to their initial description if necessary in the future.
As a claim moves forward, an employee’s description of their accident might begin to change. Taking note of inconsistencies in an employee’s story can help you build a fraud case.
The employee seeking workers’ compensation benefits might not be the only one who can describe their accident. It’s possible others also witnessed it.
Ask witnesses to provide descriptions. Just as you would pay attention to any inconsistencies in an injured worker’s description of the incident, you should also look for inconsistencies in the descriptions witnesses provide.
It’s possible your employee was being recorded at the time of their accident without knowing it. For example, perhaps the alleged accident took place in a spot that is monitored by security cameras an employee may have overlooked.
Review security footage if so. It could illustrate that an employee’s description of their accident is dishonest. Generally, you should investigate these circumstances to gather all available evidence that may show an employee is lying about the way they were injured.
Just keep in mind that these are merely a few examples of ways to prove workers’ compensation fraud. The best way to demonstrate a worker is seeking benefits they aren’t owed is to coordinate with a legal professional. At Sacks Law Group, APC, our Los Angeles workers’ compensation fraud attorneys are prepared to help you build a strong case. Learn more by contacting our firm online or calling us at 310-216-7778.
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