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501 Village Avenue, Suite 104, Yorktown, VA 23693
355 Crawford Street, Suite 814, Portsmouth, VA 23704
21 E. Queens Way, Suite B, Hampton, VA 23669
1 Columbus Center, Ste, 600, Virginia Beach, VA 23462
133 Mount Pleasant Road, Chesapeake, VA 23322
4805 Courthouse Street, Suite 204, Williamsburg, VA 23188
256 W Freemason Street, Norfolk, VA 23510
2006 Old Greenbrier Rd, Suite 5, Chesapeake, VA 23320
5041 Corporate Woods Dr, Suite G180, Virginia Beach, VA 23462
448 Viking Dr, Suite 170, Virginia Beach, VA 23452
5741 Cleveland Street, Suite 220, Virginia Beach, VA 23462
283 Constitution Dr, One Columbus Center, Suite 667, Virginia Beach, VA 23462
249 Central Park Avenue, Suite 300-91, Virginia Beach, VA 23462
4646 Princess Anne Rd, Unit 104, Virginia Beach, VA 23462
910 West Mercury Blvd., Suite 2A, Hampton, VA 23666
409 Duke Street, Unit 100, Norfolk, VA 23510
1307 Jamestown Road, Suite 201, Williamsburg, VA 23185
291 Independence Blvd, Pembroke 4, Suite 423, Virginia Beach, VA 23462
112 College Place, Norfolk, VA 23510
1240 Perimeter Parkway, Suite 404, Virginia Beach, VA 23454
555 East Main Street, Suite 1410, Norfolk, VA 23510
1108 Madison Plaza, Suite 203, Chesapeake, VA 23320
565 N. Birdneck Road, Virginia Beach, VA 23451
555 East Main Street, Suite 1212, Norfolk, VA 23510
9963 Warwick Blvd, Suite A, Newport News, VA 23601
Portsmouth Workers' Compensation Fraud Information
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What Is Workers’ Compensation?
Workers’ compensation provides benefits for workers who are injured on the job or suffer a work-related illness. Most employers are required to provide workers’ comp insurance for employees. When an employee is injured in the workplace, a workers’ comp claim provides medical coverage and partial wage replacement while the employee is unable to work.
The workers’ compensation process is generally a no-fault system. The employee is supposed to be covered for any work-related accident or occupational diseases. The worker does not have to show the employer was negligent. In return, the employer is protected from most personal injury lawsuits related to the accident and the compensation claims are limited to wage benefits, medical care, and disability benefits.
If employers or workers comp insurance carriers suspect the employee is committing fraud, they may investigate the claim to deny coverage or report the employee for fraud. If criminal fraud is suspected, law enforcement agencies may work with the insurance provider and employer to investigate the worker and could prosecute the worker for criminal charges.
What Qualifies as Workers’ Comp Fraud in Virginia?
Workers’ comp fraud involves fraud or misrepresentation in a workplace injury claim. Fraud may involve the worker trying to claim benefits for a non-covered injury or claim benefits when they are still able to work. Some examples of workers’ comp fraud include:
- Claiming a non-workplace injury happened on the job
- Claiming to be disabled when the worker can still perform their job functions
- Intentionally causing an accident or injury to get benefits
- Working another job under the table while receiving benefits
- Advising other workers on how to fraudulently claim workers’ comp benefits
- Filing multiple claims for the same injury
Fraud in workers’ comp claims can also involve health care providers. Doctors, medical service providers, and chiropractors may work together to defraud the workers’ comp system. Workers’ compensation insurance fraud rings may recruit workers to claim workplace injuries, with a medical provider making a false diagnosis of an injury, and doctors fraudulently treating the injured employees or billing for medical procedures that were never provided.
What Investigators Look For in Workers’ Comp Fraud
Some insurance providers or employers look for “red flags” that may indicate possible fraud. This may be a clue to further investigate the claim, talk to other employees, or use a private investigator to monitor the injured worker. Some possible red flags of workers’ compensation fraud may include:
- No witnesses to the accident
- Employee refusing treatment or examination
- Worker is difficult to contact after filing a claim for workers’ comp
- Injury occurred right before or after a planned vacation
- Injury occurred shortly before the employee was to leave the job
- Employee reported the injury after a poor performance review or workplace incident
- Treatment is inconsistent with the alleged injury
- Extent of injury and accident time frame do not match up
Is Workers’ Comp Fraud a Felony?
Workers’ compensation fraud can be charged as a misdemeanor or a felony, depending on the situation. As a misdemeanor, a conviction for fraud could result in up to a year in county jail and a fine. If fraud is charged as a felony, penalties can include more than a year in prison, fines, and restitution.
Some incidents of workers’ comp fraud can include additional criminal charges. The defendant may face related charges for:
- Identity theft
- Insurance fraud
- Health care fraud
Investigating Workers’ Comp Fraud
Insurance companies and the employer may investigate employees even without indications of claimant fraud. The insurance company and employer have a financial interest in denying workplace injury claims. As a result, they may wrongly deny a legitimate claim for an injured worker. Many employees do not go through the process to appeal the denial, and end up going without the benefits they deserve.
Do Private Investigators Follow Workers After a Claim?
A private investigator may follow the worker with video surveillance. Investigators may also talk to co-workers or neighbors about the worker’s activities. Social media accounts may also be reviewed for evidence that could hurt the worker’s claim. Some of the things investigators look for when an employee makes a workers’ comp claim include:
- Participating in sports or leisure activities
- Doing yard work, home improvement projects, or heavy lifting
- Going on vacation after making a claim
- Social media post showing the cause of the injury that is unrelated to work
- Medical bills for appointments the worker never attended