Top Hamilton, OH Workers' Compensation Fraud Lawyers Near You
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Lyons and Lyons is a Trusted Name in Quality Criminal and DUI Law, Serving The Butler County Community Since 1983. Please Call and Talk to Us, Before Talking to The Police!
The Citadel, 114 East Eighth Street, Cincinnati, OH 45202
Assisting people in Hamilton with their Ohio Workers' Compensation Fraud issues.
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315 s. Monument Avenue, Hamilton, OH 45011
When you need legal representation for your Workers' Compensation Fraud, connect with Michael A. Newland. Esq. in Hamilton, Ohio.
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9078 Union Centre Blvd., Suite 350, West Chester, OH 45069
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Hurley Law, LLC has experience helping clients with their Workers' Compensation Fraud needs in Hamilton, Ohio.
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8750 Union Centre Blvd, West Chester Township, OH 45069
In Hamilton, Ohio, Meadows Law Firm, a local practice, helps clients with their Workers' Compensation Fraud problem.
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810 Sycamore Street, Floor 3, Cincinnati, OH 45202
114 East 8th Street, Suite 400, Cincinnati, OH 45202
233 East Main Street, Suite #3, Batavia, OH 45103
212 W 8th St, Suite 300, Cincinnati, OH 45202
810 Sycamore Street, Cincinnati, OH 45202
425 Walnut Street, Suite 1800, Cincinnati, OH 45202
312 Walnut Street, Suite 3200, Cincinnati, OH 45202
9277 Centre Pointe Drive, Suite 300, West Chester, OH 45069
201 East Fourth Street, Suite 1900, Cincinnati, OH 45202
810 Sycamore Street, First Floor, Cincinnati, OH 45202
1244 Nilles Road, Suite 9, Fairfield, OH 45014
600 Vine Street, Suite 1004, Cincinnati, OH 45202
312 Elm Street, Suite 1850, Cincinnati, OH 45202
220 Findlay St, Cincinnati, OH 45202
810 Sycamore Street, First Floor, Cincinnati, OH 45202
9380 Main St, First Floor, Montgomery, OH 45242
810 Sycamore St, Floor 3, Cincinnati, OH 45202
3573 Columbia Parkway, Cincinnati, OH 45226
140 North Main Street, Suite B, Springboro, OH 45066
455 Delta Ave, Suite 105, Cincinnati, OH 45226
632 Vine Street, Suite 305, Cincinnati, OH 45202
Hamilton 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 Ohio?
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