Workers' Compensation

Fraud


 

 


 Georgia Law

 

Georgia Workers' Comp Act calls for criminal prosecution for various nefarious activities by participants in the system. O.C.G.A. § 34-9-19 creates a misdemeanor offense for providing false or misleading statements in obtaining or denying benefits:

Any person, firm, or corporation who willfully makes any false or misleading statement or representation for the purpose of obtaining or denying any benefit or payment under this chapter shall be guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not less than $1,000.00 or more than $10,000.00 or by imprisonment not to exceed 12 months, or by both such fine and imprisonment.

O.C.G.A. § 34-9-20 creates a felony offense for giving a false statement under oath in a workers compensation proceeding.

Any person who shall knowingly make, give, or produce any false statements or false evidence, under oath, to any member of the board or to any administrative law judge commits the offense of perjury (punishable by a minimum fine of $1,000.00 and up to 10 years in prison – O.C.G.A. § 16-10-70).

O.C.G.A. § 34-9-21 creates a misdemeanor offense for employees who receive unentitled income benefits.

Any employee who, with the intent to defraud, receives and retains any income benefits to which he or she is not entitled shall be guilty of a misdemeanor and, upon conviction thereof, shall be punished for each offense by a fine of not else than $1,000.00 nor more than $10,000.00 or imprisonment not to exceed one year, or by both such fine and imprisonment.

The Act also criminalizes receipt of unapproved fees or solicitation of employment by lawyers or physicians (O.C.G.A. § 34-9-22); violation of the Workers' Compensation Truth in Advertising Act (O.C.G.A. § 34-9-32); and failure to comply with the insurance notification requirements.  (O.C.G.A. § 34-9-126(b)).

 

Many different kinds of conduct meet the elements of these crimes. Claimant fraud includes: 1) a legitimate injury that turns fraudulent after a period of time; 2) totally faked injuries; and 3) "double dipping" claimants (claimants working while drawing benefits).

 

Examples of employer fraud include: 1) misrepresenting payroll; 2) misclassifying employee jobs to reduce insurance premiums; 3) falsified certificates of insurance; 4) "charging" employees for workers' compensation premiums; and 5) misleading workers about existence of insurance coverage.

 

 

2013 Statistics


Since the Great Recession of 2008, there has been a drastic increase in people applying for and receiving SSDI. In March 2013, these numbers reached 8.9 million, which represents 5.4% of the civilian workforce ages 25-64, as compared to 1.7% of the U.S. workforce in 1970.

 

 

How do we investigate these claims?

 

Surveillance, That's HOW!


Platinum Security & Investigations, Inc conducts a thorough investigation of a claimant’s allegation pertaining to workers' compensation benefits. If an employer becomes suspicious that a claimant has falsified or faked their injury and receives workers' comp benefits, it is our job to make sure the injury is legitimate.

 

We start the investigation by reviewing statements from the treating physician regarding the type of injury sustained. For example; if the claimant hurt his/her back on the job, the treating physician will limit there ability to perform certain types of duties or activities. This is where we come in.

 

We then set up surveillance in order to physically see and document (utilizing video and/or photography) if the claimant is complying with the orders of the treating physician. If these orders state that the claimant should not bend, crawl, stoop, climb, jump, and we video him/her engaged in physical exercise such as; climbing a ladder to clean windows, jogging several miles, or detailing a car,  then this would be grounds for the employer to claim that the employee was faking an injury and has falsified a workers' comp claim.

 

In addition, if a claimant receives workers' comp benefits and is earning money working somewhere else (usually for cash), this would also be a violation of the workers' comp act and the claimant could also face legal action for fraud.

 

Those employers that have hired private investigators in the past to catch someone who is committing workers' comp fraud can agree that it can be a time consuming task, can take many hours, or even days to prove.

 

 

If you are suspicious about an employee who may be wrongfully receiving workers’ compensation benefits, then give us a call.

 

You can't afford not to!

 

Office

1978 Rockmart Hwy

Cedartown, GA. 30125
Phone: 770-529-7968

psigeorgia@aol.com