Workers’ Comp Fraud

Under Nevada law, you are guilty of workers’ compensation fraud when you make false statements to defraud the workers’ compensation insurance provider. Employers, employees, and healthcare providers are the most common defendants in workers’ compensation fraud cases. An employer violates the law by depriving an employee of workers’ compensation coverage or evading premiums for workers’ compensation. On the other hand, employees commit fraud by filing a false claim to recover compensation for false or exaggerated injuries.

Workers' compensation fraud is a serious felony that attracts state and federal penalties. A conviction for the offense attracts a lengthy prison sentence and hefty fines. You will also be left with a stained record that can affect your personal and professional life.  Therefore, seeking legal guidance is key when facing an arrest and charges for this offense. At The Law Offices of Martin Hart, we offer the legal guidance and representation you need to battle your workers' comp fraud charges in Las Vegas, NV.

An Overview of Workers Compensation Fraud in Nevada

Workplace risk of injury and illness varies in the industry. Regardless of your industry, you may be covered by workers’ compensation insurance. The workers’ compensation is a no-fault program that compensates workers who suffer injuries at the workplace or while performing work-related duties. In Nevada, workers’ compensation coverage is a requirement for all employers with one or more employees.

In addition to insurance coverage, workers’ compensation requires employers to provide a safe working environment for all employees free from hazards or risk of injuries. Although the workers’ compensation is aimed at a good cause, exploitation of the system is inevitable. Individuals can be charged with workers’ compensation fraud for making false statements to obtain false workers' compensation benefits.

The type of workers’ compensation fraud in Nevada varies depending on the person who committed the fraud, and they include:

Applicant Fraud

Applicant fraud is the type of workers’ Comp Fraud committed by an employee who claims to be injured. Engaging in any of the following acts could result in an arrest and criminal charges for workers’ comp fraud:

  • Falsify an injury or exaggerate the injury severity. When you claim compensation for your workplace injury, you must provide accurate reports on the type and extent of the Some people exaggerate their illnesses to increase the amount they stand to recover from their claims.
  • Falsely claim that an injury occurred at work. The workers’ compensation insurance is responsible for compensating injuries that occur at work or while an employee performs work-related duties. You can be cited for workers' comp fraud if you lie about where the injury occurred in your claim forms. Companies perform thorough investigations by investigating potential witnesses and checking camera footage to determine how the injury occurred.
  • Failure to disclose a past injury. You can still be compensated if you have a previous injury that worsens after the workplace accident. However, the settlement may be much less than you would receive without an existing injury. Failure to disclose the past injury is seen as an attempt to defraud the workers’ compensation.
  • You collect compensation benefits for the same injury from multiple employers. This fraud occurs when you change jobs and tell the new employer that a previous injury occurred at the current workplace.
  • Double dipping. You will receive temporary disability benefits from the workers’ compensation when you cannot work due to workplace injuries. You are considered a double dipper when you collect the disability benefits and continue to work. This kind of workers’ comp fraud can cause severe losses to a company. An employer is responsible for ensuring injured employees have the conditions to return to work.

When you face criminal charges for workers’ comp fraud as an applicant in Nevada, the prosecutor can file additional charges for the following offenses:

  1. Grand larceny. Under NRS 205.220, grand larceny involves taking another person’s property worth $1,200 or more. A conviction for grand larceny attracts a prison sentence of up to twenty years and $15,000. The nature of penalties you face when your grand larceny charges stemming from workers’ comp fraud will vary depending on the amount you fraudulently received from the workers’ compensation.
  2. Under Nevada law, you commit a crime of forgery when you attempt to commit fraud using counterfeit documents. Most claimants who file false fraudulent worker’s compensation claims use fraudulent medical records to fake or exaggerate injuries. Therefore, the prosecution can charge you with workers’ comp fraud and forgery. Forgery is a felony punishable by four years in state prison and fines of up to $5,000.
  3. Under NRS 100.120, perjury involves making statements that you are unsure of their truthfulness. Additionally, bribing or inducing another person to make a false statement in your favor could attract charges under this statute. If you make arrangements with a physician to lie about your injuries for Workers' compensation benefits, you will be charged with perjury and fraud. A conviction for perjury attracts a prison sentence of up to four years and a maximum of $5,000 in fines.

Employer Fraud

Employers can be charged with workers ‘comp fraud for engaging in the following activities to escape paying insurance coverage for their employees:

  • Lie about the number of employees to the workers’ compensation insurance carrier
  • Threaten to punish or terminate an employee who attempts to claim workers’ compensation benefits after a workplace injury.
  • Failure to carry workers’ compensation insurance for their employees
  • Deduct money from an employee’s salary to pay the workers’’ compensation insurance premiums
  • Misrepresentation of an employee’s duties to avoid paying high premiums for their insurance coverage. Workers' compensation premiums are higher when a person performs risky work.
  • Fraudulent insurance certificates. You must have worker insurance coverage if you have at least one employee. An insurance certificate proves that you have the required insurance in place. If you have a fraudulent certificate, you can face an arrest and criminal charges.

Claim Mills Fraud

Claim mills are organized fraud rings that target workers’ compensation. These rings involve workers, attorneys, and medical practitioners. Claim mills often recruit individuals to file fraudulent workers’ compensation claims so they can share in the benefits.

Healthcare Provider Fraud

Medical practitioners are also prone to criminal charges for workers’ compensation fraud. These charges arise when doctors take advantage of individuals injured on the job through:

  • Provision of unnecessary medical treatment
  • Overbilling of services
  • Billing for services they did not provide

Fraudulent schemes by healthcare providers are uncovered when there is an inconsistency between the diagnosis and treatment. Sometimes, the prosecutor will charge defendants in these cases with additional charges for healthcare fraud. Healthcare fraud is a felony that attracts a prison sentence of one to four years.

Carrier Fraud

Workers’ compensation insurance commits carrier fraud. This kind of fraud may occur when the carrier lies about an employee’s eligibility to receive compensation. The victim in carrier fraud is a worker who receives a lower settlement than they deserve for their injuries.

Prosecution and Punishment for Workers’ Compensation Fraud in Nevada

The Department of Business and Industry enforces workers’ compensation insurance laws. Allegations of workers’ comp fraud can result in criminal charges at the state and federal levels. When proving you are guilty, the prosecution team must prove that you engaged in any acts that constitute the crime beyond a reasonable doubt.

In Nevada, workers’ comp fraud is a class D felony punishable by a prison sentence of one to four years and up to $5,000 in fines. If you face criminal charges for trying or successfully defrauding FECA, you will face a sentence of five years in federal prison and fines that do not exceed $10,000.

In addition to incarceration and fines, the court may order you to pay victim restitution after a conviction for workers’ comp fraud. Restitution is the amount of money a person who faces a conviction for a crime pays the victim. Workers’ comp fraud causes serious financial loss for an injured worker or the insurance provider.

When your professional licensing body learns of your arrest and conviction for this offense, it can suspend or revoke your license. Such action will significantly affect your livelihood. You will not be eligible for these benefits if you have a conviction for workers’ comp fraud on your record.

Legal Defense Against Workers Comp Fraud Charges

Submitting a workers’ compensation claim and obtaining compensation for workplace injuries is complicated. As an employer, you may have failed to realize something wrong. Additionally, employees could make mistakes when filing their claims. Facing a conviction and prison time for simple misunderstandings or clerical errors is scary.

Fortunately, not all workers’ compensation fraud cases result in a conviction. You can explore the following legal defense with the guidance of your attorney:

No Intent to Defraud

Workers’ compensation fraud is not a strict liability crime. Therefore, before you face criminal charges for this offense, the prosecution must prove that you acted with fraudulent intent. Accidental overbilling or mistakenly misrepresenting an employee is insufficient to attract a conviction. If you face charges for working while receiving temporary disability benefits while still working, you can argue that you honestly believed you were allowed to do both.

Proving fraudulent intent in your actions can be a challenging task for prosecutors. This gives you a chance to fight and beat the criminal charges.

False Allegations

A workers’ compensation claim passes through different parties. Before a claimant can receive compensation, the employer, physician, and insurance company must look at the document. When a fraudulent act is discovered, it may be challenging for the police and prosecution to determine the perpetrator of the crime. If another person committed the crime, the court might assume you are guilty of association or part of a claim mill.

However, the district attorney must prove beyond a reasonable doubt that you engaged in an act that constitutes workers comp fraud before holding you liable for the offense. If you can prove that you are a victim of false allegations or mistaken identity, you can avoid a conviction for the offense.

Police Misconduct

Even when you are suspected of committing a crime in Nevada, you have constitutional rights that must be respected through the investigation, arrest, and prosecution. Prosecuting workers’ comp fraud involves thorough investigations by law enforcement officers. In an attempt to gather more evidence against you, the police officers are tempted to use the wrong channels. Some of the common forms of police misconduct include:

  • Illegal search and seizure. The police officers may search your computer and personal items to discover the fraudulent documents. If the officers do not have a valid search warrant or their search exceeds the warrant's scope, you can claim police misconduct.
  • Coerced confessions. Police officers may use excessive or other tactics to force you into taking liability for a crime you did not commit.
  • False arrest. Law enforcement officers must have probable cause to arrest you for workers’ comp fraud in California. The officers cannot rely on invalidated claims to arrest you.

If law enforcement officers engage in any misconduct against you, you could file a motion to suppress the evidence they have against you. Without evidence from the police, the case against you becomes weak, and the chances of beating your charges are high.

Find a Reliable Criminal Defense Lawyer Near Me

All employers in Nevada must secure workers’ compensation insurance for their employees. You can file a claim with workers’ compensation if you suffer an injury at work. If you make any false statement intending to collect undeserving benefits from the workers’ compensation insurance, you risk an arrest and criminal charges.

The workers’ compensation fraud charges can be brought on employees who make false claims and employers who fail to pay for insurance coverage. The consequences of a conviction for workers’ comp fraud go beyond the prison sentence and fines. You could lose your professional license and have a permanent criminal record.

If you or your loved one faces criminal charges for workers’ comp fraud in Las Vegas, NV, you will require the expert guidance we offer at The Law Offices of Martin Hart. Our skilled criminal defense attorneys will protect your rights and help you build a solid defense to fight the charges and secure a favorable outcome. Contact us at 702-380-4278 today to discuss the details of your case.