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Workers' Compensation Fraud

Money is most often the motive when a person or business makes a fraudulent workers' compensation claim. Florida has established a special bureau to investigate fraudulent workers' comp claims and Florida law provides for severe penalties for workers' compensation fraud.

Both "claimant fraud" and "premium fraud" may be alleged in Florida. Depending on the circumstances, an employee or an employer may be accused of either of these types of fraud.

In many cases, a company may accuse an employee of "faking" or embellishing a work-related injury in order to receive monetary benefits that he or she is not entitled to under the law.

Workers' compensation fraud is a third-degree felony in Florida, punishable by up to five (5) years in prison and a fine of up to $5,000.

Attorney for Workers' Compensation Fraud in Miami, FL

The Hoffman Firm represents clients against unfounded accusations of Workers' Compensation Fraud. In many of these cases, the employer or the insurance company will claim that the injured worker committed misrepresentation concerning his or her physical abilities or post-accident earnings in violation of Sections 440.09 and 440.105 of the Florida Statutes.

If you suffered a work injury in Miami, or anywhere in South Florida, and your employer has asserted that the injury did not occur or was less serious than it actually was, contact an experienced workers' compensation lawyer at The Hoffman Firm to discuss your case.

The knowledgeable workers' compensation attorneys at The Hoffman Firm are dedicated to fighting for your rights and securing all the benefits to which you are entitled. Call us today at (305) 940-2307 to discuss your case.


Workers' Compensation Fraud in Miami, Florida

Under Florida law, workers' compensation fraud occurs when a person knowingly, and with intent to injure, defraud or deceive any employer or employee, self-insured program, or insurance carrier, files false or misleading information (Florida Statutes § 440.105(1)(a).)

In Florida, workers' compensation fraud is a third-degree felony subject to harsh penalties, including up to five (5) years in prison and a fine of up to $5,000. The courts may also impose civil liability for fraud involving workers' compensation, which could result in a separate monetary judgment.

Claimant Fraud

There are many ways that dishonest people attempt to cheat the system.

Claimant fraud may be alleged when an employee collects wage benefits under false pretenses. A claim is fraudulent when the claimant is untruthful about whether the injury occurred on the job, or if he or she falsely describes or embellishes the nature and extent of the injury or make false statements about the severity of the injury.

In some cases, unscrupulous medical practitioners are in on the fix in an attempt to collect money for excessive or even nonexistent treatments.

Section 440.105 of the Florida Statutes makes it illegal for any person to “knowingly make, or cause to be made, any false, fraudulent, or misleading oral or written statement for the purpose of obtaining or denying any benefit or payment under this chapter” (emphasis added).

Section 440.09(4)(a) of the Florida Statutes, bars benefits for an employee found to have “knowingly or intentionally engaged in any of the acts described in § 440.105 ... for the purpose of securing workers' compensation benefits” (emphasis added).

The Courts in Florida have recognized that “it is not necessary that a false, fraudulent, or misleading statement be material to the claim; it only must be made for the purpose of obtaining benefits.” (See Village of N. Palm Beach v. McKale, 911 So.2d 1282, 1283 (Fla. 1st DCA 2005).)

Fraud “does not limit a claimant's forfeiture to those benefits that may have been obtained by virtue of the claimant's unlawful conduct.” (See Wright v. Unifs. for Indus., 772 So.2d 560 (Fla. 1st DCA 2000) (quoting Rustic Lodge v. Escobar, 720 So.2d 1014, 1015 (Fla. 1st DCA 1999)).)

Therefore, if the injured worker makes any misrepresentation for the purpose of obtaining benefits, then he or she is barred from entitlement to benefits, even if the misrepresentation is unrelated to his or her injury or benefits based on that injury.


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Florida's Anti-Fraud Reward Program in Workers' Compensation Cases

Any person who, knowingly and with intent to injure, defraud, or deceive any employer or employee, insurance company, or self-insured program, files a statement of claim containing any false or misleading information commits insurance fraud, punishable by the provisions of the Florida Statutes, § 817.234. 

Florida law provides rewards of up to $25,000 for individuals who provide information leading to the arrest and conviction for any person committing insurance fraud. Many claims investigations begin with a report of insurance fraud to the Florida Division of Workers' Compensation's Bureau of Workers' Compensation Fraud. 

Many suspected cases of fraud are reported anonymously to the Florida Workers' Compensation Fraud Hotline: (800) 378-0445, or www.myfloridacfo.com/fraud.


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Additional Resources

Florida Statutes, Title XXXI, Chapter 440, Section 440.105 — Read the section of the Florida Statutes that address workers' compensation fraud as the law applies to insurance carriers, employers and employees. A related law, F.S. § 440.1051, provides for civil immunity for anyone who makes a valid report of workers' compensation fraud.

Florida Department of Financial Services — Bureau of Workers' Compensation Fraud — The Bureau of Workers' Compensation Fraud has five dedicated squads statewide. Three of these units are in South Florida, including Miami, West Palm Beach, and the MSB squad, which is comprised of detectives from the West Palm Beach and Broward Field Offices, as well as two Broward County Sheriff’s Office and one Palm Beach County Sheriff’s Office detectives. These units investigated more than 1,300 fraudulent workers' compensation referrals in 2014.

Florida Department of Financial Services — Workers' Compensation Fraud — A pamphlet published by the State of Florida explains the two main types of fraud in workers' compensation claims — claimant fraud and premium fraud — as well as the ripple effect of fraudulent claims on the state's economy, insurance markets and employers and employees.


Find an Attorney for a Workers' Compensation Fraud in Miami, FL

If you were injured on the job in Miami, Florida, or anywhere in South Florida, including Fort Lauderdale, Broward County, West Palm Beach, or Palm Beach County, and you filed a Workers’ Compensation claim, but your employer or your employer's insurer is disputing your claim by accusing you of fraud, contact a dedicated workers' compensation lawyer for assistance.

The knowledgeable workers' comp attorneys at The Hoffman Firm are familiar with the tactics — including false accusations of fraud — that some businesses attempt in order to deny benefits to injured workers after a workplace injury occurs. We also know how to appeal a case after fraud is alleged.

Our offices are conveniently located in Miami in Miami-Dade County, Fort Lauderdale in Broward County, and West Palm Beach in Palm Beach County, FL. We represent clients in workers' compensation cases throughout South Florida. Call The Hoffman Firm at (305) 940-2307 today to discuss your case.

This article was last updated on Tuesday, May 31, 2016.

 

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Evan A. Hoffman

Evan A. Hoffman

Mr. Hoffman’s philosophy is "our knowledge and experience is your best defense." He has been a featured author on criminal law issues such as driving under the influence, domestic violence and illegal searches.

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