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Workers Compensation Claim: Employer Thinks it’s Fraudulent

Worker's compensation claim form with calculator on the background.

If you get hurt on the job, you expect your employer to take care of you. A workers compensation claim is one way of doing so. If you weren’t doing your job, you never would have gotten hurt. This is why it can be very frustrating to find out that your claim has been denied. At least if it’s denied, you’ll be able to find out why and reach out to a Cincinnati workers comp lawyer right away.

What can be even more frustrating, is to be told that your case is under investigation. They don’t often tell you why your case is being investigated. You may assume that they’re looking to make sure that your injuries are legitimate. Or you might think that they need to speak to a couple more of your coworkers who saw what happened. Unfortunately for you, when your employer says that your workers comp claim is still being investigated, it’s usually a red flag that they think you’re claim was fraudulent.

Learning that your employer thinks that you fabricated an injury just to qualify for workers compensation benefits can be devastating. This is especially true if you’ve worked for your company for a long period of time. Why would they think that you filed a fake claim? That’s not something you would do. You would think that after all your years of service they would know that about you. However, given the increase in the number of fraudulent workers compensation claims being filed in Ohio, your employer has to protect himself. If enough red flags appear surrounding your claim, your employer owes it to themselves and their insurance company to do a thorough investigation.

Rather than wait to find out what their findings are, you may want to call and schedule your free consultation with a Cincinnati workers comp lawyer. They can review your workers compensation claim and reach out to your employer to find out what’s going on. If, as they suspect, your claim is being reviewed as a potentially fraudulent claim, you and your lawyer will be fighting in uphill battle.

Has Your Employer or Their Insurance Company Out and Said This Directly?

When you first come into our office and meet with one of our Cincinnati workers comp lawyers, they’re going to ask you what proof you have that your employer is chalking your claim up to being fraudulent. If it has already been a week or two and you still have not received a letter from your employer or their insurance carrier, it could be very good news or very bad news. It could mean that they have not found anything to substantiate their claims that your workers compensation claim was false. It could also mean that they’ve already made their decision and have just not drafted their letter of denial yet.

There Certain Things Employers Look for in a Fraudulent Claim

You’re probably wondering what things your employer looks out for to indicate that someone has filed a fraudulent workers compensation claim. Some of these may seem like common sense to you. For example, if you report your workplace accident first thing on a Monday morning, your manager and human resources director are going to be suspicious. This is especially true if you are a relatively new employee.

Another red flag is if there’s no witnesses to your accident. If no other coworkers or managers saw what happened, it is very easy for them to argue that there was no accident at all. Another sign that may lead your employers to think that your workers compensation claim was fake is if you’ve posted on social media about an accident you suffered over the weekend prior to your alleged workplace accident. It can seem awfully coincidental that you got hurt outside of work on Sunday and reinjured yourself again on Monday while working.

If Your Case Raises Too Many Red Flags It Will Be Denied

There are certain things that make employers suspicious when it comes to a workers compensation claim. We like to call these things red flags. If your employer or their insurance carrier sees these red flags, they’ll have no choice but to deny your claim. You can certainly ask your Cincinnati workers comp lawyer to file an appeal on your behalf, but there’s no guarantee you’ll win on appeal.

Most companies are unwilling to accuse somebody of filing a fraudulent claim unless they have very strong evidence against them. They don’t want to look like the kind of company that doesn’t want to take care of their employees. They also don’t want to ruin your reputation as a good worker. But that doesn’t mean that they’re going to pay your claim despite their strong suspicions that it’s fake.

You do have the option of appealing your claim. Perhaps once your Cincinnati workers comp lawyer gets a chance to see why they think you’re claim was fake, they’ll be able to convince them otherwise. But usually, by the time your employer makes a determination that a claim is fraudulent, an appeal is not going to do much to help you. It may be more important to recognize what these red flags are so that this sort of thing never happens to you again. You always have the option of getting a job somewhere else. If you’re adamant that the fact that your claim is legitimate, you can file suit against your employer.

Your Lawyer Can Help Appeal Your Workers Compensation Claim

One thing your Cincinnati workers comp lawyer can do is reach out to the workers compensation Commission and ask for a hearing on the matter. If you do decide to appeal your claim and proceed with the hearing per your attorney’s suggestion, you may get a copy of whatever information your employer has indicating that your claim was fraudulent. If you’re Cincinnati workers comp lawyer can prove that their ideas or theories are incorrect, then there’s a remote chance that your benefits will be paid. Knowing that your employer has the option of pursuing criminal charges against you, you have a tough decision to make.

We suggest that you contact our office as soon as possible after you find out something strange is going on. We do offer new clients a free, initial consultation so you have nothing to lose.

Jay A. Bolotin is a partner at the injury law firm of Young, Reverman & Bolotin. Serving the people of Indiana, Kentucky, and Ohio, Jay dedicates his career to helping clients in the tri-state area obtain financial compensation after suffering serious injuries. He focuses his practice on cases involving car accidents, trucking accidents, dog bites and animal attacks, and other types of personal injury incidents.

Years of Experience: More than 25 years
Registration Status:: Active
Bar Admissions: Illinois, Kentucky, Ohio, Indiana, and Cincinati Bar Association