Workers’ Compensation Attorneys Serving Clients in Princeton, Ewing, Hamilton, Pennington and across Mercer County, NJ
The concept of insurance fraud continues to find its way into the New Jersey Workers’ Compensation claims. Insurance carriers are now directing their lawyers to pursue fraud claims against injured employees as a means to terminate medical and monetary benefits. However, the nature of this fraud does not always lie in acts that could be recognized as “obvious.” An obvious example would be when an employee exaggerates the severity of their medical condition and is later found engaging in activities inconsistent with the nature of their complaints. Another obvious example is when an injured employee is found collecting money while engaged in a work-related activity which is more strenuous than the work they performed for their employer.
Legitimate Claims and Disabled Employees
Unfortunately, there are allegations of fraud being made against disabled employees with legitimate claims. These employees are complying with the instructions of their treating physicians and adhering to the directions of their insurance adjusters. Nonetheless, the insurance carriers are attempting to terminate their obligation to provide benefits by invoking N.J.S.A. 34:15-57.4. This is a New Jersey law holding that an employee is guilty of fraud if they file a workers’ compensation claim for medical or temporary disability benefits when they know that the claim contains false or misleading information. A violation of this statute under the New Jersey Criminal Code is a crime of the fourth degree, which could subject the person to a sentence of up to 18 months in county jail. The penalty in workers’ compensation court is the termination of all benefits and an order to repay back the benefits already received.
Insurances Carries and Fraudulent Actions performed by employees
Insurance carriers in New Jersey are bringing fraud actions when they believe they can prove that an employee knowingly failed to reveal prior injuries, accidents, or other claims. This is because the employee filing the claim has an obligation to notify either the treating physician, the evaluating physician, or the insurance carrier insuring their employer of these other factors.
The success or failure of the insurance carrier’s approach in these cases is almost completely in the hands of the workers’ compensation judge who is assigned to the case.
However, there is some guidance for judges when confronted with a fraud claim.
- First, the alleged infraction must be more than an inaccurate or inconsistent statement made during the course of treatment. Many people cannot recall the names or dates of physicians who treated them for injuries in the past – especially those individuals with a lengthy personal injury history.
- Second, the alleged infraction must be more than an omission of prior diagnoses to their treating physician. Many people cannot recall all of the tests performed or their test results. It is enough that the injured employee informs his treating doctor that they had a prior injury to the area of the body which they are alleging arose out of the work-related accident.
Keep in mind that major treatment, such as surgery or the recommendation for surgery, is also information that should be shared with your physician. This is common sense, as you want your doctor to know your complete history so that you can receive the very best treatment available to you.
As a general rule, if you are injured at work, you need to be honest with your doctors. Follow their directions and restrictions at all times.
Contact our Trenton Personal Injury Staff of Attorneys
If you have any questions about your obligations when injured, please contract Kamensky, Cohen & Riechelson we have experienced attorneys in Princeton, Ewing, Hamilton, Pennington and across Mercer County, New Jersey.