Source: https://loisllc.com/tag/fraud/
Timestamp: 2019-04-22 20:44:46+00:00

Document:
New York State workers’ compensation fraud may take many forms and result in a myriad of consequences. WLC § 114(a) not only governs circumstances of fraud but also describes significant penalties for those who are caught committing fraud such as a permanent ban on their eligibility to receive indemnity benefits and/or a permanency award.
WCL § 114(a) directs that a claimant is to be penalized if he or she “knowingly makes a false statement or representation as to a material fact . . . .” in furtherance of receiving workers’ compensation benefits. This mandatory penalty is a forfeiture of all compensation that is directly attributed to the false statement. Workers’ compensation fraud penalties only apply to indemnity benefits and permanency awards, paid medical benefits are not subject to forfeiture in a fraud determination. See Jacob v. New York City Transit Auth., 26 A.D.3d 631, 809 N.Y.S.2d 618 (App. Div. 2006); Matter of Robinson v. Interstate Natl. Dealer, 50 A.D.3d 1325 (3rd Dept. 2008).
Explainer: Fraud as a Defense in New York Workers’ Compensation Claims.
How does New York define “Fraud”?
Any person who knowingly and intending to defraud the workers’ compensation system by presenting (or assisting in presenting) an application for benefits, which contains a misrepresentation of a material fact. The penalty: Class E Felony charges. In addition to a Class E Felony conviction, the claimant who is convicted loses the right to all past and future compensation benefits. Fraudsters have to return any money they got through their fraud. WCL § 114. This is contrary to the general rule of law that claimants do not have to pay back money fraudulently obtained.
A claimant who applies for workers’ compensation benefits is required to provide accurate records and truthful statements to the WCB, the insurance carrier, and the employer. However, the law does not require the claimant to give a truthful account of their condition to their medical care provider. The prohibition on false representations appears to only apply to false statements made to get a monetary benefit – it does not appear to apply to medical awards or benefits, since the prohibition on lying applies only to WCL § 15 (indemnity awards) and not expressly to § 13 (medical benefits) or § 16 (death benefits).

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