You may have heard that workers’ compensation fraud is a common problem in Georgia. There are many employers and insurance companies who benefit from saying so, because this discourages workers from filing workers’ compensation claims, minimizes the compensation that they receive when they do, and justifies unfair treatment of injured workers. You might hear anecdotal ‘evidence’ of this widespread abuse of the system, including stories about workers who exaggerated their injuries or faked them altogether. While this surely does happen occasionally, the truth is that it is very uncommon for employers to make fraudulent workers’ compensation claims. In fact, it is more common for employers and insurance companies to engage in fraudulent behaviors, as we will discuss further.
The likelihood of employees filing fraudulent claims, exaggerating, or faking their injuries has been found to be less than one percent. This is because there is not much advantage for the employee to do so. If successful in filing a fraudulent workers’ compensation claim in Georgia, the employee could get their medical expenses covered and perhaps some time off of work to recover from their faked or exaggerated injuries, but ultimately, the effort of doing so is not worth the outcome. The employee would be jumping through hoops to get the benefits, only to end up with 2/3 of their former wages and coverage of medical expenses. Most employees would rather continue with their normal work duties, continue to receive their usual pay, and avoid the difficulties and obstacles that they have to face to receive workers’ compensation.
On the other hand, there is far more benefit for employers and insurance companies to engage in fraudulent behaviors to refuse or minimize workers’ compensation benefits to employees who are truly injured. The employer and insurance company can benefit from this tremendously by not having to pay (or not having to pay as much), and they don’t even have to jump through a lot of hoops to achieve that goal. Yet, they also benefit from spreading the rumors and the myths of rampant employee fraud in workers’ compensation claims. So, this is what you hear about, and you hardly ever hear about the much more common instances of fraud on the part of the employers or the workers’ compensation insurance companies.
Employers Have Greater Incentive to Commit Fraud than Employees Do
As we’ve already pointed out, employers stand to benefit from fraudulent behaviors much more than employees do. Just how much greater is their incentive? It is a difference between an employee gaining perhaps $500 per week (taking a significant cut in pay) and the employer saving millions of dollars by not covering valid injuries.
At the same time, you have to consider the likelihood of getting caught, which is much greater on the part of an employee than it is for an employer. The employer can easily get away with denying that your injuries are work related or denying your coverage for any other reason. If you don’t fight it, then they save money without any consequences.
Even if you do fight it, and even if you are successful, the employer doesn’t get into any trouble. They don’t generally get accused of fraud. They simply fail in their efforts to save the money they hoped to save by denying your claim. So, there are no major or severe consequences for the employer. On the other hand, if an employee is caught in fraudulent behavior, there are very serious consequences. The employee will likely lose their job and get no benefits at all, putting their entire way of life in jeopardy, possibly resulting in homelessness or other serious financial consequences. Here, it is easy to see why an employee would be more likely to avoid any temptations to commit fraud, whereas and employer has little motivation to avoid this.
Examples of Fraudulent Behavior in Workers’ Compensation Claims From Employers
While it is a myth that there are many examples of employee fraud in Georgia workers’ compensation claims, there are plenty of examples of fraudulent behavior on the part of employers. Following are some of the most common of these examples:
- Employee Misclassification – Georgia law requires that any employer with three or more regular employees must carry workers’ compensation coverage. However, this is not the case if they are not ‘regular employee.’ The employer can classify you as an independent contractor and completely avoid having to purchase workers’ compensation coverage. Imagine how much the employer stands to gain when hundreds or thousands of employees are classified as independent contractors!
- Refusal of Medical Coverage – If you are an injured in employee in Georgia, then you have a right to receive all necessary and reasonable medical care, prescriptions, diagnostic testing, specialist appointments, etc. Yet, your employer or the workers’ compensation insurance provider might deny coverage for some or all of these needs.
- Referral to Doctors Who are Biased – Doctors who are on the workers’ compensation insurance approved panel of physicians stand to benefit from minimizing your injuries or releasing you to return to work when you are not truly well enough.
- Employer Retaliation – While employer retaliation is illegal, it can be difficult to prove. Your employer might fire you after you file a workers’ compensation claim, but deny that this is the reason. They may cite any reason at all for termination.
Contact a Georgia Workers’ Compensation Attorney
If you think you might be a victim of workers’ compensation fraud, or if you are being wrongfully accused of workers’ compensation fraud yourself, then you should immediately contact a determined Georgia workers’ compensation attorney. At The Law Office of John B. Jackson, we are happy to provide a free consultation and protect your workers’ compensation rights.