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Workers' Compensation Fraud
Most cases that involve fraud really are not fraud cases at all. Those are the situations in which one doctor examines a worker and concludes that he or she is fully recovered from whatever injuries he or she sustained, while another doctor ' usually a treating physician ' says that the worker remains symptomatic and is still not able to go back and perform the job he or she had when the injury occurred.
There is another side to fraud. That component deals with employers and insurance companies. For this reason, it is pleasing to see that prosecutors in Pennsylvania have targeted employers as well as employees who violate the Workers' Compensation Act.
Case in Point
In one case I handled, the employer claimed that his workers were independent contractors and that he had no obligation to purchase workers' compensation insurance. Nevertheless, when he applied for motor vehicle insurance, he listed those same “independent contractors” as employees.
The tragic part is that my client suffered catastrophic injuries and was forced to obtain benefits from the Uninsured Employers Guaranty Fund. The UEGF, which was created by the legislature to provide coverage for injured workers whose employers have evaded the law by failing to purchase the mandatory workers' compensation insurance, paid nearly $290,000 in benefits as of June 2015.
Fortunately, the Montgomery County, PA, district attorney prosecuted the employer, who pleaded guilty to the crime of failing to procure workers' compensation insurance. The employer was also ordered to repay the UEGF and while it is unlikely the UEGF will ever be fully reimbursed, this prosecution does send a message to other employers that they should think twice before deciding to misclassify workers to save money on workers' compensation insurance.
Daniel J. Siegel writes for The Legal Intelligencer, an ALM sibling publication in which a longer version of this article also appeared.
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