Workers' Compensation FraudWorkers’ compensation laws in Texas are intended to protect injured employees and make sure they are provided for if they get hurt. Unfortunately, people sometimes take advantage of the system and commit fraud. There are five different types of fraud in the Texas workers compensation system according to the Texas Department of Insurance. These include “injured worker benefit fraud; insurance carrier fraud; employer premium fraud; health care provider fraud; and attorney fraud.”

The penalty for making a false workers’ compensation claim in Texas will vary depending upon the circumstances. For individuals who commit fraud by lying about their injuries, exaggerating how badly they were hurt, or being dishonest about receiving medical care, the penalties are generally determined based on how much the individual obtained in ill-gotten gains. You need to understand how the laws apply to you and make sure you do not commit fraud after suffering a work injury. A Texas workers’ compensation lawyer at Abbott and Associates, L.L.C. can evaluate your injuries and help you to determine if you have the right to make a legitimate claim for benefits.

What is the Penalty for Making a False Workers’ Comp Claim in Texas?

If you make a false workers’ compensation claim in Texas, you could have the fraud referred to law enforcement for investigation. Texas Penal Code section 35.02 addresses insurance fraud. Under the law, you could be charged with:

  • A Class C misdemeanor if your false claim resulted in $50 or less in benefits. Penalties could include a fine of up to $500.
  • A Class B misdemeanor if your false claim resulted in more than $50 and up to $500 in benefits.  Penalties could include a fine up to $2,000 and up to 180 days of incarceration.
  • A Class A misdemeanor if you receive benefits exceeding $500 but not more than $1,500 due to you false claim. Penalties could include a fine up to $4,000 and up to a year of incarceration.
  • A state jail felony if you false claim resulted in benefits of $1,500 or more but less than $20,000. Penalties include between 180 days and two years of incarceration.
  • A third degree felony if your claim resulted in benefits of $20,000 or more but less than $100,000. Penalties include between two and 10 years of incarceration.
  • A second degree felony if the value of the claim was $100,000 or more but did not exceed $200,000.  Penalties include between two and 20 years of incarceration.
  • A first degree felony if the value of your false claim resulted in benefits of more than $200,000.  Penalties include between five and 99 years of incarceration.

The potential penalty for making a false workers’ compensation claim in Texas is clearly very serious.  Insurers use a number of different tactics to try to identify when fraud has occurred including looking for red flags such as:

  • Significantly delayed reports of injury.
  • A past history of making many workers’ compensation claims.
  • Changing doctors frequently.
  • Injuries occurring when there were no witnesses.
  • Injuries occurring early on a Monday morning or late on a Friday afternoon.
  • Injuries occurring when an employee is anticipating termination.
  • Injuries occurring shortly before a planned strike.
  • Injuries occurring shortly before a holiday.
  • Injuries that occur outside of a location where an employee would normally work.
  • Injuries that are not consistent with an employee’s normal job duties.
  • Injured workers observed engaging in activities that are inconsistent with the injury that has been reported.
  • Conflicting diagnoses from different medical care providers.
  • Evidence that an employee is working elsewhere while collecting workers’ compensation benefits.

It is very important to make accurate reports of your work injury. If you lie about or exaggerate your impairment or illness, you could find yourself faced with a penalty for making a false workers’ compensation claim in Texas. A Texas work injury lawyer at Abbott and Associates, L.L.C. will help you to ensure you file paperwork completely and accurately to get benefits and avoid accusations of false claims.

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