What Happens If You Get Caught Working While on Workers Comp?

Receiving workers’ compensation benefits aids employees in their recovery from work-related injuries or illnesses by helping with medical expenses and replacing their lost wages. However, not following the rules associated with these programs can have severe consequences.

Can Employees Work While on Workers’ Compensation?

Yes, it is permissible for you to work while receiving workers’ compensation benefits. However, there are some important steps and communications that must take place. If you’re returning to work but performing a lighter-duty job than before your injury, both your pre-injury employer and their insurance company need to be kept updated about the situation.

If, on the other hand, you find another light-duty position with a different employer altogether during this period of rehabilitation, there’s still an obligation on your part to report any income generated from this new employment. You must share this information with the insurance company of your former employer who is paying out your workers’ compensation benefits.

If your current earnings are less than what you were making before your injury, you may still be eligible for workers’ compensation benefits, known as partial wage loss benefits. The calculation of these benefits depends on the difference between what you earned prior to getting injured and the current wages.

How Would You Get Caught Working?

If you’re supposed to be receiving workers’ compensation benefits and are working at the same time, there are numerous ways in which this could potentially come to light. If for some reason your employer suspects that you are working, they may initiate their own investigation.

Alternatively, their insurance company or even the state workers’ compensation commission can initiate an inquiry.

Corroboration may take different forms such as hiring a private investigator who would observe your activities, assess if they align with the medical limitations indicated by your claim for worker’s comp benefits, and then report on any discrepancies. These investigations often involve checking social media accounts for posts that contradict reported injuries or capabilities.

Additionally, third-party reports from fellow employees or other people aware of both your injury claim and work situation can end up being relayed back to your employer or their insurance company, initiating an investigation.

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What Happens if You’re Caught Working When You Shouldn’t Be?

If you are caught working while receiving workers’ compensation benefits, it’s seen as a serious offense under U.S. law and is usually considered fraud – an action that could invite significant legal consequences.

The Department of Labor’s Office of Inspector General (OIG) investigates potential violations tied to fraud within workers’ compensation programs, looking into allegations such as failing to disclose income or employment while collecting benefits, presenting false medical documents, feigning injuries or disability statuses. This department also scrutinizes any possible participation from medical professionals in deceitful acts. Those found guilty can face penalties ranging from fines to prison sentences.

Exaggerating Symptoms: This involves employees claiming their injuries are more severe than they actually are to obtain benefits they are not entitled to. For example, a worker may claim that a minor back injury prevents them from sitting or standing for long periods, despite medical evidence to the contrary.

Lying About the Ability to Work: Employees may falsely claim that they are unable to work in any capacity due to their injuries while they are, in fact, working another job or engaging in activities that contradict their stated limitations.

Falsifying the Circumstances of the Injury: This form of fraud includes incidents where employees claim an injury occurred at work when it happened elsewhere. An example would be an employee who injures themselves during a weekend sporting event but reports the injury as occurring on the job site.

Misrepresenting Previous Injuries: Workers may hide or lie about previous injuries to the same body part or condition to make a current claim appear more serious, thereby attempting to receive higher compensation.

Malingering: This involves an employee extending their absence from work under the pretext of work-related injury recovery when they are medically fit to return to work. Malingering is often done to continue receiving benefits without the intent of returning to work soon.

Fabricating Injuries: This involves claiming an injury that never occurred. An employee might report a nonexistent injury following a near-miss incident or even create a scenario in which an injury could have plausibly occurred but did not.

Understanding and identifying these examples of workers’ compensation fraud is crucial for employers, employees, and insurance providers, ensuring that genuine claims are honored and fraudulent claims are appropriately dealt with, maintaining the integrity of the workers’ compensation system.

Preventive Measures for Employees to Avoid Unintentionally Committing Fraud

By adopting transparent practices and maintaining open lines of communication with employers and insurers, employees can help avoid misunderstandings that could potentially be misconstrued as fraudulent. Here are some tips to achieve this:

  • Regular Updates: Keep your employer and insurance provider updated with regular progress reports about your recovery and work status. Frequent and honest communication prevents any misinterpretation of your situation.
  • Accurate Timekeeping: Maintain accurate records of work hours, days off taken due to medical appointments, and any adjustments to your work schedule. This documentation helps verify the legitimacy of your claim and ensures transparency.
  • Medical Documentation: Provide timely and comprehensive medical documentation to support any claims related to injury or recovery status. This includes doctor’s notes, treatment plans, and medical bills.
  • Understand Policies: Make an effort to understand your employer’s policies related to leave, disability, and workers’ compensation. Knowledge of these policies can help you adhere to the required procedures, thereby avoiding any actions that could be seen as fraudulent.
  • Seek Clarification: If you’re unsure about how to report your work status, recovery progress, or any aspect of your claim, don’t hesitate to ask for clarification from your employer or insurance provider. It’s better to seek advice than to make assumptions that could lead to unintentional errors.
  • Honest Communication: Be honest and forthcoming about your capabilities and limitations upon returning to work. Misrepresenting your ability to perform certain tasks can lead to misunderstandings and potentially fraudulent situations.

By following these preventive measures, employees can significantly reduce the risk of unintentionally committing fraud, ensuring that their recovery and return to work process is conducted with integrity and transparency.

Why You Need An Attorney For Workers Compensation Claims

Why You Need An Attorney For Workers’ Compensation Claims

Undеrstanding and properly navigating workers’’ compеnsation law can bе complеx. This is whеrе a skilled Washington D.C. workers’ compensation lawyеr becomes invaluable.  An еxpеriеncеd attorney can providе guidance to ensure that you comply with all required rules related to workеrs’ compеnsation, avoiding any unintended violation.

Dеpеnding on your unique situation, you might still bе еntitlеd to carry out another job whilе receiving benefits, something a lawyеr from Lightfoot Law can hеlp you dеtеrminе. If you havе questions or need hеlp, don’t hesitate to contact us to schеdulе a frее consultation.