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NYC Workers Comp Fraud Lawyers

Understanding Workers’ Compensation Fraud and Penalties in New York

The workers’ comp system helps protect employees who are injured on the job. Injured workers don’t need to prove negligence in order to get their disability benefits or to get medical bills covered pertaining to the on-the-job injuries. As long as the employee shows the injury or illness was from work tasks, the employee gets the benefits. The benefits can be huge, especially if the employee can no longer work due to the disabling illness or injury.

The Problem of Workers’ Compensation Fraud

The problem is if you lie about it or lie about the extent of your injuries, and then you’re proven to be lying. That’s when you need a New York workers’ comp fraud lawyer to help defend you.

Workers’ compensation fraud is taken VERY seriously by authorities. The New York State Insurance Fraud regularly encourages people to report suspected workers’ compensation fraud. The Office of the Inspector General of the Worker’s Compensation Board is dedicated to investigating any violations of workers’ compensation fraud and finding fraud cases. If fraud can be proven, you could face jail, restitution, fines, and other penalties. If you’re accused of worker’s compensation fraud, you need to ensure you understand your legal options. You need to fight aggressively in order to make sure these allegations don’t compromise you and your future.

At Spodek Law Group, PC, we understand the importance of having a competent workers’ compensation fraud claims attorney. We understand the long-lasting impact this can have on your life and your family. We understand the legal complexities associated with fraudulent workers’ compensation claims. Our criminal defense law firm was founded by former prosecutors and knows how to win cases. If you need a solid defense, then you need our New York criminal defense lawyers who can advocate for you and give you the legal representation you deserve.

What’s Workers’ Compensation Fraud?

Workers’ compensation fraud happens when someone knowingly makes false statements in order to obtain benefits for themselves or someone else. Workers’ comp fraud can be committed by employees who apply for and receive these benefits. In some cases, employers and health care providers have also been known to commit workers’ compensation fraud when they knowingly try to deny benefits in order to save money. Anyone who’s involved in a workers’ compensation scam can end up facing charges for criminal behavior that he/she did, in addition to the behavior of co-conspirators. Often, we see “fraud rings,” which consist of many people working to manipulate the workers’ compensation system in order to gain or deny benefits.

Examples of Fraud

Worker’s comp fraud can come in many forms, depending on who’s carrying out the scam. Sometimes, it can be an employee, an employer, or even a health care provider. Here are some examples of fraud we’ve seen in the past:

  • Claiming an injury happened on the job when no injury occurred
  • Claiming the injury was sustained through work-related tasks when it was in fact caused by something else
  • Exaggerating the symptoms to make the injury look worse, with the goal of remaining on disability for as long as possible
  • Working under the table and not reporting income while collecting workers’ compensation benefits
  • Falsifying medical records to deny coverage

Employers have also been known to commit workers’ compensation fraud. Employers are required to purchase workers’ comp insurance and are restricted from deducting the premium payments from the wages of workers. If an employer does something to commit any form of fraud related to workers’ compensation coverage, this can result in serious criminal penalties.

Health care providers have also been known to commit worker’s compensation fraud as well. Often, providers work hand-in-hand with employees who are committing fraud. Medical care providers help employees fake or exaggerate injuries so the employee can collect disability benefits and not work. The medical care provider continues to collect payment for unnecessary medical services.

Here are some examples of health care providers’ workers’ compensation fraud our lawyers can help with:

  • Unnecessary testing of workers to bill insurers
  • Unnecessary treatment to bill insurers
  • Billing for medical treatment not performed
  • Double billing for the same service

Employers, employees, and medical care providers alike can be charged with criminal fraud. If you are such a party, we encourage you to contact our NYC workers’ compensation criminal lawyers today.


There are penalties that can be imposed for workers’ compensation fraud. It’s a Class E felony to knowingly prepare or submit statements that support a workers’ compensation claim if the written statement is false or has material misrepresentations.

The same also applies to employers and insurance carriers who make false statements when reporting, investigating, or adjusting benefit claims in order to avoid providing benefits. Employers making such false representations can be charged with a Class E felony. Repeat offenders who commit similar offenses within a 10-year period of a conviction can be charged with a Class D felony.

Felony convictions are severe. Class E felonies can lead to imprisonment for 1-4 years. Defendants could also be charged with other fraud crimes and offenses, such as mail fraud and wire fraud.

Misclassification of Employees as Independent Contractors

What’s the Difference?

As a business owner, the types of personnel you utilize can impact the way you conduct your business and how you compensate the individuals performing work. For instance, there are certain benefits you must provide to hired employees that don’t necessarily apply to freelance workers, outsourced contractors, or interns. For this reason, the Department of Labor may conduct an audit to verify your personnel are functioning in their designated capacity.

When the Department of Labor determines that an audit of your business is necessary, you’ll receive a letter. This will provide you notification of the process, allowing you time to prepare. This is often a good time to hire an attorney to help you avoid unpleasant consequences of noncompliance with the state employment laws. An attorney can help you explore your options and give you a better understanding of how the laws apply to your business.

What are the Characteristics of an Employer/Employee Relationship?

The establishing of an employer/employee relationship isn’t determined by one or two concrete details but by an assembly of factors. These different characteristics are commonly found in most employer/employee relationships and generally are concerned with the ways in which the work is performed. In this type of arrangement, a commonly accepted principle is that the employer provides more direct supervision of the person performing the work.

An employee must adhere to a predetermined work schedule and must perform work in a manner defined by the employer. The employer also designates where and how the work will be performed, usually leaving the employee with detailed instructions on the performance of his or her duties. This usually requires that the employee perform those duties on-site or at a location designated by the employee.

Additionally, it will be up to the employer to set the pay or salary range for each position and often demand exclusivity of service from the employee. This means that the employee may not perform those duties for other employers or businesses while also demanding that the employee personally completes those tasks. As an employee, an individual may not enlist a third party to perform tasks he has been assigned.

How to Identify a Freelancer or Independent Contractor

In the simplest terms, an independent contractor has more freedom in the performance of his duties. He’s generally left unsupervised to perform the work when and how he chooses, which indicates he may or may not have to perform the work at the employer’s place of business. The Department of Labor recognizes a few other factors that can be used to distinguish an independent contractor from a direct hire employee.

For instance, an independent contractor or freelancer generally operates a business of their own. The business usually focuses on a specific skill set, which the freelancer is experienced in providing to multiple clients. This means the independent contractor will also have their own tax identification number and will be able to provide services to the general public. Clients may consist of individuals or other businesses.

As a freelancer or independent contractor, this type of professional is responsible for his own marketing campaigns. This may mean he has his own business cards, pays for online or print advertising, or uses social media to generate new leads. He may also work out of his own home or occupy a separate place of business, where he invests in machines, furniture, and equipment to help him perform his job.

Another good way to identify an independent contractor is by the expenses he pays out to continue performing his duties. This may include paying taxes and insurance premiums but also involves other expenses associated with operating his business. As the owner of the business, the individual also takes sole responsibility for any profits or losses he incurs. This is why the freelancer usually sets his own fee, which the client must pay if he wants that freelancer’s services.

There is more freedom for an independent contractor as well. He may delegate assignments to employees of his own, or he may perform the work himself. Additionally, he has the choice of when and where to perform the work, though this can depend on the nature of the work. An independent contractor also has the right to reject clients or refuse specific work offers.

While these conditions can go a long way toward helping you understand the differences between a direct employee and a contractor, consulting an attorney may be your best option. An audit can change the way you conduct your business and may subject you to legal penalties if you don’t make necessary changes. An experienced lawyer will know what changes you will need to make to help you obtain a more favorable outcome from a Department of Labor audit. In the end, hiring a lawyer is an investment in your business that can save you money down the road.

Why You Should Hire a Workers’ Compensation Lawyer

Being injured at work is a difficult experience that can get expensive if you don’t know what steps to take as you move forward. Your injuries can stop you from reporting to work and cause you to lose your wage while you recover, but you must also consider the medical bills you will likely face.

Trusting their employer to do the right thing, many victims opt not to get a lawyer and are unable to receive the compensation they deserve. No matter how long you have worked for your company or the nature of your injuries, having a legal professional on your side is vital.

Build Your Case

If you want to get the best possible results, building your case immediately after the accident takes place is important. Everything you do or say can affect the way your case plays out if you go to court, and you don’t want to take the wrong path. Your NYC employment lawyer will guide you through the critical first steps and help you form a solid case that will enhance your odds of reaching a fair outcome. Having a talented and caring lawyer on your side will let you know you are in good hands, and the smart choice will become clear.

Protect You From Retaliation

Those who are injured at work are entitled to file for workers’ compensation to cover medical fees and lost wages. Sadly, not all companies are happy with employees who file claims and will try to retaliate.

Unless you already know your legal rights and how you can defend them, you will need an experienced lawyer for support. Your attorney will let you know if your manager or supervisor has crossed the line and what you can do about it. Nobody should be afraid to seek the needed compensation to make it past a workplace injury, and a legal expert can keep you out of harm’s way.

Work Out a Fair Settlement

The company for which you work likely has a legal team tasked with protecting the company’s interests, which means paying you as little as possible. Your employer might try to convince you to accept an unfair settlement by stating you don’t have a strong case.

Without experience in workers’ compensation lawsuits, you won’t know if your company is being honest. On the other hand, your employer will likely back off when it sees you have a competent lawyer on your side. After building your case and reviewing the evidence, your lawyer will negotiate to get you the best possible settlement, helping you avoid the uncertainty of a trial.

Fight for Your Rights in Court

Workplace injury victims are not always happy with the settlement offered by their employer, which is understandable. The lawyer you hire will want to know how you feel about the terms before accepting the settlement, and he will support you if you decide to fight in court.

In front of a judge or jury, your attorney will showcase the evidence in your favor and explain why you are entitled to compensation for your losses. The law requires companies to provide a safe workplace that is free from unnecessary dangers, and your lawyer will pursue justice when your employer fails to live up to that obligation.

Final Thoughts

Although dealing with a workers’ compensation lawsuit is not always easy, the right lawyer will simplify the process and boost your chance of reaching your goal. You will take action without stress because you will know you are in good hands from the start. Dedicated to meeting your needs, your lawyer will zealously defend your rights and strive to get you the required compensation to cover your injuries, medical bills, and lost wages.

If you have been accused of workers’ compensation fraud or need assistance with a workers’ compensation claim, don’t hesitate to contact the experienced attorneys at Spodek Law Group. Our NYC workers’ compensation fraud lawyers are ready to provide you with the legal representation you deserve.

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