In Nevada, when a business fraudulently tries to pay less for insurance premiums, this is referred to as workers compensation employer fraud. The owner or supervisor of a company can face charges and legal penalties if found guilty. However, there are legal defenses for those who are not guilty of such charges.
Nevada Workers Compensation Employer Fraud Defined
When an employing individual attempts to pay less or nothing at all for workers’ comp benefits, this is called employer fraud. The employing personnel may use deceit or threats to engage in fraudulent activity by:
- • Lying about the number of workers employed by the company to lower premiums or avoid carrying coverage
- • Failing to carry workers’ comp insurance coverage when required
- • Deducting income from employees’ paychecks to pay insurance premiums
- • Lying about employee job duties to pay lower premiums
- • Threatening employees with punishment or termination to reduce claims filed
Other Types of Workers Compensation Fraud
There are other individuals in the Nevada workers’ comp process that may also use fraudulent activities or information in order to profit from benefits, resulting in possible legal action against the guilty party. These types of fraudulence are identified by which person in the process purposely falsifies information or otherwise tries to manipulate the system.
The applicant may try to obtain benefits to which he or she is not entitled by faking or exaggerating an injury, claiming that an injury occurred on the job that actually occurred in a different location, failing to disclose information regarding an existing or previous injury, receiving benefits from multiple places of employment for the same injury, denying any previous workers’ comp claims or filings, and illegally working while collecting benefits.
A workers’ comp insurance carrier may also use fraudulent measures by lying about an injured worker’s eligibility to receive the allowable benefits under a claim in order to pay less money for the health care and lost wages of an injured worker.
An organized ring of participants that may include attorneys, doctors, and other staff, often referred to as a claim mill, file false claims in order to illegally obtain money from insurance benefits.
A doctor or other medical care provider may also deceive the insurer by giving the injured worker additional treatments that are not necessary, billing extra for provided services, or charging for services that are never provided to the worker.
Prosecution of Employer Fraud
All types of fraudulent activity regarding workers compensation are investigated by the Nevada’s Department of Business and Industry. If there is enough evidence, the Workers Compensation Unit of the Nevada Attorney General’s Office will prosecute such fraudulent activity. Additionally, anyone who helps or conspires in such fraudulence will be prosecuted as well.
Federal Laws regarding Employer Fraud
Federal employees have their own system of workers’ comp benefits that works similar to those provided through the state. This program, called the Federal Employees’ Compensation Act (FECA), is maintained and regulated through the United States government.
Defense to Nevada Workers Comp Employer Fraud
Those who are in an employment capacity who are accused and charged with fraudulent activity regarding workers comp benefits are not automatically prosecuted without all information being considered. There are circumstances that may prove that the employing individual did not intentionally commit fraudulent activities.
If the employing individual did not purposely intend to provide misleading information, this may result in a defense of no intent to defraud. In order to be prosecuted, intend must be present.
If one of the other parties in the workers’ comp process blames the employer to cover their own guilt, this may result in a defense of false accusations, and the employing individual can be found not guilty.
Another defense occurs when law enforcement illegally obtains information that is pertinent to the case. This police misconduct may result in the illegally obtained evidence being suppressed and the case being dismissed.
Penalties for Nevada Workers Comp Employer Fraud
Fraudulent activity regarding Nevada workers compensation may result in a fine of up to $5,000, 1-4 years in prison, and victim restitution, as well as the potential suspension or revocation of any professional licenses. Those who are guilty of fraudulence regarding federal workers’ comp may receive a $10,000 fine and spend 5 years in a federal prison.
Legal Resources for Nevada Workers Compensation Fraud
Those who have questions regarding fraudulence and workers comp or who need assistance in their workers’ comp claim or benefits may contact the Morris / Anderson Law Firm. The attorneys have experience in working with these issues and can provide legal representation or the necessary assistance.Go to the Next Article