Employers attempt to hide injuries from the system so that their workers’ compensation rates are not affected. Will the employer be prosecuted for this fraud? Sadly, no. Enforcement of fraud laws against employers is the only way to curb this type of conduct. Such action by a district attorney would be surprising. As a result, this type of conduct repeats itself as I have, unfortunately, seen too many times to recount.
Today, I received a call from an auto body technician who seriously burned his leg at work. This should have triggered a workers compensation claim. However, instead of providing him with a workers’ compensation claim form, the employer told him to go to the doctor and (1) just use his private insurance and (2) tell the doctor that the injury occurred at home. This employer conduct is workers’ compensation fraud. Insurance Code 1871.4 defines fraud, in part, as making or causing to be made “a knowingly false or fraudulent statement with regard to entitlement to benefits with the intent to discourage an injured worker from claiming benefits or pursuing a claim.”
Fearing for his job, this injured worker unfortunately followed the direction of his employer. However, it has been several months since the injury, and he is still having problems from the burn and related nerve damage. He is now feeling like he should have filed a workers compensation claim. But, he is naturally concerned about the inaccurate statements he made to his doctor about the genesis of the injury. If he files a claim, the workers’ compensation carrier will likely deny it given the history set forth in the medical record. It will take many months and much in the way of unnecessary expense to get this sorted out.