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5 ways employees commit workers compensation fraud

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It seems that every day another story about workers' compensation insurance fraud is hitting the news wire. The recent allegations and lawsuit filed against former NFL player, turned reality star, Brad Culpepper provide just one example of potential workers' compensation fraud committed by an employee. Both employers and health care providers are also subject to laws dealing with fraudulent acts, but the following is limited to a review of claims against employees. Employees can commit fraud in several different ways and  this list is far from comprehensive, but it provides an overview of the the types of actions that may lead to a fraud charge.  Here is a list of 5 ways an employee can commit workers compensation fraud:

  • Working or receiving wages "under the table" while collecting workers' compensation benefits
  • Claiming that an injury suffered elsewhere was sustained on the job
  • Faking an injury, malingering, or misrepresenting the severity of an injury
  • Intentional or self-inflicted injury
  • Providing false information on documentation submitted to authorities


Examples of claimant fraud:

Working while receiving benefits is perhaps the most common fraudulent act committed by claimants. Just this week, a Montgomery County (MD) Police Officer Gilbert L. Payne was accused in Baltimore City Circuit Court with perjury and felony workers compensation fraud. Payne left the Baltimore Police Department on a full disability pension in 2007, prosecutors said. The charges allege that Payne falsely testified under oath at a September 2008 workers' compensation hearing that he was not employed at the time, nor had he been employed since retiring from the city police department. In fact, he was working full time as a sworn Towson University Police Officer, prosecutors said. The charging document alleges that, as a result of this fraudulent misrepresentation, he received just more than $30,000 in payments to which he was not entitled.

A recent fraud case in Pennsylvania was filed against Robert M. Fowler of York Springs, Pennsylvania.  Mr. Fowler was charged with workers' compensation fraud involving $24,934.68 of benefits he was not entitled to receive.  According to U.S. Attorney Peter Smith, Fowler allegedly sustained an on-the-job injury in 1999 while working at the Defense Industrial Plant Equipment Center in Mechanicsburg, Pennsylvania, and began receiving federal workers' compensation benefits from the Office of Workers' Compensation Programs (OWCP) shortly thereafter.  Recipients of these benefits are required to submit forms to OWCP on a periodic basis to insure they are still eligible to receive the benefits.  The charges filed against Fowler allege that he lied on several forms he submitted because he falsely claimed he was not incarcerated during the prior 15 months for a felony and was residing with his wife.  In fact, Fowler was in the Adams County Jail between September 2012 and July 2013 and had not resided with his wife between October 2010 and March 2014.  As a result of the false statements, OWCP paid Fowler $24,934.18 which he was not entitled to receive.

The two examples are just a sampling of recent cases that include employees admitting to workers' compensation fraud. Given Brad Culpepper's inclusion in the recent NFL concussion class action settlement, his prominence as a Tampa Bay personal injury attorney, and his public persona, his case will be an interesting one to follow throughout the legal process.

Bill, Thanks for taking the time to read the blog. Just so you are aware, we represent ONLY injured workers, not the employer or insurance company. This post was in no way meant to "frighten" injured workers from filing claims; in fact, we help people do that on a daily basis! To the contrary, this was provided as an informative post regarding workers compensation fraud, when there was a noteworthy case in the news (Brad Culpepper the former NFL player). The exclusivity provision of most workers compensation acts certainly does strip certain rights of the injured worker, unfortunately, challenges to that provision have repeatedly been rejected (most recently in Florida). Thank you for the suggestion of the LA Times series, if you have the link to send, I will certainly take the time to read the series. Frank Lafferty
Posted by Frank Lafferty on January 30, 2015 at 12:20 PM
READ the LA Times investigative series on work comp fraud. Conclusion: Vast majority of Fraud committed by employers & the workers compensation. Yet, no employer has ever been charged or convicted.... Because employer group 100% funds the police work comp. fraud department....hmmmm. The whole WC system is fraud where employees are stripped of their right to sue by given WC coverage...which is then controlled & articles like this are publicized to frighten employees from filing. Most know their careers done if file.
Posted by bill on January 30, 2015 at 01:17 AM

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