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What Is Considered Workers’ Compensation Fraud in Ohio?

June 6, 2022

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Workers’ compensation is an important government program in Ohio and other states in the U.S. It helps injured workers pay for their medical bills and replace their lost wages whether they are temporarily or permanently disabled after an injury on the job.

However, one of the biggest drawbacks to workers’ compensation is the lengthy and complex process of getting approved for benefits. Many first-time applicants are denied, and that’s because the Ohio Bureau of Workers’ Compensation (BWC) has a strict review process to attempt to reduce fraud.

Workers’ compensation fraud is a major issue, and it costs taxpayers, businesses, and the state big money every year.

Workers Can Commit Fraud by Receiving Benefits They’re Not Entitled To

One of the most common forms of workers’ compensation fraud is workers applying for and receiving benefits that they shouldn’t be eligible to receive. This can include workers who were injured outside of their workplaces applying for benefits and workers exaggerating their injuries and disability levels to be approved for benefits or prolong their benefits. In some cases, it can even involve workers fabricating injuries to get benefits.

The BWC requires evidence of injuries and their disabling effects on workers, but sometimes, people can fool the BWC into believing they’re eligible for benefits. Medical providers may play along to assist in this type of fraud. In other cases, injured workers with initially valid claims can continue receiving benefits for weeks, months, or even years after they’ve recovered enough to go back to work by lying about their recovery and disability status.

Employers Can Commit Fraud by Misclassifying Workers, Denying Injuries, and More

Almost all employers in Ohio are required to have workers’ compensation insurance to protect their employees. However, having workers’ compensation insurance isn’t free. To reduce their operating costs and boost their profits, some business owners opt to reduce their workers’ compensation insurance premiums through fraud.

One of the most common ways employers do this is by misclassifying employees as contractors. Because contractors aren’t eligible for workers’ compensation benefits, employers use this tactic to reduce the number of workers they’re required to cover via their workers’ compensation insurance policies.

Another common tactic employers use is to simply deny that workers were injured on the job or to intimidate them into not filing claims. In some cases, employers may pretend to be helpful and proactive when injured workers say they’re going to file claims, only to hide or destroy documentation when the BWC requests it from injured employees.

Medical Providers Can Commit Fraud by Lying about Treatments or Exaggerating Injuries

Many of the medical treatments injured workers receive are paid for by the BWC. Medical providers can commit workers’ compensation fraud by saying they performed certain tests and procedures that their patients never received to receive money from the BWC for those services.

They also may work with injured workers to falsely diagnose them with more serious injuries or by increasing their level of disability from temporary to permanent. This can result in injured workers receiving benefits for significantly longer periods than they would otherwise be eligible.

What Happens to People Charged with Workers’ Compensation Fraud?

Workers’ compensation fraud is a serious offense. Workers, medical providers, and business owners who are charged with workers’ compensation fraud are often required to pay back benefits they earned or to pay large fines. They may also even face prison time.

It’s not always easy for the BWC to catch instances of workers’ compensation fraud. While the BWC investigates suspicious cases, it also relies on tips from people who are aware that it’s occurring. Stopping workers’ compensation fraud helps save the state and taxpayers a significant amount of money, and the BWC reports that its special investigations department helped save $1.6 billion by identifying fraudulent cases between July 1993 and June 2015.

However, bad actors who commit fraud make it harder for legitimately injured workers to get the help they need.

Let Our Lawyers Help You Get Workers’ Compensation Benefits Fair and Square

At Nurenberg, Paris, Heller & McCarthy, we play by the rules while also working hard to ensure our clients get the maximum benefits they deserve when they’ve been legitimately injured in the course of their job. If you or someone you love suffered an injury or illness at work or while participating in work-related activities, we want to hear from you.

Our Ohio workers’ compensation lawyers have decades of experience building, submitting, and appealing claims for injured workers throughout the state, and we know what it takes to prove they have a legitimate claim. Every claim we build is 100% compliant with the BWC’s standards and requirements, which not only protects our clients legally but also speeds up their claims and improves their chances of approval.

Contact us today for a free consultation to find out how we can help.

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