San Antonio Workers' Comp Fraud Attorney
Workers' Compensation and Fraud in San Antonio
Texas has strong laws that regulate workers' compensation claims across the state. Whenever an injured worker files a claim, there are strict protocols that must be followed to ensure that all necessary actions are being followed to protect both the worker and the employer. Punishment for fraud in any part of the system can be harsh. To ensure you are following the requirements of workers' compensation laws and that your employer is as well, we recommend you consult with a workers' compensation attorney from the Malaise Law Firm. Our office will carefully review your claim and explain any necessary steps to provide you with the best opportunity to have your claim accepted. Below is a brief outline of some of the types of fraud that can occur in the system and that you should watch out for.
Benefit Fraud
- An employee fakes an injury in order to collect benefits
- An employee who is being paid workers' compensation benefits because due to an injury but is working full time at an unreported job
- A health care provider assists the employee in a fraudulent scheme
- A health care provider bills for services not provided
Fraud by Employers
- Classifying their employees as a different category in order to lower their insurance premiums
- Inconsistent Payroll information
- A large change in premium to a lower amount from one year to the next
- A large employer claiming very little payroll in order to pay little in workers' compensation insurance premiums
- Frequent additions and cancellations of coverage
Fraud by Health Care Providers
- Medical reports that seem to be mere copies of generic type medical reports
- Treatment dates on holidays or weekends for non-emergency situations
- Bills from a healthcare provider or attorney that represent an unreasonable amount of billable hours per day
- Bills or explanation of benefits for services from health care providers or insurers that seem unnecessary or fictitious
- Attorney relationship with a health care provider that appears to be a partnership in handling workers' compensation claims
Fraud by Employees
- No witnesses to an injury
- Injury occurring late Friday or early Monday
- Injury not reported in a timely manner
- Employer disciplinary action on the employee followed by a workers' comp claim
- Injury occurring before a strike or holiday, or in anticipation of termination
- Injury occurring in a location where the employee would not normally work
- Injury that is inconsistent with normal job duties
- Employee observed in activities inconsistent with the reported injury
- Employee history of workers' comp claims
- Conflicting diagnoses from subsequent treating providers
- Evidence of employee working elsewhere while drawing benefits
If you suspect fraud in any claim you are filing on the part of the employer or health care provider, report it at once to your attorney or the workers' compensation insurance company. If, on the other hand, you are accused of some type of fraud in filing a claim, you will need the assistance of our knowledgeable staff to determine exactly what occurred and get the matter cleared up as quickly as possible. At the Malaise Law Firm we are ready to assist you with whatever legal help you need when it comes to your workers' compensation benefits.
If you have any questions about workers compensation fraud, call the Malaise Law Firm to discuss with an attorney.