Committing fraud in connection with Nevada’s workers’ compensation system is a crime. Anyone in the system can potentially commit fraud. Conviction can carry hefty financial penalties, jail time, and the long-term consequences that come with a felony on one’s record. The state attorney general’s Workers’ Compensation Fraud Unit investigates suspected cases.
Injured workers must avoid committing applicant fraud
A worker who behaves dishonestly to get workers’ compensation benefits may be committing applicant fraud. Applicant fraud includes things like faking injuries, lying about pre-existing conditions, trying to pass off an injury suffered at home as work-related, or continuing to work while receiving disability wages. Workers sometimes think they can get away with these things because they are small fish in a big pond. But insurers vigilantly defend themselves against claims fraud and won’t hesitate to report suspicious activity.
Bear in mind that criminal fraud requires an intentional act to deceive. Mistakes on a form or forgetfulness during a physician evaluation don’t rise to the level of fraud unless a worker decides not to correct the problem once it’s discovered. Also remember that the no-fault nature of workers’ compensation means that an injury suffered while working is covered regardless of whether the employee’s negligence caused the injury. It’s important to tell the truth about what caused the injury; lying to hide mistakes may not only threaten a fraud charge, it may also place one’s coverage at risk.
Insurers and health care providers can commit fraud, too
An insurer or doctor’s office can commit fraud as well. Insurers commit fraud by deliberately undermining a worker’s claim to avoid costly payouts. Of course, an insurer will often work hard to find excuses to deny claims, and once it finds a defensible rationale it will reduce or eliminate an injured worker’s benefits with the expectation that the worker will not have the resources to fight the decision. Sharp business practices, by themselves, aren’t fraud. Like applicant fraud, insurer fraud requires a deliberate, dishonest act.
A health care provider can also commit fraud to rack up unwarranted fees. It can do this in a variety of ways, many of which will be invisible to the worker (lying on reimbursement forms, for example) while others may give the worker reason to be suspicious (ordering unnecessary treatments or dragging treatment on well after the incident).
Workers must take care not to become part of a fraudulent scheme by an insurer or health care provider. Paying attention and asking questions can go a long way toward avoiding becoming a part of a criminal enterprise. If something doesn’t seem right, don’t hesitate to reach out to the attorney general’s office or consult with a personal lawyer.
Workers are not alone
The law firm of Greenman Goldberg Raby Martinez represents workers’ compensation clients in the Las Vegas area. If you think you may be the victim of workers’ compensation fraud and would like to talk to an attorney about your legal options, we are happy to help. For a free attorney consultation, reach out to us today at 702-388-4476, or ask us to call you through our contacts page.