Workers’ compensation insurance is meant to protect employees and businesses by covering medical expenses and lost wages for workers injured on the job. However, fraudulent claims can be a serious problem for New York contractors. One particularly frustrating scenario is when a worker files a claim months later—sometimes directly with the New York Workers’ Compensation Board—without notifying the employer at the time of the alleged incident. This can leave contractors blindsided, facing increased premiums and potential legal battles.
If you’re a contractor dealing with a fraudulent workers’ compensation claim, it’s essential to know your rights and how to defend yourself. Below, we outline steps you can take to fight back against fraudulent claims and protect your business.
How a Fraudulent Workers’ Comp Claim Can Happen
New York law allows workers to file a workers’ compensation claim within two years of an injury. However, some dishonest employees may exploit this system by filing fraudulent claims, often months after leaving a job. Contractors frequently encounter cases where a former worker claims they were injured on a site they never reported at the time. This can lead to a lengthy dispute, higher insurance costs, and unnecessary legal expenses.
The process usually unfolds like this:
- You Receive a Notice from the Workers’ Compensation Board – Instead of being informed by the worker at the time of injury, you first learn of the claim when you receive an official notice.
- The Employee Alleges an Injury from Months Ago – The worker claims they were injured while working for you but did not report it at the time.
- You’re Asked to Respond – The Board and your insurance carrier will expect you to provide evidence or statements regarding the alleged injury.
- Your Insurance Premiums Could Increase – If the claim is accepted, it could impact your experience modification rate (EMR), leading to higher insurance costs.
Steps to Defend Against a Fraudulent Workers’ Comp Claim
1. Gather Employment and Payroll Records
Your first line of defense is proving whether the claimant was even working for you at the time they claim they were injured. If you have accurate payroll records, timecards, or subcontractor agreements, you can use these to dispute false claims.
2. Check Incident Reports
If an injury truly occurred, it should have been reported at the time. If there was no report filed and no supervisors or coworkers recall an incident, this can support your case. Keep detailed records of all reported injuries to ensure fraudulent claims stand out.
3. Collect Witness Statements
Did anyone see the alleged injury occur? If the employee never mentioned an injury or worked without issue, getting statements from supervisors or coworkers can help disprove their claim.
4. Review Medical Records
If the claimant sought medical attention, their records should reflect the injury’s date and circumstances. Sometimes, fraudulent claims involve injuries sustained outside of work, and medical records may indicate inconsistencies.
5. Conduct a Background Investigation
If you suspect fraud, look into the claimant’s history. Have they filed multiple workers’ comp claims in the past? Are they currently employed elsewhere doing similar work? In some cases, hiring a private investigator can help gather evidence that disputes the claim.
6. Notify Your Insurance Carrier Immediately
Your insurance carrier has investigators and attorneys who specialize in workers’ comp fraud. The sooner they are involved, the better your chances of contesting the claim. Provide them with all relevant documentation, including employment records, witness statements, and any available surveillance footage.
7. Request an Independent Medical Examination (IME)
If the claim moves forward, you have the right to request an independent medical examination. This can help determine whether the injury is legitimate and work-related. If the worker refuses the IME, it could weaken their case.
8. Challenge the Claim with the Workers’ Compensation Board
If you have evidence proving the claim is fraudulent, you can formally challenge it. This process may involve hearings and legal representation. Be prepared to present your case with strong documentation.
9. Consider Legal Action for Fraud
If you can prove fraud, you may have grounds to pursue legal action against the claimant. New York law imposes penalties on individuals who commit workers’ compensation fraud, including fines and criminal charges.
How to Protect Your Business from Future Fraudulent Claims
Fraudulent claims can cost contractors thousands of dollars in increased premiums, legal fees, and lost productivity. Preventative measures can help protect your business.
- Require Immediate Injury Reporting – Have a strict policy requiring workers to report injuries immediately and in writing.
- Use Surveillance Cameras – Video footage from job sites can help dispute false injury claims.
- Maintain Detailed Employee Records – Keep accurate records of work schedules, job duties, and safety training.
- Conduct Post-Employment Reviews – If a worker leaves your company, document any injury claims they made before they left.
- Partner with a Workers’ Compensation Specialist – A workers’ comp expert can help monitor claims, prevent fraud, and keep your premiums as low as possible.
BGES Group – Your Workers’ Compensation Specialist in the Tri-State Area
At BGES Group, we specialize in workers’ compensation for contractors throughout New York, New Jersey, and Connecticut. We help businesses navigate complex claims, fight fraudulent filings, and keep their insurance costs under control.
With decades of experience, we know how to protect contractors from fraudulent workers’ comp claims that can drive up premiums and put businesses at risk. We offer:
✔ Claims Investigation Assistance – We work with top investigators to uncover fraudulent claims.
✔ Workers’ Comp Policy Optimization – We ensure you have the right coverage at the best rates.
✔ Fraud Prevention Strategies – We help you implement safeguards to prevent future fraudulent claims.
✔ Expert Representation – If a claim goes to court, we connect you with top legal professionals.
If you’re facing a fraudulent workers’ compensation claim or want to ensure your business is protected, contact us today.
BGES Group
📞 (914) 806-5853 – Gary Wallach
📧 bgesgroup@gmail.com
🌐 www.bgesgroup.com
Don’t let fraudulent claims put your business at risk. Let BGES Group help you fight back and keep your workers’ compensation costs under control.