Under CRS 8-43-402, it is a crime in Colorado to make a false statement on a workers’ compensation claim in order to obtain benefits, payments, or compensation to which the person is not lawfully entitled.
Workers’ compensation fraud is a felony punishable by jail time, fines, loss of workers’ comp benefits, and having to repay any benefits that a person wrongly received.
In this article, our Denver Colorado criminal defense lawyers will address:
- 1. What is workers’ compensation fraud?
- 2. What are the penalties for workers’ comp fraud?
- 3. What are the signs of workers’ comp fraud?
- 4. What are defenses to charges of workers’ comp fraud?
- 5. What if I am being investigated for workers’ comp fraud in Colorado?
- 6. Related Offenses
1. What is workers’ comp fraud?
Workers’ comp fraud involves making a false statement or representation of material fact in filing a workers’ compensation claim for the purpose of obtaining benefits, payments, compensation, or awards.1 In order for a prosecutor to prove a case of workers’ compensation fraud, they must prove the defendant:
- Made false statements or representations;
- Claim decisions were made based on the false statements or representations material to the workers’ comp claim; and
- The statements or representations were made with the intent to defraud.
For workers claiming compensation, fraud may include:
- Making a false workers’ comp claim
- Exaggerating injuries
- Filing multiple claims under different names
- Falsely claiming an injury is work-related
- Working under the table while receiving workers’ comp
Workers’ comp fraud is not limited to workers filing false claims. Healthcare providers, insurance adjusters, and employers can all be involved in workers’ comp fraud. Healthcare providers, including doctors and chiropractors, may bill insurance companies for services never provided or help a worker file a false disability claim. Adjusters and employers may misrepresent facts to deny claims or discourage employees from seeking workers’ compensation.
2. What are the penalties for workers’ comp fraud?
Under C.R.S. 9-43-402, workers’ compensation fraud is a class 5 felony. The penalties for workers’ compensation fraud may include 12 to 18 months in prison and a fine of up to $100,000. There is a mandatory parole period of 2 years for a class 5 felony.
In addition to prison time and fines, after a conviction for workers’ compensation fraud, the defendant shall forfeit all right to compensation. They may also be required to pay back money unlawfully received through workers’ compensation.
3. What are the signs of workers’ comp fraud?
Employers, investigators, and insurance companies look for signs of possible workers’ compensation fraud. This may indicate fraud or give investigators reason to look into the claim to discover fraud. Some potential red flags include:
- Injury without any witnesses
- Claimant has recently been reprimanded at work
- Conflicting statements on the cause of injury
- Injury occurring during the first shift of work
- Services billed inconsistent with type of injury
- Untimely reporting of the accident
- Claimant is a new employee
- Injury occurs shortly before or immediately after a vacation
- Injury occurs during the final days on the job
4. What are defenses to charges of workers’ comp fraud?
There are many defenses to charges of workers’ comp fraud. This includes:
- You did not intend to commit workers’ comp fraud
- You believed you were submitting an accurate and legitimate workers’ comp claim
- Incorrect information was entered by mistake or was a typo
- You were a victim of identity theft
- An employer retaliated against you by falsely reporting workers’ comp fraud
5. What if I am being investigated for workers’ comp fraud in Colorado?
Workers’ compensation fraud may be investigated by the workers’ comp insurance company, employer, or by Colorado officials. Colorado’s Workers’ Compensation Fraud Investigation Unit is the office that conducts investigations for claims of workers’ comp fraud for the state. The Division of Workers’ Compensation also provides online fraud reporting forms that allow individuals to confidentially report fraud. This includes reporting fraud against a worker, employer, healthcare provider, or anyone else involved in workers’ comp fraud.
Insurance companies may hire private investigators to watch a claimant and look for signs of fraud. This includes conducting video surveillance, reviewing online social media activity, and speaking to neighbors about your activity. They may be looking for signs you are not disabled, such as doing yard work, playing sports, or going on vacations. In many cases, the insurance company uses this evidence to deny a workers’ compensation claim even if the worker is unable to work. If you suspect you are being investigated for workers’ comp fraud, contact your Colorado workers’ compensation fraud attorneys.
6. Related Offenses
Workers’ comp fraud may involve other related offenses. This includes identity theft charges when another person’s information was used to get workers’ comp benefits. Workers’ comp fraud may also involve insurance fraud for claims involving health, medical, or disability insurance.
6.1 Identity Theft C.R.S. 18-5-902
In Colorado, it is a criminal offense to use another person’s personal or financial identifying information to obtain anything of value. This includes using another person’s identity to file a claim for workers’ comp benefits. Identity theft is a class 4 felony in Colorado. Penalties for identity theft include 2 to 6 years in prison and a fine of up to $500,000.
6.2 Insurance Fraud C.R.S. 18-5-211
Insurance fraud involves presenting a false insurance claim for a loss, claiming a loss for damage that occurred prior to coverage, intentionally damaging covered property, or presenting a false statement for an insurance claim. This includes medical insurance, disability insurance, or other types of insurance fraud. Insurance fraud is a class 5 felony. The penalties for insurance fraud include up to 3 years in prison and a fine of up to $100,000.
If you have been accused of workers’ comp fraud or are being investigated by the Workers’ Comp Fraud Investigation Unit, please contact us at Colorado Legal Defense Group.
- C.R.S. 9-43-402