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You never expect to get hurt during a typical day at work, but injuries happen every day – often through no fault of your own. While the rate of nonfatal workplace injury in North Carolina’s private industries is significantly lower than the national average, thousands of our employees rely on the workers’ compensation program to pick up the slack when illness or injury renders them unable to work. The North Carolina Industrial Commission (NCIC) reported more than 52,000 workers’ comp claims opened in 2023 alone.

Unfortunately, there are plenty of unscrupulous workers who take advantage of workers’ comp benefits by defrauding the system.

A 73-year-old Mooresville resident and former U.S. Postal Service worker Johnnie Franklin Sullivan, Sr. was convicted last month of grossly exaggerating his injury to collect benefits after investigators found photographic proof on his social media.

Sullivan was injured in May 2005 while working as a mail processing clerk in Charlotte and began receiving workers’ comp benefits later that year. To maintain those payments, workers must submit regular reports on the status of their condition and inability to perform their jobs.

Court documents revealed that Sullivan repeatedly submitted false statements and documentation about his condition and medical restrictions, including that he couldn’t sit for long periods, drive, or participate in recreation and hobbies. He received more than $100,000 in payments over the next several years.

At the same time, said U.S. Attorney for the Western District of North Carolina Dena King, Sullivan was posting pictures online of himself hiking, ziplining, surfing, and dancing throughout the U.S. and Europe.

Sullivan pled guilty to workers’ comp fraud, which is a felony punishable by hefty fines and years in prison.

Workers’ Comp Fraud Hurts Everyone

When someone dishonestly receives workers’ comp payments they might think they are stealing only from the government, but the consequences of this crime hurt everyone the program is designed to protect.

And it’s not just employees who try to game the system; in fact, most cases of workers’ comp fraud are committed by employers. Recent research by the Coalition Against Insurance Fraud (CAIF) found that while employees nationwide commit $9 billion worth of fraud annually, employers are responsible for $23 billion. In fact, workers’ comp fraud is the fastest-growing type of insurance fraud, costing over $7 billion every year.  

Examples of employee (claimant) fraud include:

  • Falsely claiming a self-inflicted injury, one that never occurred or one that happened outside of work
  • Exaggerating an injury’s severity to get more money and time off
  • Claiming their injury prevents their ability to work, then get a different job to receive benefits and a salary at the same time

Employees who are attempting to commit workers’ comp fraud might claim an incident with no witnesses, refuse medical treatment, wait to report the injury for no clear reason, frequently change jobs or primary care doctors, be difficult to reach while on leave, and show signs of being employed elsewhere or doing activities their injury should prevent.

Most employers who cheat the system are doing it for lower workers’ comp insurance premiums. Some ways they do this:

  • Not maintaining active workers’ comp insurance (illegal if you have three or more full-time employees)
  • Billing legal or medical providers for nonexistent or exaggerated services 
  • Lying about the type of work performed, number/employment status/salary of employees, or existence of a workplace safety training program

Unfortunately, the employees and employers who commit fraud don’t realize or care that their actions make it more difficult for honest working people to provide and benefit from workers’ comp. 

Fraud often means that premiums go up, forcing employers to pass those higher rates to their customers and/or cut employee jobs and benefits. 

More than 28,000 workers’ comp fraud cases were reported during North Carolina’s 2022-23 fiscal year. Employees who suspect fraudulent employers should contact their local labor department; employers should inform their insurance carrier, who will open an investigation.

How To Prevent Workers’ Comp Fraud

The CAIF says that 20 percent of small business owners wouldn’t know how to identify a workers’ comp scam. Given the many ways to cheat the system, it’s important to know how to protect yourself or your business through prevention.

Before hiring someone, conduct a thorough background check and call previous employers for insight on suspicious behaviors. Depending on the carrier, you might be able to ask for a history of any prior claims.

Buffer the workplace by installing security cameras, keeping meticulous payroll records, training employees on workers’ comp procedures and fraud warning signs, encouraging whistleblowing with incentives, and instituting a clear zero-tolerance fraud policy.

Do I Need A Workers’ Comp Lawyer?

Workers’ comp fraud doesn’t just drive up premiums; it can also increase the likelihood that an employee with a legitimate claim is denied or faces employer retaliation. A North Carolina workers’ compensation lawyer can assist in cases like these.

While you don’t need a lawyer to file a workers’ comp claim, if anything goes wrong during the process or you haven’t met all the requirements, without the help of a workers’ comp attorney you could be denied and plunged into the often devastating debt created by medical bills and lost wages. 

Your employer’s insurer could deny your claim by insisting that your injury or illness happened outside of work and/or was preexisting, or deem your injuries too mild to qualify for long-term or permanent disability. And a vengeful employer can find ways to make your work life miserable that don’t directly break anti-retaliation laws.

The workers’ compensation attorneys at Whitley Law Firm have the knowledge and experience to win your claim on your behalf. We have been helping North Carolina injured workers obtain their full benefits, get their checks on time, and fight back against employer retaliation for decades. If your claim is denied or escalated to a trial, we can represent you confidently and aggressively. Please click here or call 919-785-5000 for your free case review.

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