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New York Workers' Compensation Blog For Small Business Owners

What are signs of possible insurance fraud?

Insurance fraud is unfortunately an all-too-common occurrence. While most policyholders are honest when making claims, others may falsify information to receive compensation under fraudulent pretenses. That's why it's crucial for insurance companies to be on the lookout for potential red flags. Doing so can possibly heady off fraudulent claims and prevent payouts that aren't warranted for legitimate reasons. 

A list of suspicious loss indicators was established by the National Insurance Crime Bureau to help insurance agents. These indicators should trigger a more thorough review of a claim, especially when multiple indicators are present in a single claim. For example, is the person reporting the claim in a calm manner even though the loss was substantial? Most people exhibit some level of stress when reporting a claim, especially when it involves their house or vehicle. Also, is the person attempting to provide handwritten receipts to establish proof of ownership? Was the insurance amount increased shortly before the claim was made? 

How can I identify workers' comp fraud?

According to Business News Daily, fraudulent workers' compensation claims cost a staggering $7.2 billion per year. That's why it's crucial that employers are able to properly identify common red flags indicating a work injury is not all it seems. The following are a few signs you can look out for if you suspect your employee is making a false claim in order to receive compensation. 

While work injuries can occur at virtually any time, many false claims have a pattern of falling on certain days. For instance, a worker in search of an extended weekend might file a claim first thing Monday morning while claiming the accident or injury actually took place on Friday. Work injuries should be reported to the appropriate parties as soon as they occur, and it stands to reason that workers would want the matter attended to quickly. That's why unexplained delays are often considered suspicious.

Defending blocked workers’ compensation claims

New York workers sustain injuries on the job every day. Whether you run a construction business or have a small office, accidents happen. However, not all injuries sustained while on the job or company property are compensable. At Stockton, Barker & Mead, LLP, we often assist clients with a wide range of workers’ comp issues.

FindLaw reports that accidental injury and occupational disease issues are the most common claim categories. Depending on the circumstances, there are a variety of defenses that can apply to a particular claim.

  • The deadline for notifying an employer of an injury ranges from 30-90 days. Failure to do so within the time frame may make your employee ineligible for a claim.
  • Time limits for filing a claim is different from a worker notifying you of their injury. Statute of limitations ranges from one to three years.
  • Independent contractors injured on the business premises may be ineligible for compensation benefits. This is true even if the company is negligent.
  • Employee negligence occurs when they perform duties while intoxicated or while engaging in “horseplay.” This term applies when a person’s injuries result due to their own carelessness.
  • To have a workers’ compensation claim approved, employees must have an independent medical exam. It verifies the case is authentic and is the basis for the benefits paid. If an employee fails to have this exam, they may receive a claim denial.

Workers compensation claims rise during the summer months

The hot months, June through September, are a volatile time for on-the-job injuries and loss productivity due to the filing of workers compensation claims. Employers need their staff on site, not on the mend. For employers, hurt staff often leads to lost revenue.

The Bureau of Labor Statistics found that 40% of the injuries sustained were sprains, strains and tears. An added 11% were surface wounds like scrapes or abrasions and 10% of the injuries were open wounds like punctures or cuts.

Can an independent contractor waive employee rights?

As someone who owns and operates a small business in the state of New York, at times you may need to hire an independent contractor to handle tasks that an employee is not qualified for. In doing so, you are aware that state and federal law carefully distinguishes between employees and independent contractors and can penalize you for treating an independent contractor as an employee. So you should be careful while designating a worker as an independent employee.

The New York Department of Labor website explains that some employers may consider having an independent contractor sign an agreement that explicitly waives their rights as employees while they are in service to the employer. The statement may claim that the worker is an independent contractor and not an employee. An employer might also try to have the contractor acquire a DBA, or a Doing Business As designation that gives the contractor an operating business name.

Understanding sovereign immunity

There are some who might argue that people are more hesitant to bring claims against government or municipal agencies because the thought of battling it out with such organizations may seem daunting. On the other hand, as the representative of such an agency, your experience may have shown you that people see state and local governments as easy targets. Many in your same situation often come to us here at Stockton, Barker & Mead, LLP questioning exactly what rights their employees have when bringing claims against their agencies. They often cite a legal principle that is widely misunderstood: sovereign immunity. 

The idea of sovereign immunity comes from Old English times, when making claims against the ruling body was not allowed. The same principle was applied with the establishment of democratic governments. However, the right to recognize sovereign immunity has been left to the individual states. According to the New York City Bar, New York has officially waived the right to sovereign immunity, meaning that people can bring claims against government and municipal agencies (including workers' compensation claims). However, such claims must often be managed differently than a traditional workers' compensation case. 

When might an employee not be covered?

The general assumption regarding workers' compensation benefits is that all eligible employees have access to them, regardless of fault. This offers you (as an employer in Troy) an added sense of security in knowing that not only is your workforce protected, but so are you. Yet could there be situations where an employee is excluded them receiving workers' compensation coverage?

The New York State Workers' Compensation Board identifies those types of employees not eligible for coverage. Some of the more common groups include: 

  • Volunteers for non-profit organizations 
  • Clergy members
  • Real estate and insurance agents operating as independent contractors
  • Participants (including coaches and players) in amateur athletic events 

Slip and fall injuries can happen in summer

You may think that customer slip and fall injury concerns have passed along with the winter. While it’s great to have your parking lot plowed and salt the sidewalks of your property during the winter, that vigilance should be continued into the warmer months. Unfortunately, slip and fall season is year-round.

OSHA reports that slip and fall injuries are the second-leading cause of accidental deaths behind motor vehicle accidents nationwide. These injuries comprise one-fourth of all reported injury claims and can affect your insurance costs and the productivity of your employees.

A closer look at workers' comp fraud

Workers' compensation benefits are meant to help employees who have sustained job-related injuries and are struggling with the consequences of these injuries, such as financial problems due to missed work and medical costs. Unfortunately, some people take advantage of the system and attempt to pursue benefits that they are not entitled to. There are a number of reasons why people try to obtain workers' comp benefits that they should not be entitled to and our law office believes that this is unacceptable. Unfortunately, many people have gotten away with fraudulent workers' comp claims and received benefits that never should have been awarded.

Workers' comp fraud may occur in a number of ways. In some instances, an employee may file a claim over an injury or illness that has been completely fabricated. Or, an employee may be struggling with a relatively minor injury or illness, but they may exaggerate the extent of their suffering in order to become eligible for these benefits. Furthermore, a worker may sustain an injury that took place outside of the workplace and they may try to claim that they were hurt on the job in order to qualify for workers' comp.

Workers' comp claims over slip-and-fall accidents

Workplace injuries take place in many different ways, and it is important for employers to consider various preventative measures to keep employees safe and avoid some of the consequences of workplace accidents. Unfortunately, workplace accidents cannot always be avoided, no matter how much a company focuses on employee safety. Moreover, there are times when workers falsely claim that they were hurt on the job and attempt to pursue workers' compensation benefits that they should not be entitled to. Sometimes, these cases may involve an alleged slip-and-fall accident.

An employee may falsely claim that they were hurt in a slip-and-fall accident, or they may purposely create a scenario which leaves them injured in order to gain access to benefits. For example, an employee may pretend to fall down due to a slippery surface, and claim that they were hurt when they were not injured in the accident. Or, they may have suffered an injury in another manner (such as an accident that took place outside of the workplace) and decide to place the blame on a slip-and-fall accident that never occurred.

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