Last month I posted about a food worker that L&I said wrongfully obtained over $11,000 in workers’ compensation benefits. Today L&I announced that it has accused a Washington State woman with stealing over $11,000 in workers’ comp benefits. L&I has been investigating this case since 2015. Now, she has been charged criminally with first degree theft. Revised Code of Washington, Title 9A, is the relevant criminal statute. The statute allows a business or individual to be charged for theft against L&I.
What is willful misrepresentation in an L&I claim?
Here again, this story illustrates how seriously L&I takes fraud allegations. Under the Industrial Insurance Act, fraud is called willful misrepresentation. It means obtaining workman’s compensation benefits you are not entitled too. It includes intentional, conscious, or deliberate false statements and misrepresentations, omissions, or concealment of fact to obtain or increase benefits. L&I has a detailed checklist it provides self-insured administrators that outlines reporting requirements for willful misrepresentation. Simply put, in L&I’s view, it is willful misrepresentation for a person to intentionally obtain benefits they are not entitled to by willfully misrepresenting or omitting material facts.
The impact on L&I work injury claims in Washington State
According to L&I, this type of fraudulent behavior costs the system millions of dollars each year. Employers, employees, insurance carriers and Washington consumers pay the cost of fraud. These costs include lost jobs and profit, and lower wages and benefits. On top, there are increased costs for services and premiums. Fraud can be committed by employees, employers, health care providers, attorneys and others. To this end, RCW 51.48.020 allows felony (class C) charges to be filed against any employer that knowingly misrepresents to L&I the amount of payroll or worker hours. The employer is liable for up to ten times the difference in premiums due. Furthermore, the employer is liable for any reasonable expenses of auditing the employer’s books.
If interested, more information about L&I’s efforts to investigate and prosecute fraudulent behavior can be found on the L&I website.
what if the department willfully miscalculate your wages and do not change it, what can i do
You have 60 days within which to protest or appeal the “wage order” . On appeal you can produce pay stubs or other documentation you have to show that the wage rate calculation is wrong. However, if you do not protest or appeal the wage order within 60 days then it will become final and binding and there isn’t anything you can do.
what can I do when false accusations are placed into my l an I file by my employer representative or medical
You can write your own response describing the falsehood and explaining the truth and submit it to the file.