Last week L&I announced that a food service employee will be required to repay more than $11,000 in disability payments. The employee was caught working at a nursing home and hotel while collecting time-loss workers’ compensation benefits. Time-loss benefits are only payable when an injured worker is incapable of working. L&I provides these benefits while the injured worker is recovering from an industrial injury or occupational disease.
Workers’ compensation willful misrepresentation and fraud
Under RCW 51.32.240, it is “willful misrepresentation” for an injured worker to obtain workers’ compensation benefits they are not entitled too. Willful misrepresentation includes intentional, conscious, or deliberate false statements. It also includes misrepresentations, omissions, and concealment of facts. The key is that these actions are with the intent of obtaining or increasing workers’ compensation benefits. Injured workers failing to disclose work-type activities that results in income, repeatedly, may face willful misrepresentation.
If L&I determines that willful misrepresentation occurred, it can charge the injured worker 50% penalty in addition to recouping over-payments. On top, if L&I thinks it is warranted, it will seek criminal fraud charges. However, it is important to note that criminal charges are for fraud. And recall that fraud has a different legal definition than willful misrepresentation.
Misunderstanding and confusion among injured workers
Many injured workers that I represent do not understand the meaning of willful misrepresentation and fraud. The lack of understanding causes anxiety regarding simple activities and daily living. Some injured workers fear that activities such as grocery shopping or volunteering could be willful misrepresentation or fraud. To ease anxieties, I often remind injured workers that being totally disabled doesn’t mean being physically or mentally helpless. In other words, injured workers should certainly engage in appropriate activities.
L&I has an active fraud division to investigate alleged willful misrepresentation. According to L&I: “workers’ comp fraud is not a victim-less crime. Cheaters take resources away from legitimately injured workers and raise costs for employers and employees who pay into the […] system”. Most importantly, injured workers who collect appropriate benefits and are not engaging in intentionally deceptive behavior have nothing to worry about.
You made a good point that charges for willful misrepresentation of worker’s compensation can result in a 50% penalty with recouping overpayments. My cousin has recently been accused of faking an injury for worker’s compensation. Maybe we should get in touch with a worker’s compensation defense attorney to help him make a case for his injury.
I have a question about disability, work comp, and unemployment. I have been on SSDI for quite some time, survived a massive heart attack at age 37, it did major damage to the lower half of my heart. So I would still try to get 20 hrs/wk, which was definitely enough. I was working the morning shift at a fast food restaurant when I fell off a ladder. I shattered the bones in my ankle. I landed on 1 foot, so it took a pretty bad hit. I came home with hardware that included a plate and 12 screws. The ortho surgeon said, down the road, we will have to go back in and remove a couple of the screws. That’s when I really understood how long this recovery could be. Work comp paid a percentage of my meager wages, and covered all my medical bills, and I agreed to a meager settlement. Although, I was not agreeing to let them close the future medical. Good thing, because I ended up having to have the rest of the hardware removed. During this surgery, they were doing invasive work to remove the plate that had shifted. While irrigating it before closing, they noticed my fibula was split, higher up . This led them needing to put in a different plate and 6 screws. Nearing this particular recovery , I was released for light duty. Which was all I could do anyway, due to the heart issue. I went back to work, but only 1 day, because my balance was not nearly good enough to manage those slippery floors, I also was not nearly as fast, and it seemed as though I would have to constantly reach for something to keep me steady. This is not considered to be a productive employee. Moves too slow, can’t stay standing, and making it more difficult for other employees work behind and around me. Clearly I wasn’t as ready as my surgeon’s assistant thought I should be. So in his own smug condescending way, he released me to just work half days! What exactly did Mr. I’ma doctor, think I worked? He had only been told a million times that I only worked part time, to begin with?! So work comp stopped paying me the scraps, they had been. I was still obviously not steady enough to go back, and was pretty certain I shouldn’t apply anywhere else, at that time. So there I was, no income whatsoever! Then suddenly, without any notification, the owner just locked the doors. Employees showed up, only to find a note that said CLOSED permanently. So where does that put me? No matter how I look at it, I couldn’t be more broke(n). I now require the services of more Drs. Rheumatologist, chiropractic, and still a cardiologist. None of which work for free. I don’t know where, what , who, how?!
Hoping for any suggestions.
Great explanation of the difference between the meaning of willful misrepresentation and fraud!
What about the Insurance carrier refuse to pay to the injury worker and use they’d power to destroy they’d lives whom is going for them . They do what ever and none one say any or do anything