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  • Writer's pictureDeCiccio & Johnson

Workers’ Compensation Fraud in FL—You Can Lose Everything!

Updated: Feb 22, 2023

What is workers’ compensation fraud in Florida? It is purposefully lying or not telling the whole truth to get workers’ compensation money or medical benefits. The lie or half-truth can be made to the adjuster or your employer, to a doctor or to the defense lawyer in a deposition. The lie can be about a prior medical condition, claim, injury, accident or medical treatment. The lie can be about a different body part than your workers' compensation injury. The lie can be using a false social security number when getting medical treatment for your work-related injury.

What happens if the insurance company claims you committed fraud? The insurance company stops all benefits until the Judge of Compensation Claims decides your case.

What happens if you are receiving workers' compensation and the Judge finds you committed fraud? You forfeit all benefits. You owe the workers’ compensation carrier for what it paid you. You can face criminal felony prosecution and possibly the loss of your liberty if convicted—that’s pretty much everything.

Any question in your case about a prior medical condition, a prior injury or treatment or a prior accident, can be a fraud trap if you lie, answer incorrectly or guess wrong.

How do you avoid workers’ comp fraud?

  • Tell the truth, always.

  • Don’t rely on your memory and never guess.

  • Search your memory and records about previous injuries, conditions and treatment; write them down, make a list.

  • Obtain your prior medical records and hand them to the doctor—you can count on the insurance company getting your prior medical records and checking if you had any prior claims.

  • If asked orally or in writing about prior conditions, don’t answer “yes” or “no” if unsure. Leave it blank or just say you don’t remember or don’t know—be truthful.

  • Review your pre-accident medical records before giving any statements or depositions.

Let’s say you hurt your back at work and your employer authorizes an urgent care clinic. The nurse at urgent care on your first office visit asks you if you every hurt your back before and you say “no,” but you did: 10 years ago, you went to the hospital and had an MRI of your back. In your records, the nurse writes, “patient denies any prior back injury or treatment.” The insurance company gets your old hospital records, claims you committed workers’ compensation fraud and denies your claim. You say you “forgot.” You go back to urgent care, and they tell your case is closed, you are now without medical treatment for your back.

This is when you seek experienced workers’ compensation counsel who tries and wins fraud cases.

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