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Massachusetts Workers’ Compensation Fraud

In Massachusetts, a worker who is injured or becomes ill as a result of employment may be entitled to Massachusetts workers’ compensation benefits. An eligible worker may receive benefits that cover treatment of the injury or illness as well as total or partial wage replacement. A worker who claims these benefits, yet continues to work, can be charged with a crime in Massachusetts.

The Massachusetts workers’ compensation system is a no-fault system, meaning that an injured employee is not required to prove negligence on the part of the employer. If the injury or illness occurred within the scope of employment, then a claim for benefits will likely be approved. If, however, a worker applies for wage replacement benefits, the worker must certify that he or she is unable to work and that he or she did not work for the time period for which benefits are claimed.

Wage replacement benefits can be total or partial. Total wage replacement benefits are based on a worker not being able to work at all, whereas partial wage replacement benefits replace only the income the worker loses as a result of an injury or illness. If, for example, you were working 40 hours a week and a work-related injury causes you to be able to work only 20 hours per week, you may qualify for wage replacement benefits for the 20 hours you cannot work.

A worker who claims wage replacement benefits is certifying to the Commonwealth of Massachusetts that he or she did not work during the time period claimed. If the worker did actually work, this is a crime. Not only can the worker lose the right to workers’ compensation, but criminal fraud charges can be filed against the worker.

In Massachusetts, the Insurance and Unemployment Fraud Division of the Attorney General’s Office as well as the Insurance Fraud Bureau investigate claims of fraudulent workers’ compensation claims. In 2012, the Attorney General’s Office obtained more than $1.6 million in restitution orders in 32 matters. These fraudulent claims raise the costs associated with the workers’ compensation system for everyone involved, which is why the Commonwealth vigorously investigates and prosecutes offenders. To report suspected workers’ compensation fraud, call 800-32FRAUD or use the IFB Hotline Tip Form.

Get Advice from a Workplace Injury Lawyer

If you have suffered a work-related injury or illness in Massachusetts, you may be entitled to workers’ compensation benefits. Eligibility for benefits depends on the unique facts and circumstances of your injury or illness. An experienced Massachusetts workers’ compensation attorney can advise you about your legal options. The workplace injury lawyers at Kantrovitz & Associates, P.C., can be reached by calling 800-367-0871 or by using our online contact form.