The Colorado Workers' Compensation Act, §8-43-402 C.R.S., provides that if a person willfully makes a false statement or representation material to a Workers' Compensation claim for the purpose of obtaining benefits, payments, compensation, or awards such person commits a class 5 felony, punishable as provided in §18-1-105 C.R.S.
To be convicted of Workers' Compensation fraud in Colorado, it must be proved that material false statements or representations were made..
TYPES OF FRAUD:
- Applicant/Claimant Fraud . . .
- Knowingly making a false Workers' Comp claim
- Faked or exaggerated injuries
- Multiple claims/identities
- Injuries not sustained at work
- Unreported income/second jobs
- Billing or Provider Fraud . . .
- Inflated/over-billing
- Services not rendered
- Employer Fraud . . .
In worker's compensation claims some of the
common fraud indicators include:
- The accident occurs soon after either the policy inception date or the worker becomes employed.
- The accident occurs shortly before layoffs, termination or strikes are announced.
- The circumstances of the claim are suspicious for various reasons, such as no witnesses, inconsistent versions of the accident, the nature or extent of the injury is inconsistent with the job type or there is difficulty reaching the claimant at home during normal, weekday business hours.
- A surveillance reveals the totally disabled worker is currently employed elsewhere.
- After injury, the injured worker is never home, or a spouse/relative who answers the phone says the injured worker “just stepped out.”
- The claimant demands quick settlement decisions or commitments.
- The claimant is unusually familiar with workers’ compensation claims handling procedures and laws.
- The accident occurs late Friday afternoon or shortly after the employee reports to work on Monday.
- Fellow workers hear rumors circulating that the accident was not legitimate.
- The accident is not promptly reported by the employee to a supervisor.
- A "Monday morning" injury, The injury is reported early on the first work day of the week.
- Injury is not witnessed
- Claimant is disgruntled or has been reprimanded
- There is material misrepresentation of facts
- Claimant malingers, Prolongs recovery and/or exaggerates symptoms.
