Illinois Workers’ Compensation Fraud

Committing workers’ compensation fraud is a huge mistake. That said, if you’re wrongfully accused of committing it, you’re likely extremely worried–after all, workers’ compensation fraud is, in some cases, a felony in Illinois. Our firm can help. Continue reading and reach out to a seasoned Illinois workers’ compensation attorney from the Law Firm of Kevin A. Moore to learn more about what constitutes workers’ comp fraud, the penalties for it, and how we can assist if you’ve been falsely accused.

What Counts as Illinois Workers’ Compensation Fraud?

Workers’ compensation fraud can be committed by either employees or employers, and in Illinois, both parties are held to high standards of honesty when filing or handling claims. That said, it’s important to understand exactly what constitutes fraud so you can avoid it, and so you can identify when someone may be wrongly accused. Examples of workers’ compensation fraud committed by employees may include the following:

• Faking an injury or falsely claiming that an injury occurred at work when it happened elsewhere.
• Exaggerating the severity of an injury in order to receive greater compensation or extended benefits.
• Collecting benefits while working another job–especially if that job involves physical activity inconsistent with the reported injury.
• Failing to report recovery or an ability to return to work, thereby continuing to receive benefits under false pretenses.
• Submitting false medical records or receiving treatment from a provider in on the scheme.

Employers and insurers can also commit workers’ compensation fraud. Examples include:

• Misclassifying employees as independent contractors to avoid providing benefits.
• Underreporting payroll to lower workers’ compensation insurance premiums.
• Dissuading employees from filing legitimate claims or outright denying claims without proper investigation.
• Failing to carry required workers’ compensation insurance, while falsely claiming that coverage exists.

Examples of Illinois Workers’ Compensation Fraud by Employees and Employers

The consequences for workers’ compensation fraud in Illinois can be severe. Depending on the nature and extent of the fraud, you could be facing not only financial penalties, but also criminal charges. In many cases, these charges rise to the level of a felony. Some of the potential penalties you may face are as follows:

• Criminal Charges: Under Illinois law, the offense class depends on the value of the property obtained or attempted to be obtained: a Class A misdemeanor at $300 or less, a Class 3 felony from $300 to $10,000, a Class 2 felony from $10,001 to $100,000, and a Class 1 felony above $100,000.
• Sentencing Exposure: A Class 3 felony carries a sentence of two to five years, a Class 2 felony three to seven years, and a Class 1 felony four to fifteen years, along with significant fines.
• Restitution: Courts often order individuals found guilty of fraud to repay any benefits received improperly, which may include wage replacement benefits, medical expenses, and other costs.
• Civil Liability: Beyond criminal penalties, a person convicted of fraud may be civilly liable to the payor for three times the value of benefits wrongfully obtained, or twice the value of benefits attempted to be obtained, plus reasonable attorney’s fees and expenses.
• Loss of Benefits: If you’re found to have filed a fraudulent claim, you will likely lose all current and future workers’ compensation benefits, even if part of your original claim was legitimate.
• Reputational Damage: A fraud conviction can damage your professional reputation and may impact your ability to find employment in the future.

Defending Against False Accusations of Illinois Workers’ Compensation Fraud

Being falsely accused of workers’ compensation fraud is not only stressful–it can feel deeply unfair, especially when you’re already trying to recover from a legitimate work-related injury. Unfortunately, misunderstandings, miscommunications, or even employer retaliation can lead to serious allegations that put your health, finances, and freedom at risk. False accusations can arise in a variety of situations, including:

• Innocent mistakes on paperwork–such as errors in dates, injury descriptions, or income information–that are misinterpreted as deliberate misrepresentations.
• Disputes over the origin of the injury, especially if there were no witnesses or if the employer questions whether the injury truly occurred on the job.
• Employer pushback when a worker files a claim, and the company attempts to reduce liability by questioning the worker’s honesty or character.
• Surveillance footage taken out of context–for example, video of you lifting groceries might be used to suggest you’re not injured, even if your doctor cleared you for light activity.

If you’re facing a false accusation, do not try to handle it on your own. Even unintentional errors can be painted as intentional fraud, especially when insurance companies or employers are looking to deny a claim.

At The Law Firm of Kevin A. Moore, we take these accusations seriously. Our team will carefully examine the details of your case, gather medical evidence, speak with experts, and advocate aggressively on your behalf. We can also help you respond to inquiries from the Illinois Workers’ Compensation Commission or law enforcement, ensuring that your side of the story is fully and fairly presented.

Most importantly, we know how devastating it can be to be treated like a criminal for simply seeking the benefits you’re entitled to. You don’t have to go through it alone–we’re here to fight for your name, your benefits, and your future.

Common Questions About Illinois Workers’ Compensation Fraud Allegations

What determines how serious an Illinois workers’ compensation fraud charge is?

The value of the property obtained or attempted to be obtained. Since 2011, the Act has used graduated tiers rather than a single offense class, so the same conduct can be charged very differently depending on the dollar amount involved.

Is being accused of workers’ compensation fraud the same as being charged?

No. Reports go to the Department of Insurance fraud unit, which investigates and may refer a matter to the Attorney General or a State’s Attorney. Those offices decide whether to prosecute. Many reports are closed without any charge being brought.

Can my employer report me for fraud because I filed a claim?

The Act makes it unlawful for an employer, insurance carrier, or service adjustment company to file or threaten to file a fraud report against an employee because the employee exercised rights under the Act. Anyone who intentionally makes a false report commits a Class A misdemeanor.

How an Illinois Workers’ Compensation Attorney Can Help You Fight Fraud Allegations

The Law Firm of Kevin A. Moore is dedicated to representing injured workers throughout the state of Illinois. If you’ve been injured on the job, you can depend on us to effectively fight for the full and fair compensation to which you are entitled. Likewise, if you’re wrongfully accused of workers’ compensation fraud, we can effectively advocate for your rights and benefits. Contact the Law Firm of Kevin A. Moore for a free initial consultation today.