Workers' compensation fraud is illegal and may be prosecuted both criminally and civilly. Under the Connecticut General Statutes, it is a felony for any person to intentionally misrepresent or intentionally fail to disclose a material fact in an attempt to receive workers' compensation benefits. A "material fact" is broadly defined to include the existence, time, date, place, location, or symptoms of a claimed injury. Therefore, failure to give complete details regarding an injury or failure to disclose a prior injury or condition may be deemed fraudulent. The Chief State Attorney's office has a fraud investigation unit which has broad powers to pursue workers' compensation fraud through the criminal courts. In addition to criminal prosecution, a fraudulent employee may be liable in a civil proceeding for three times the amount of benefits obtained by the fraud.
In response to the abuses in the workers' compensation system, The Workers' Compensation Trust has adopted a vigorous program to help combat fraud. Our program consists of the following:
The goal of this program is to actively prosecute those cases in which there exists not only a good faith belief that fraudulent conduct has taken place, but also where this conduct can be clearly demonstrated. The Trust believes that one of the best ways to address workers' compensation fraud is through civil and possibly criminal prosecution.
To pursue this aggressive stance, the Trust needs the cooperation of each of its members. While the Trust will review all workers' compensation cases for possible fraud, input from human resource departments and other management and supervisory personnel will be critical in assessing the viability of a fraud action against a suspected employee.
The Trust and its members must be careful to avoid falsely accusing any employee of fraud as this could result in a defamation or invasion of privacy suit against the Trust and the employer. Therefore, all evidence of possible fraud must be carefully gathered to determine if a civil lawsuit or a state fraud complaint is viable. This difficult assessment process can be made easier with team effort and information sharing.
We believe that civil prosecution, based on substantiated grounds, will not only lead to the closing of fraudulent claims for benefits, but may also deter other employees from filing fraudulent claims.