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4 Facts about Fraud Findings in New York State

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4 Facts about Fraud Findings in New York State


4 Facts about Fraud Findings in New York State

Workers’ compensation fraud is rampant in the workplace today. Whether your business operates in the public or private sector, is large or small, or is publicly traded or a not-for-profit, workers’ compensation fraud has likely already impacted your bottom line.


If you have already begun to investigate suspicious workers’ compensation cases within your New York-based company, you likely have the ultimate goal of bringing the case before the New York State Workers’ Compensation Board in an effort to obtain a fraud finding, also called a 114a. If your investigative evidence is substantial, there is a distinct possibility that the Board will overturn the claimant’s allegations and find them fraudulent. Read on for 4 things you need to know about fraud findings in New York State.


1. Fraud findings require proper chain of custody procedures.


In order to convince the Workers’ Compensation Board that you have a legitimate case, you need to follow proper procedure when it comes to chain of custody. Documents, notes, or video obtained in the field by an investigator must be delivered securely to the office of your investigative company and then stored securely. Every individual who has access to these documents, from field investigator to case manager to your internal staff, must document their actions with the documents. This is critical information to have when you appear before the Board.


2. Claimants are subject to penalties if found to be misrepresenting.


According to Article 7, Section 114a of New York’s Workers’ Compensation law, if a “claimant knowingly makes a false statement or representation as to a material fact, such person shall be disqualified from receiving any compensation directly attributable to such false statement or representation. In addition, as determined by the board, the claimant shall be subject to a disqualification or an additional penalty up to the foregoing amount directly attributable to the false statement or representation. Any penalty monies shall be paid into the state treasury.”


In other words, not only will claimants stop receiving payments if they are found to be falsely representing the extent of their injuries, they also may have to pay a penalty for their behavior.


3. Fraud findings can be hard to come by.


As with all things in the United States legal system, a claimant is considered innocent until proven guilty of misrepresentation. Without excellent evidence that is considered incontrovertible, your allegation that a claimant has been dishonest in their claim likely won’t result in a 114a fraud finding. Improper chain of custody procedures can also harm your case, so be sure you are treating any evidence you do come across properly.


4. Partnering with an investigative firm can help.


Chances are, no one in your HR department has the time to investigate employees out collecting workers’ compensation. Furthermore, without the equipment and know-how to conduct a proper field investigation, it’s unlikely that any evidence you turn up would go the distance to secure a 114a.


If you have strong reason to believe that one of your employees is misrepresenting their injuries, contact a licensed investigative firm today. Alliance Risk Group has decades of industry experience and provides skilled investigators the best training and technology to ensure that due diligence is done.


For more information on strategies to combat workers’ compensation fraud, please contact us today! We are happy to answer any questions you might have and to help you strategize how best to approach an investigation into potential fraud.


To read more about some of the technology that makes workers’ compensation investigations so successful, click here.

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