Some Of The Laws Relating To Workers' Compensation Fraud In Connecticut
If you work part time or receive income from self-employment, you may have to report such income or wages to your workers' compensation carrier. You should discuss any concerns about this first with an attorney. You don't want to be accused of workers' compensation fraud - it's a serious offense. If you are in any doubt as to whether or not you are permitted to work in any capacity while receiving worker's compensation benefits, you should immediately consult this office.
At Berman & Russo, we represent people who have been accused of committing workers' compensation fraud. An arrest can occur even as a result of an innocent misunderstanding of the law. If you have been contacted by any law enforcement agency in connection with any investigation of your activities, you should offer no information and make no statement before talking to us. Under some circumstances, workers' compensation fraud can be punished as a felony in Connecticut.
CGS § 31-290c Fraudulent Claim Or Receipt Of Benefits, Penalties
(a) Any person or his representative who makes or attempts to make any claim for benefits, receives or attempts to receive benefits, prevents or attempts to prevent the receipt of benefits or reduces or attempts to reduce the amount of benefits under this chapter based in whole or in part upon (1) the intentional misrepresentation of any material fact including, but not limited to, the existence, time, date, place, location, circumstances or symptoms of the claimed injury or illness or (2) the intentional nondisclosure of any material fact affecting such claim or the collection of such benefits, shall be guilty of a class C felony if the amount of benefits claimed or received, including but not limited to, the value of medical services, is less than $2000, or shall be guilty of a class B felony if the amount of such benefits exceeds $2000. Such person shall also be liable for treble damages in a civil proceeding under section 52-564.
(b) Any person, including an employer, who intentionally aids, abets, assists, promotes or facilitates the making of, or the attempt to make, any claim for benefits or the receipt or attempted receipt of benefits under this chapter by another person in violation of subsection (a) of this section shall be liable for the same criminal and civil penalties as the person making or attempting to make the claim or receiving or attempting to receive the benefits.
§ 53-440. Short title: "Health Insurance Fraud Act"
As used in sections 53-440 to 53-443, inclusive:
(a) “Statement” includes but is not limited to any notice, statement, invoice, account, bill for services, explanation of services, medical opinion, test result, computer-generated document, electronic transmission or any other evidence of loss, injury or expense;
(b) “Person” means any individual, corporation, limited liability company, partnership, association or any other legal entity;
(c) “Insurer” means any insurance company, health care center, corporation, Lloyd’s insurer, fraternal benefit society or any other legal entity authorized to provide health care benefits in this state, including benefits provided under health insurance, disability insurance, workers’ compensation and automobile insurance or any person, partnership, association or legal entity, which is self-insured and provides health care benefits to its employees or governmental entity, which provides medical benefits to Medicare or Medicaid recipients.
A person is guilty of health insurance fraud when he, with the intent to defraud or deceive any insurer, (1) presents or causes to be presented to any insurer or any agent thereof any written or oral statement as part of or in support of an application for any policy of insurance or claim for payment or any other benefit from a plan providing health care benefits, whether for himself, a family member or a third party, knowing that such statement contains any false, incomplete, deceptive or misleading information concerning any fact or thing material to such claim or application, or omits information concerning any fact or thing material to such claim or application, or (2) assists, abets, solicits or conspires with another to prepare or present any written or oral statement to any insurer or any agent thereof, in connection with, or in support of, an application for any policy of insurance or claim for payment or any other benefit from a plan providing health care benefits knowing that such statement contains any false, deceptive or misleading information concerning any fact or thing material to such application or claim. For purposes of this section, “misleading information” includes but is not limited to falsely representing that goods or services were medically necessary in accordance with professionally accepted standards.
§ 53-443. Penalty. Order Of Restitution. Attorney Fees And Investigation Costs Included In Restitution.
Any person who violates any provision of sections 53-440 to 53-443, inclusive, shall be subject to the penalties for larceny under sections 53a-122 to 53a-125b, inclusive. Each act shall be considered a separate offense. In addition to any fine or term of imprisonment imposed, including any order of probation, any such person shall make restitution to an aggrieved insurer, including reasonable attorneys’ fees and investigation costs.
Any insurer, as defined in subsection (c) of section 53-441, who is aggrieved as a result of an act of insurance fraud may institute an action against the perpetrator of such fraud to recover all damages resulting from the fraud.
If you are being investigated for alleged workers’ compensation fraud, contact our office in South Windsor as soon as possible. Call 860-644-1548 or contact us online to schedule a free consultation with one of our attorneys. We also have an office in Hartford.
We represent clients throughout Hartford County (east of the Connecticut River) and Tolland County, including the communities of South Windsor, Windsor, East Windsor, Hartford, Bloomfield, Enfield, Windsor Locks, East Hartford, Manchester, Glastonbury, Marlborough, Somers, Stafford, Stafford Springs, Union, Ellington, Tolland, Willington, Vernon, Bolton, Coventry, Mansfield, Storrs, Andover, Hebron, Columbia and Middletown.