Workers’ Compensation Traps: “Jim from Johnstown, NY”

Jim works for a gas station in Johnstown, NY. While lifting crates of beer, he injures his back and files a Workers’ Compensation claim. The insurance company accepts his case and begins make lost wage payments to him. Jim does not know whether or not he is getting the correct amount from the insurance company but is happy that there is some money coming in.

Jim continues to treat with his doctor. Two months after his injury he receives a form in the mail from the insurance company with a letter telling him that he must complete the form so that his benefits will continue. One of the questions on the form asks if Jim has returned to work. Jim completes the form and indicates that he has not returned to work. Two weeks later, Jim receives a copy of a letter that the insurance company sent to the Workers’ Compensation Board asking that a hearing be scheduled because Jim answered one of the questions incorrectly. The insurance carrier contends that Jim has violated Section 114a of the Workers’ Compensation Law and has committed fraud. Jim has no idea what the insurance company is talking about.

At the time of the hearing, the insurance carrier’s lawyer informs Jim that they have evidence that he has, in fact, performed work activities from his home in Johnstown, NY. At that point, Jim remembers that he did sell a few items on E-Bay and babysat for his neighbors periodically during the last several months. Jim is in quite a predicament because his innocent statements, from a legal standpoint, were not true. While Jim did not consider selling items on E-Bay or babysitting for very little pay as “returning to work” it is possible that a Law Judge would find that Jim has violated the fraud statute of the Workers’ Compensation Law.

If Jim is found guilty of Section 114a fraud, his Workers’ Compensation lost wage benefit could be lost forever. The moral of the story is that you are always better consulting with an attorney before a problem arises.

In our office, we advise our clients not to complete these forms. However, if the forms are completed we have them sent to us for review and to make sure that the information contained therein is accurate and that the client is aware that even innocent, minor activities, which may generate revenue can be considered work under the Workers’ Compensation Law.

If you have a Workers’ Compensation case and would like a free consultation, please feel free to contact our office.