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Workers’ Compensation Fraud in West Virginia

Helping employers uncover fraudulent injury claims

Workers’ compensation fraud is a major concern for employers and insurers alike, and it amounts to millions of dollars each year in ill-gotten benefits. While workers’ compensation fraud can ultimately be a criminal matter, it often falls to employers, insurers and claims administrators to identify questionable claims, gather the necessary proof and present that evidence to prevent benefits from being paid or to stop current benefits. The comprehensive workers’ compensation litigation services of Pullin, Fowler, Flanagan, Brown & Poe helps employers and insurers throughout West Virginia, Ohio and Kentucky resist fraudulent claims and protect themselves from liability for unwarranted benefits.

Types of workers’ compensation fraud

Workers’ compensation fraud occurs when claimants falsify facts in an attempt to receive benefits to which they are not legally entitled. To qualify for workers’ compensation, an employee must meet several criteria, and the best way to proceed in investigating a fraudulent claim depends on which one of these criteria the employee is falsifying. Our attorneys at Pullin, Fowler, Flanagan, Brown & Poe have the experience and resources to help you uncover the truth.

  • Exaggerated severity — This is perhaps the most common type of workers’ compensation fraud. In these cases, a real injury does occur and is work-related. But the employee feigns disability or covers up recovery to receive or continue to receive wage-loss benefits. Uncovering this type of fraud can require medical expert testimony stating that the claimed degree of incapacity or recovery time is inconsistent with the severity of the injury. It can also require the use of private investigators to expose claimants performing activities outside the workplace that they claim to be unable to perform.
  • Falsifying work-related nature — In this type of case, a real and disabling injury does occur, but it is not related to the employee’s job. An example would be an employee who obtained a back injury lifting weights at home claiming that the injury occurred at work. Investigating this type of injury requires detailed analysis of the employee’s job duties, an examination of the alleged accident scene and interviews with eyewitnesses.
  • Fabricated injuries — This relatively rare type of fraud occurs when an employee simply makes up an injury based on a fabricated accident or the opportunistic use of a workplace accident that did not actually result in an injury. Entities that are exempt from workers’ compensation can fall victim to this type of fraud in civil litigation. Investigating these claims requires the full range of resources, including medical experts, eyewitness testimony and private investigation.


Pullin, Fowler, Flanagan, Brown & Poe uncovers the truth in workers’ compensation claims

The comprehensive litigation defense and workers’ compensation firm of Pullin, Fowler, Flanagan, Brown & Poe helps employers throughout West Virginia, Kentucky and Ohio uncover and resist fraudulent injury claims. Call us at 304-344-0100 or contact us online to begin a relationship with a law firm that is nationally recognized for experience and quality while remaining dedicated to its community and employees.


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