Accused of workers' comp fraud? Start with what the statute actually requires
An accusation is not a charge, and in most files it never becomes one. In nearly every state the fraud statute that applies to injured workers carries a mental-state word — knowingly, intentionally, wilfully, or with intent to defraud — and in most states it also carries a purpose element: the false statement has to have been made for the purpose of obtaining a benefit. Those words are elements. An element is something the accuser has to prove before anything happens. Being wrong is not on the list, which is why an honest inconsistency or a misread restriction slip does not meet the definition.
The second thing worth knowing on day one is that an accusation splits into three separate proceedings, and people conflate them constantly. Your carrier can raise fraud inside your comp claim to stop paying you — that is a benefits fight, decided by a comp judge or board on an ordinary administrative standard. Your carrier can separately try to get money back. Only a prosecutor can file criminal charges, and the insurance company is not a prosecutor. Those three things fail and succeed independently of each other.
The scale is worth seeing before you read anything else. Ohio's Bureau of Workers' Compensation runs a Special Investigations Department with separate teams for injured-worker fraud, employer fraud, health-care provider fraud and safety violations, plus an intelligence unit and a fugitive task force. Across fiscal years 2024 and 2025 combined it received 4,502 allegations of workers' compensation fraud of every kind, referred 223 for prosecution, and obtained 119 convictions — claimant, employer and health-care provider cases all counted together (Ohio BWC SID annual reports, FY2025 and FY2024). Allegations are common. Convictions are not.
Read your statute and notice what the accuser has taken on. In Texas the offense requires both an intent to obtain benefits and a knowing or intentional falsehood. In New York the statement has to be knowingly false as to a material fact. Nobody has to prove you were right about your own body. They have to prove you knew you were wrong and said it anyway to get paid.
The four elements — and why most accusations stop at one of them
The pattern repeats across the country with unusual consistency. A claimant-fraud offense normally has four parts, and a state usually requires all of them.
- A statement or representation. In several states an omission counts too — concealing a material fact, or altering or destroying a document.
- Falsity. The statement has to actually be untrue.
- Materiality. The fact has to matter to the claim. New York's appellate courts define it as "significant or essential to the issue or matter at hand."
- A culpable mental state, plus a purpose. Knowing or intentional falsity, made to obtain or deny a benefit.
Here is the text, state by state. The wording changes; the structure does not.
- Texas, Labor Code § 418.001(a). An offense is committed by a person who, "with the intent to obtain or deny payment of benefits ... knowingly or intentionally" makes a false or misleading statement, misrepresents or conceals a material fact, or fabricates, alters, conceals or destroys a document other than a governmental record. Two mental-state requirements stacked on each other.
- Florida, Fla. Stat. § 440.105(4)(b). It is unlawful to "knowingly" make a false, fraudulent or misleading statement "for the purpose of obtaining or denying any benefit or payment."
- New York, WCL § 114-a(1). A claimant who "knowingly makes a false statement or representation as to a material fact" to obtain compensation is disqualified from the compensation "directly attributable to" that statement.
- Ohio, R.C. § 2913.48(A). The prohibited conduct must be undertaken "with intent to defraud or knowing that the person is facilitating a fraud."
- Illinois, 820 ILCS 305/25.5(a). Nine categories of intentional conduct. Subsection (a)(1) covers anyone who would "intentionally present or cause to be presented any false or fraudulent claim for the payment of any workers' compensation benefit"; (a)(2) covers a false or fraudulent "material statement or material representation for the purpose of obtaining or denying any workers' compensation benefit."
- North Carolina, N.C.G.S. § 97-88.2(a). "Any person who wilfully makes a false statement or representation of a material fact for the purpose of obtaining or denying any benefit or payment."
- Pennsylvania, 18 Pa.C.S. § 4117(a)(2). "Knowingly and with the intent to defraud."
- Federal employees, 18 U.S.C. § 1920. "Knowingly and wilfully" falsifies, conceals or covers up a material fact.
Look at what is missing from all of them. None of these statutes criminalizes inaccuracy — not an optimistic account of a good day, and not a form you filled in wrong. If you want the plain-English version of terms like material and misrepresentation, the glossary has them defined the way you would explain them to a family member.
Three tracks, not one: benefits, money, and criminal charges
This is the distinction that calms most people down, because the thing they are picturing is the rarest of the three. An accusation can succeed on one track and die on the other two. They have different deciders, different standards of proof and wildly different frequencies.
| The question | Track 1 — Benefits | Track 2 — Money back | Track 3 — Criminal |
|---|---|---|---|
| Who starts it | The carrier or self-insured employer, inside your existing claim | The carrier, by civil suit or a credit against future benefits | Only a prosecutor — a District Attorney, State's Attorney or Attorney General |
| Who decides | The comp agency — a judge, board, commission or hearing officer | A civil court, or the comp agency where the statute gives it recoupment power | A criminal court; a grand jury may indict first |
| Standard of proof | The agency's ordinary administrative standard — in New York, board findings are reviewed for substantial evidence | Civil — preponderance of the evidence, varying by state | Beyond a reasonable doubt |
| What is at stake | Benefits attributable to the statement; in some states, all benefits | Repayment with interest; treble damages in Pennsylvania for a proven pattern | A fine, probation, a sentence, a record, restitution |
| Statutes that set it up | NY WCL § 114-a(1); Fla. Stat. § 440.09(4)(a) | Va. Code § 65.2-712; 820 ILCS 305/25.5; RSMo § 287.128(8) | Tex. Lab. Code § 418.001; Fla. Stat. § 440.105(4)(f); R.C. § 2913.48 |
Track 1 is where an accusation actually bites, and it bites quickly, because it needs no prosecutor and no jury. The two ends of that spectrum are worth naming. Florida is the harsh end: under Fla. Stat. § 440.09(4)(a) an employee "shall not be entitled to compensation or benefits" at all if a judge, court or jury finds the described conduct — total forfeiture rather than partial. New York is surgical: WCL § 114-a(1) disqualifies you only from compensation "directly attributable to" the false statement, though the Board may add a discretionary penalty on top.
If your checks have stopped and someone has used the word fraud, that stop is a decision you can contest like any other. The denied-claims guide covers the mechanics of forcing a written reason and putting the dispute in front of the agency.
What the states' own numbers show about workers' comp fraud investigations
No federal agency publishes a national fraud rate, and the state bureaus that publish data use incompatible definitions and fiscal years, so there is no honest national figure to give you. What there is instead is better: several states publish their own referral-and-outcome tables, and those tables tell a consistent story.
Florida publishes the cleanest one. The Department of Financial Services files a joint annual report with the Division of Workers' Compensation showing every referral by type and every prosecution by type. In fiscal year 2023-24 the Bureau of Workers' Compensation Fraud logged 1,055 referrals. Here is what happened to them.
| Referral type (Florida, FY2023-24) | Referrals | Presentations | Arrests | Successful prosecutions |
|---|---|---|---|---|
| By employee claimant | 516 | 26 | 27 | 25 |
| Employer premium | 154 | 64 | 49 | 35 |
| Working without coverage | 136 | 62 | 64 | 79 |
| By employer | 77 | — | — | — |
| Violation of stop-work order | 56 | 17 | 15 | 12 |
| ID theft of number or name | 25 | 18 | 5 | 7 |
| By provider | 20 | — | — | — |
| Fictitious certificate of insurance | 14 | 2 | 2 | 3 |
| All types | 1,055 | 194 | 166 | 163 |
Selected rows from the FY2023-24 joint DIFS / Division of Workers' Compensation annual report. The full table carries fourteen referral categories summing to 1,055. Dashes mark categories the enforcement table does not break out. The "All types" line is the total exactly as printed by the state; the rows shown here are a selection and do not sum to it.
Run the arithmetic on the state's own figures. Claimant referrals were 516 of 1,055 — 48.9% of everything reported to Florida's workers' compensation fraud bureau that year. Claimant cases produced 25 of 163 successful prosecutions — 15.3%. Put the two together and a claimant referral converted into a successful prosecution about 4.8% of the time. An employer-premium referral converted at about 22.7%. A working-without-coverage referral converted at about 58%. The four employer-side rows — employer premium, working without coverage, violation of a stop-work order, and fictitious certificate of insurance — together produced 129 successful prosecutions from 360 referrals.
In Florida that year, injured workers were reported roughly as often as employers, and convicted about a fifth as often. The same report notes that "twenty presentations received prosecution declinations from state attorney offices" — prosecutors look at these files and say no.
Illinois publishes among the most candid numbers in the country. The Department of Insurance's Workers' Compensation Fraud and Noncompliance Unit reported that in fiscal year 2025 it received 44 workers' compensation fraud allegations of all types statewide, completed 17 investigations, and referred one case for prosecution. In the same year it received 358 allegations that an employer was operating without coverage. In fiscal year 2024 the split was 25 fraud allegations against 262 noncompliance allegations, with five cases referred, of which two were declined by prosecutors.
The same unit's fiscal year 2022 report contains a detail nobody advertises: of 59 completed fraud files, 14 were closed because the statute of limitations had expired. Roughly a quarter of that year's completed files died because nobody acted in time. That is a state agency reporting on itself.
Ohio supplies the counterexample, and it deserves its caveat. Ohio's Special Investigations Department reports "savings" by team, and in fiscal year 2025 the three claimant-fraud regional teams reported $66,603,089 against the Employer Fraud Team's $12,815,339. On that one metric, claimant fraud is the larger category in Ohio. But the report publishes no definition, footnote or methodology for "savings" anywhere, so it is not a count of money stolen and not comparable to a court's restitution order — it plausibly includes projected future benefits not paid on terminated claims. On the metric that is defined, the same FY2025 report shows the claimant teams producing 34 convictions from 1,044 closed cases and the Employer Fraud Team producing 18 from 301.
Massachusetts measures the same question in dollars a court actually ordered. The Insurance Fraud Bureau of Massachusetts breaks its annual report into "W/C Claimant" and "W/C Premium Evasion" and publishes cumulative court-ordered restitution for each. Through 31 December 2023 the totals were $78.7 million for premium evasion and $3.9 million for claimant cases. The claimant figure had not moved at all since the 31 December 2021 report. The same 2023 report records 4,023 referrals received that year and 156 cases referred to prosecutors, of which seven were workers' compensation.
New York rounds the picture out. The state's Workers' Compensation Fraud Inspector General received 1,436 complaints in 2024 and made 14 arrests; in 2025 it received 1,520 complaints and made 22 arrests. Those arrest counts cover claimant, employer and provider cases together, in a state of roughly twenty million people.
How a workers' comp fraud investigation is actually assembled
The volume of referrals is high partly because carriers are legally required to generate them. Florida requires an insurer writing $10 million or more in direct premium to "establish and maintain a unit or division within the company to investigate possible fraudulent claims" or to contract for one, with an administrative fine of up to $2,000 per day for non-compliance (Fla. Stat. § 626.9891). New York's Insurance Law § 409 requires every workers' compensation writer above a policy-count threshold to file a fraud prevention plan providing for a full-time special investigations unit, with fines of up to two thousand dollars per day for failure. Texas puts it in one sentence on the form itself: "Filing this report meets the state law requiring you to report suspected insurance fraud to TDI."
Pennsylvania adds the part that explains the incentive. Under 31 Pa. Code Ch. 119 insurers must maintain an anti-fraud plan and are directed to report suspected workers' compensation fraud to district attorneys or the Attorney General, and sections 1106 and 1107 of the Workers' Compensation Act grant insurers and their representatives an express grant of civil and criminal immunity for reporting. A carrier that reports you and turns out to be wrong faces essentially no downside. That is a design choice in the statute, and it is why a referral is often a compliance act rather than a considered accusation.
What goes into the referral is documented too. The Illinois fraud unit publishes its referral form, and it reads like a checklist of what a carrier assembles:
- A fraud-type checkbox — claimant, employer or agent, premium, or medical provider.
- The specific false statements alleged, and where and to whom each was made.
- "Activity level/description of activity" showing violations of physical limitations.
- Witness names and contact details.
- Supporting documents: written and recorded statements, and examinations under oath.
- For claimant fraud specifically, evidence of employment while receiving benefits.
Two things follow from reading that form. First, your recorded statement and any examination under oath are listed as the primary supporting documents in a fraud referral — that is what they are for once a file turns adversarial, and it is worth understanding how recorded statements work before you give another one. Second, surveillance arrives pre-interpreted: the form asks the carrier to supply its own description of your activity level and how it violates your limitations. The footage does not speak for itself, and the carrier's theory of the case is written on the form before anyone sees the video. Our article on surveillance and social media covers what investigators can and cannot do.
The medical exam matters more than most people expect, because it is frequently where the alleged misrepresentation is said to have been made. New York's rules are the clearest published set: under WCL § 137 and Form IME-5 you get mailed notice at least seven business days ahead, you must be told if the examiner intends to record, you have the right to record the exam yourself, you may bring someone with you, and the report goes to you on the same day and in the same manner it goes to the carrier. Rules differ by state, so check yours — but the insurer's medical exam is worth preparing for on the assumption that what you say there ends up in a file.
Insurers query industry claims databases you never see. Under the Fair Credit Reporting Act, the consumer reporting companies the CFPB lists must give you a copy of your file on request — LexisNexis C.L.U.E. and A-PLUS Property (by Verisk) each provide one free report every 12 months. If an accusation turns on a prior claim you barely remember, that is where the record lives, and pulling it costs nothing.
Where do referrals come from? In Florida in FY2023-24 the largest sources were insurance companies (403), the National Insurance Crime Bureau (218), anonymous tips (117) and law enforcement agencies (113), with citizen complaints at 98. In Illinois in FY2025, special investigations units filed 22 of the 44 fraud allegations (50%) and third-party administrators filed 17 (38.6%). The industry reports itself into these numbers. If you want to understand the person on the other end of the phone, adjuster tactics is the companion piece.
Is exaggerating an injury fraud? What the video cases actually decided
This is the question people search at two in the morning, and there are published appellate answers to it. New York's Appellate Division hears § 114-a cases regularly, and the decisions are posted by the state Workers' Compensation Board. Three of them, read together, draw the real line.
In Winkelman v. Sumitomo Rubber USA, decided 20 June 2024, the claimant was under restrictions limiting him to lifting 10 to 15 pounds. An investigator filmed him at craft-vendor events lifting boxes, carrying plants and selling items. The carrier moved for a § 114-a violation. The court affirmed a finding of no violation, because "the record is bereft of any proof that the items that claimant lifted or transported exceeded the weight restrictions," and because the help he gave was "sporadic, incidental and uncompensated." He was awarded reduced-earnings benefits. Video of an injured worker lifting boxes was not enough, because nobody weighed the boxes and nobody showed an intent to deceive.
Now the other side. In Reyes v. H & L Iron Works Corp., decided 17 March 2022, the claimant collected indemnity benefits while working as a DJ, testified he did the work without lifting, and failed to disclose that work to his examining physicians. Surveillance showed him repeatedly lifting heavy equipment. Three physicians testified that lifting ability was relevant to the extent of his disability, which is how materiality gets proved — with medical testimony, not with footage. Permanent disqualification from future indemnity benefits was affirmed. In Yolas v. New York City Transit Authority, decided 22 February 2024, the claimant told a permanency evaluator he had retired in 2014 while continuing to work in a family flooring business; surveillance showed him stripping and installing floors. Lifetime disqualification was affirmed.
The difference between those outcomes is not how physical the video looked. It is undisclosed work and undisclosed earnings. Winkelman lifted boxes for free and won. The two claimants who lost were both working for money — one as a DJ, one in a family flooring business — and neither had disclosed it. If you are working at all while a claim is open, even part-time or for family, the rules on reporting it are covered in working while on workers' comp — and reporting it is free, immediate, and the single most protective thing on this page.
One more point the cases settle. An omission counts. Yolas holds that "an omission of material information may constitute a knowing false statement or misrepresentation." Not mentioning the job is treated the same as denying it.
So what does get people prosecuted? The documented categories are narrow.
The Texas Division of Workers' Compensation describes claimant fraud as "employees drawing benefits while working unreported jobs or faking injuries." Reyes and Yolas are both this fact pattern. The word doing the work is unreported.
Virginia's statute requires a claimant to disclose a return to employment or an increase in earnings immediately, and lets the employer recover payments procured by "fraud, misrepresentation, or failure to report." Failure to report is a separate trigger that does not require proving you meant to deceive anyone.
Texas § 418.001(a)(3) reaches anyone who "fabricates, alters, conceals, or destroys a document other than a governmental record." Ohio's statute covers altering or destroying records needed to establish a claim's validity, and forging certificates. Florida logs separate referral categories for fictitious certificates of insurance and of exemption.
Florida logged 25 referrals for identity theft of a number or name in FY2023-24, producing 5 arrests and 7 successful prosecutions.
The common thread is concealed income and fabricated paper. It is not "my back felt better on Tuesday."
Workers' comp fraud penalties, state by state
Penalty structures vary by two orders of magnitude, and where the fraud unit sits changes who is actually looking at your file — an insurance department, an attorney general, or the comp agency itself. Illinois turns a misdemeanor into a Class 3 felony at $300. Texas draws its line at $2,500. Florida's lowest tier is already a third-degree felony. Georgia is the outlier at the other end, where claimant fraud is a misdemeanor at any amount. Virginia and New Jersey set no dollar threshold at all.
| State | Where the fraud unit sits | Claimant-fraud statute | Penalty tier as written |
|---|---|---|---|
| Texas | DWC Fraud Unit, Texas Department of Insurance | Tex. Lab. Code § 418.001 | Class A misdemeanor under $2,500; state jail felony at $2,500 or more |
| Florida | Bureau of Workers' Compensation Fraud, Dept. of Financial Services | Fla. Stat. § 440.105(4)(b); forfeiture at § 440.09(4) | All felonies — third degree under $20,000, second degree to $100,000, first degree above |
| New York | Workers' Compensation Fraud Inspector General, NYS Offices of the Inspector General | WCL § 114-a (benefits); WCL § 114 and Penal Law § 176.15 (criminal) | WCL § 114: class E felony, class D on a second conviction within ten years |
| Pennsylvania | Insurance Fraud Section, Office of Attorney General | 18 Pa.C.S. § 4117 | Third-degree felony under § 4117(a); civil treble damages for a proven pattern |
| Ohio | Special Investigations Department, Ohio Bureau of Workers' Compensation | R.C. § 2913.48 | First-degree misdemeanor base; F5 from $1,000, F4 from $7,500, F3 from $150,000 |
| Illinois | WC Fraud and Noncompliance Unit, Dept. of Insurance; the Attorney General or a State's Attorney decides whether to prosecute | 820 ILCS 305/25.5 | Class A misdemeanor to $300; Class 3 above $300; Class 2 above $10,000; Class 1 above $100,000 |
| Georgia | Enforcement Division, State Board of Workers' Compensation | O.C.G.A. § 34-9-19 | Misdemeanor at any amount — $1,000 to $10,000 fine, up to 12 months, plus costs |
| North Carolina | Criminal Investigations and Employee Classification Division, Industrial Commission — sworn officers | N.C.G.S. § 97-88.2 | Class 1 misdemeanor under $1,000; Class H felony at $1,000 or more; restitution available |
| New Jersey | Office of the Insurance Fraud Prosecutor, Office of the Attorney General | N.J.S.A. 34:15-57.4 | Crime of the fourth degree, no dollar threshold; forfeiture and repayment with interest |
| Virginia | Virginia Workers' Compensation Commission (recovery under § 65.2-712) | Va. Code § 65.2-312 | Class 6 felony, no dollar threshold |
| Missouri | Fraud and Noncompliance Unit, Division of Workers' Compensation, DOLIR | RSMo § 287.128 | Class E felony, fine to $10,000 or double the value; class D felony for a prior offender |
| Washington | Department of Labor & Industries fraud program | RCW 51.48.020(2) | Felony or gross misdemeanor, graded by the theft provisions of Title 9A RCW |
| Massachusetts | Insurance Fraud Bureau of Massachusetts, funded equally by auto and workers' comp insurers | — | — |
| California | Fraud Division, Department of Insurance | Cal. Ins. Code § 1871.4 | County jail up to 1 year, or 2, 3 or 5 years; fine to $150,000 or double the value |
| Federal employees (FECA) | US DOL OWCP; prosecuted by US Attorneys | 18 U.S.C. § 1920 | Felony above $1,000, up to 5 years; misdemeanor at $1,000 or less |
Penalty tiers are the statutory ceilings as written, not typical outcomes. Massachusetts appears for its fraud bureau and its published restitution data; its criminal statute was outside the scope of this review. Compare how your state runs the rest of the claim in the state guides.
Prosecution deadlines are sourced in only two of these states, so treat the rest as unknown rather than absent. Florida sets five years for a felony violation of § 440.105 under Fla. Stat. § 775.15. Texas applies a three-year felony catch-all under Code of Criminal Procedure art. 12.01. That is the whole of what is verifiable here, and the Illinois report described above shows what happens when a clock runs out.
The first week: what to do, in order
Almost everything useful in the first week is free, and none of it requires you to argue about whether you committed fraud.
- 1
Get the accusation in writing
Ask the carrier, in writing, for the specific basis of any suspension or denial. In most systems the carrier must file a formal notice with the agency, and that filing is the accusation.
- 2
Find out which track you are on
A benefits dispute, a demand for repayment, and contact from a prosecutor or fraud bureau are three different problems. Ask which one this is.
- 3
Fix the record, do not fix your behavior
If a chart or a form is wrong, correct it on your own initiative and in writing. Changing what you do because you think you are being watched changes nothing in the file.
- 4
Report any work and any earnings now
Immediately and in writing, even unpaid help, even one shift. This is the fact pattern that produces almost every real case.
- 5
Pull your own records
Your claims-history file from the consumer reporting companies, your full medical chart, and every letter you have been sent. Build the timeline before anyone asks you about it.
"Claim number [number], date of injury [date]. I am writing to ask for the specific factual basis on which benefits were [suspended / denied] on [date], including any form or notice filed with [agency] and its filing date. Please state in writing what statement or conduct is at issue and the date it is alleged to have occurred."
Why this works: it asks only for what already exists on paper, it fixes a date, and it converts a vague phone call into a written position the carrier has to stand behind. More wording in the What to Say guide.
"At my last visit I said I can't [activity]. I want to be precise: I can do it briefly on a better day, but it causes [symptom] and I avoid it. Can we update my chart so it's accurate?"
Why this works: most alleged misrepresentations are loose words, not lies. A record you corrected yourself is very hard to characterize as a knowing falsehood made to obtain a benefit.
When you need a lawyer — and when you genuinely don't
The line here is unusually clear, so here are both halves of it.
The moment there is any criminal element, get a criminal defense lawyer. Always. That means a prosecutor's office, an interview request from a state fraud bureau, a grand jury subpoena, an investigator with a badge, or a referral you have been told about. This is not a cautious hedge. The people investigating you may be sworn law enforcement — North Carolina's Industrial Commission employs officers certified through the state's Criminal Justice Education and Training Standards Commission, and Ohio's fraud unit runs a fugitive task force. In New York, WCL § 136 empowers the Workers' Compensation Fraud Inspector General to subpoena witnesses, administer oaths, take testimony and compel the production of records.
A disputed benefit or a nasty letter is usually the other kind of problem. A suspension you disagree with, a demand that you repay an overpayment, a § 114-a-style motion in your comp case — those are money and benefits, not liberty. Many people handle the early stages of those themselves, and a comp lawyer rather than a criminal one is the right call when they escalate. The do I need a lawyer tool walks the distinction with your own facts.
There is also a real list of things you never need a lawyer for. Requesting your own claims-history file under the FCRA is free. Asking the carrier to put the accusation in writing is free. Attending a properly noticed medical exam and using your statutory rights there is free — in New York that includes recording it and bringing someone with you. Reporting a return to work or a change in earnings promptly and in writing is free, and it is the most protective single act available to you. Georgia's own employee handbook tells workers plainly that a lawyer is not needed to file a claim with the Board.
In a criminal trial no adverse inference may be drawn from silence. In civil and administrative proceedings the rule is different — the Supreme Court held in Baxter v. Palmigiano (1976) that permitting an adverse inference from silence at a disciplinary hearing is "not, on its face, an invalid practice." Baxter concerned prison discipline and the precise rule varies by jurisdiction, but the general principle is why this matters: staying silent at a comp hearing to protect yourself criminally may cost you the hearing, while testifying freely there hands a prosecutor sworn testimony. That trade-off is not one to work out alone.
Five costly mistakes people make after an accusation
Every version of your story becomes a document. The Illinois referral form lists recorded statements and examinations under oath as the supporting evidence in a fraud referral. Ask what the allegation is, in writing, before you answer it.
A stopped check and a criminal charge feel identical at 2am and are completely different problems with different deciders. Find out which one you actually have before deciding anything.
Altering, concealing or destroying a document is itself listed conduct in these statutes — Texas § 418.001(a)(3) names it outright, and Ohio's R.C. § 2913.48 covers altering or destroying records needed to establish a claim's validity. Whatever you are tempted to clean up, leave it where it is and get advice about it instead.
This is the fact pattern in the cases that actually go against claimants. Reporting it late is survivable. Not reporting it is the allegation.
An adjuster who uses the word fraud on a call has said something with no paper behind it. Written allegations can be answered, dated and appealed. Spoken ones just sit there and frighten you.
Frequently asked questions
A professional read on a suspension letter, an investigation notice, or a request for an examination under oath settles the question quickly and costs nothing. If contact has come from a prosecutor or a state fraud bureau, that is a criminal defense question and worth acting on straight away.
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