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Alex J. Esq.
Alex J. Esq., Licensed Attorney
Category: Fraud Examiner
Satisfied Customers: 16449
Experience:  Licensed Attorney / former Law Enforcement Agent
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An employer reported a work related "injury" on an employee,

Customer Question

An employer reported a work related "injury" on an employee, the employee had the responsibility of turning in a form for that "injury", failed to turn in that form, and the employee subsequently had treatment that the employer sponsored major medical insurance paid for. Is that fraud against the health care insurance? What are the potential consequences to the employee?
Submitted: 11 months ago.
Category: Fraud Examiner
Expert:  Alex J. Esq. replied 11 months ago.
Hello. My name is***** am a US licensed attorney and I will be happy to answer your question.I am sorry to hear about this unfortunate situation.Please note, I cannot comment on your specific situation, as this services is only limited to general information and for any legal advice / legal service you should contact your local attorney.Did employee in fact got injured on the job and received medical treatment covered by the employer's insurance related to the work related injury?
Customer: replied 11 months ago.
The employee REPORTED the problem as having occurred on the job, YES. The injury was reported by the employer to its insurance carrier as BEING WORK RELATED. Apparently the employee had a form to complete and return but that form was never received. The employee eventually received MORE ADDITIONAL MEDICAL TREATMENT. THAT MEDICAL TREATMENT WAS PAID FOR BY THE EMPLOYER SPONSORED MAJOR MEDICAL HEALTH INSURANCE AND THE EMPLOYEE. Did the employee commit fraud?
Expert:  Alex J. Esq. replied 11 months ago.
Thank you for your follow up.While I cannot comment on your specific case, generally, unless the employee misrepresented the facts related to the cause of the injury, simple failure to submit a form required by the employer in case there is a claim for a work related injury by an employee, would not constitute insurance fraud or any other criminal offense. I wish you the best of luck!