Fraudulent Workers’ Compensation Claims: How New York Contractors Can Protect Their Business

Running a construction business in New York comes with many challenges, but one of the biggest threats to a contractor’s financial stability is fraudulent workers’ compensation claims. When employees falsely claim injuries, contractors face increased insurance premiums, potential legal issues, and unnecessary financial burdens.

Workers’ compensation fraud is a growing problem, and fraudulent employees often know how to manipulate the system. These claims can be difficult to disprove, especially when there are no witnesses or clear evidence refuting them. In this article, we’ll examine four common fraudulent claims that New York contractors frequently encounter, how employees attempt to get paid on these claims, and what contractors can do to protect their businesses.

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Four Common Fraudulent Workers’ Compensation Claims

1. The “Unwitnessed Fall” Scam

One of the most common fraudulent claims involves an employee who reports a fall at the job site when no one is around to witness it. Here’s how it typically unfolds:

? The worker claims they slipped, tripped, or fell while performing their job.

? There are no witnesses or video evidence of the accident.

? They immediately seek medical treatment and file a workers’ compensation claim.

? The medical report may confirm an injury, but there’s no way to verify if it actually happened on the job.

Because these claims lack eyewitness accounts, insurance companies often approve them by default, leading to increased costs for the employer. Without proper safeguards, contractors have little recourse to challenge the claim.

2. The “Two-Hour Back Injury” Trick

Some employees take advantage of the system by claiming a back injury shortly after starting their shift. This scam typically follows a predictable pattern:

? The worker arrives at the job site and begins their regular duties.

? After about two hours, they suddenly complain of severe back pain and claim they are unable to continue working.

? They insist the injury occurred while on the job, despite no witnesses or specific incident being reported.

? A doctor diagnoses them with a strain or soft tissue injury, which is difficult to disprove through medical testing.

Back injuries are notoriously hard to verify, making them an easy target for fraudulent claims. Since pain is subjective, fraudulent employees can manipulate the system to secure workers’ compensation benefits.

3. The “Ladder Fall Without Witnesses” Ruse

Falls from ladders are serious incidents in the construction industry, but they also present an opportunity for fraud. Here’s how an employee may attempt to exploit this type of situation:

? The worker claims they fell from a ladder while working alone.

? There are no witnesses or video evidence of the fall.

? They report the incident after leaving the job site or even the next day.

? They seek medical treatment and file a workers’ compensation claim.

Because falls from ladders can lead to severe injuries, insurance companies often approve these claims quickly. If a contractor lacks proper documentation or surveillance, disputing the claim becomes nearly impossible.

4. The “10-Month Surprise” Claim

Perhaps the most frustrating and deceptive tactic occurs when an employee files a workers’ compensation claim long after the alleged incident—sometimes as late as 10 months later. This is how the scheme works:

? The worker never reports an injury to the employer.

? Instead of notifying the company, they go directly to the New York Workers’ Compensation Board and file a claim.

? The employer is completely unaware of the claim until they receive a notification from the board months later.

? By this point, gathering evidence to refute the claim is nearly impossible, as records, witness statements, and surveillance footage may no longer be available.

This tactic is particularly dangerous because it bypasses the employer entirely, leaving them blindsided and with little opportunity to challenge the claim.

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How Fraudulent Employees Try to Get Paid

Workers’ compensation fraud often follows a similar playbook. Employees looking to exploit the system typically use the following strategies to increase their chances of a payout:

1. Delayed Reporting to Avoid Immediate Investigation

Fraudulent workers often delay reporting their injuries, giving them time to fabricate a convincing story. By the time the claim is filed, any immediate evidence that could disprove their version of events is long gone.

2. Using Medical Documentation to Support Their Claim

Many fraudulent claims rely on medical reports as the primary evidence. Since doctors usually rely on a patient’s description of their pain, injuries such as back strains or soft tissue damage are easy to fake.

3. Seeking Legal Representation Early

Some workers’ compensation attorneys specialize in maximizing settlements for employees, even in questionable cases. Fraudulent claimants often contact a lawyer immediately, making it harder for contractors to dispute the claim.

4. Creating a False Narrative with the Help of Co-Workers

In some cases, dishonest employees convince co-workers to support their claim, either by falsely stating they heard the worker complain of pain before reporting the injury or by backing up an unwitnessed fall.

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How BGES Group Helps New York Contractors with Workers’ Compensation

At BGES Group, we specialize in workers’ compensation insurance for New York contractors. We understand how fraudulent claims can impact your business and work closely with you to reduce risk, manage claims, and secure affordable insurance coverage.

Why Choose BGES Group?

? Industry Expertise – We specialize in workers’ compensation for contractors, so we understand the unique risks you face.

? Fraud Prevention Assistance – We help contractors implement strategies to prevent and dispute fraudulent claims.

? Access to the Best Insurance Programs – We work with top insurance carriers to find the best coverage options for your business.

? Claims Management Support – If you’re dealing with a questionable claim, our team can guide you through the process and help you build a strong defense.

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Need Workers’ Compensation Insurance? Contact BGES Group Today!

If you’re a New York contractor struggling with fraudulent claims or need better workers’ compensation coverage, BGES Group is here to help. We provide expert guidance, competitive insurance options, and the support you need to protect your business.

Contact Information:

? Contact Person: Gary Wallach

? Phone: (914) 806-5853

? Email: [email protected]

? Website: www.bgesgroup.com

Don’t let fraudulent claims increase your insurance costs—contact BGES Group today for expert assistance!