In Florida workers compensation cases, the workers compensation insurance company and their attorney will deny money and medical benefits if they think they can show that the injured worker made false, fraudulent, or misleading statements in connection with their workers compensation claim.
The defense is found by reading F.S. 440.09(4) (a) and F.S. 440.105(4)(b)1. together. If any administrative hearing officer, court, or jury convened in Florida, finds that the injured worker knowingly or intentionally made or caused to be made, any false, fraudulent, or misleading statement, either verbally or in writing, to obtain any benefit under the workers compensation law, the employee loses all further entitlement to money or medical care.
To prove the fraudulent misrepresentation defense the insurance company must prove two things. First, the insurance company must show that the injured worker made or caused to be made, a false, fraudulent or misleading statement in connection with the workers compensation claim. Second, the insurance company must show that the injured worker intended that the statement be made for the purpose of obtaining benefits under the worker s compensation law and not for another purpose.
The false, fraudulent or misleading statement can be in many forms. A good example is giving a false social security number. In one case the employee gave a false social security number to be was hired. The judge found that the false statement was not to get workers compensation benefits. Instead, the false social security number was used to get the job. In another case the employee gave a false social security number to the insurance company in his recorded statement and to the hospital to be treated. In the second example the employee was denied benefits because the “intent” for giving the false social security number was to receive workers compensation benefits. False statements to doctors about the severity of the injuries or false statements in depositions are other examples of the ways false statements can be made. It is important to note that the false statement does not need to be under oath.
The effects of the so-called “fraudulent misrepresentation” defense can have devastating consequences. For example, suppose the injured worker is a paraplegic who is being paid money and medical benefits for the rest of his life. He claims $100.00 in medical mileage for trips to the doctor which he didn’t make. If the employer/carrier proves the fraudulent misrepresentation defense, the injured worker is cut off from all further benefits for the rest of his life.
If you have been injured on the job you must be very careful when you report your injuries, claim benefits, or speak with your doctors or the insurance company. Preferably, you should speak with a workers compensation attorney before making any statements.
If you have been denied compensation benefits or if you simply have questions concerning your claim, call for a free consultation. Compensation you deserve….it’s what we work for.