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Course Details

Course Information
  • smart_display Format

    On-Demand

  • signal_cellular_alt Difficulty Level

    Intermediate

  • work Practice Area

    Employment and Workers Comp

Date & Time
  • event Date

    Tuesday, November 19, 2024

  • schedule Time

    1:00 p.m. ET./10:00 a.m. PT

  • timer Program Length

    90 minutes

Credit Information

  • This 90-minute webinar is eligible in most states for 1.5 CLE credits.

$197.00
CLE
ALL

This CLE webinar will provide a comprehensive overview of workers' compensation (WC) fraud and the impact it has on businesses. The panel will examine who commits WC fraud and what to look for as signs of fraud. For counsel representing employers and insurance companies, the panel will address how to investigate potential WC fraud and what needs to be demonstrated to make a fraud claim. The panel will also discuss how to defend a party against a fraud claim.

Faculty

James K. MacAlister
Attorney
Cohen, Snyder, Eisenberg & Katzenberg, PA

Mr. MacAlister has represented workers injured on the job or those who suffer occupational diseases since 1990. He also represented personal injury plaintiffs, including people hurt in car accidents or as a result of injuries that occurred on another’s property. Mr. MacAlister is admitted to practice before Maryland’s state and Federal Courts. He is a trial lawyer who handles hearings at the Maryland Workers’ Compensation Commission, and jury trials of appeals taken from Commission decisions. He also tries District Court trials and Circuit Court jury trials for clients injured by the negligence of others. Lastly, he has handled appeals in all of Maryland’s appellate Courts, including the Supreme Court, and the U.S. Court of Appeals for the Fourth Circuit.

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Matthew J. Troy
Partner
Conroy Simberg

Mr. Troy represents employers, carriers, TPAs, uninsured employers, PEOs and self-insured funds in all types of workers’ compensation cases including permanent total disability, catastrophic injuries, toxic exposure, heart and lung bill presumption cases, drug test denials and PEO coverage. He is a frequent presenter on workers’ compensation legal issues.

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Description

WC fraud costs businesses billions of dollars each year. Fraud can be perpetrated not only by employees, but also employers, insurance companies, and healthcare providers.

Common types of fraud committed by employees include faking or exaggerating injuries, claiming injuries are work-related when they occurred elsewhere, or continuing to receive WC payments after they are healed. Employer fraud includes knowingly altering the facts of an injury to avoid paying a claim or underreporting wages or misclassifying employees to lower WC insurance premiums. And healthcare providers commit fraud when inflating medical bills or billing for services not rendered.

Investigations into potentially fraudulent WC claims are triggered by certain red flags, and when fraud is found to have been committed could result in serious penalties including criminal charges, hefty fines, and restitution.

Listen as our expert panel provides a comprehensive overview of WC fraud. The panel will examine what constitutes WC fraud, red flags that may signify fraud, and how to conduct a fraud investigation. The panel will also discuss what needs to be demonstrated to make a fraud claim and examine how to defend a party against such a claim.

Outline

  1. Introduction
    1. Parties who commit WC fraud
    2. Types of WC fraud
    3. Impact of WC fraud on businesses
  2. Conducting WC fraud investigations
    1. Red flags in a WC claim
    2. Methods for detecting fraud
    3. Proving a claim is fraudulent
  3. Defending WC fraud claims
  4. Penalties for committing WC fraud
  5. Best practices for preventing WC fraud
  6. Practitioner takeaways

Benefits

The panel will review these and other key considerations:

  • Who commits WC fraud?
  • What activities constitute WC fraud? What are red flags that signify fraud may be occurring?
  • What are best practices for conducting a WC fraud investigation?
  • What must be demonstrated to make a WC fraud claim?
  • What are the potential penalties for committing WC fraud?