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Defining Workers' Compensation Fraud in Colorado

When a person makes false statements or false representation concerning key information in a workers' compensation claim in order to obtain a particular benefit, that individual can be accused of workers' comp fraud. According to the Colorado Revised Statutes (C.R.S. §8-43-402 C.R.S.), this offense is considered a class 5 felony, with the criminal charges applying whether the individual committed the fraud for self-gain or for the gain of another person. The Colorado Department of Labor & Employment's Division of Workers' Compensation provides a detailed overview of the types of actions can be considered workers' comp fraud.

According to this state division, this type of fraud occurs by the workers' compensation applicant or claimant when that individual does any of the following:

  • Intentionally makes a false workers' compensation claim
  • Fakes or exaggerates an injury
  • Uses multiple claims or identities
  • Claims worker's compensation benefits for injuries that are not work-related
  • Fails to report additional income or secondary jobs

Other parties that can also be charged with workers' comp fraud include the provider of the compensation (such as through over-billing), the claims adjuster (such as through changing claim evidence so a denial can be made), the employer (such as through lying in order to prevent an employee from filing a claim) and others. In order to prove workers' comp fraud, prosecutors must be able to prove several factors. These include the fact that the suspect statement or representation was actually false, the fact that the false information was provided with the intention of committing fraud, and the fact that claims decisions were made as a result of the misleading statements or representations.

When claimants are accused of fraud, they not only risk losing their workers' comp benefits, but they can also suffer from criminal penalties such as incarceration and expensive fines. There are many cases in which claimants are falsely accused of such fraud—perhaps they simply made honest mistakes during the application process, or perhaps someone else's error led to the false information. In other situations, a claimant might be a victim of fraud, requiring him or her to prove that the wrongful actions of an employer or claims adjuster led to an unfair claim denial.

At Busch Law Offices, we have an in-depth understanding about a number of different issues related to workers' comp law, including fraud. Our Loveland workers' comp lawyers can help you ensure you are filing your claim properly so you can better avoid being accused of fraudulent activity. We can also assist you after workers' compensation allegations have been made. Our goal is to help you obtain the benefits you need after a work-related injury. Call us today to learn more about our services!