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Disability Insurance Fraud: Prevention and Penalties

Disability Fraud Attorney

Have you ever known someone who’s receiving long-term individual or group disability benefits but seems unusually healthy? They claim they can’t work their desk jobs, but they just got back from a week at Walt Disney World.

Sometimes, the disability is real. For example, they may appear physically healthy but suffer from a mental, emotional or cognitive condition that hurts their ability to focus and concentrate.

Some people make less than candid long-term disability claims, so protecting against disability insurance fraud can affect how your long-term individual or group disability carrier reviews your claim. Some legitimate self-reported disabilities, such as fibromyalgia or depression, lend themselves to fraudulent individual or group disability claims, putting insurance companies on guard against them, while other serious disabilities are harder to feign.

Individual or group disability insurance companies may force some claimants with valid partial or total disability claims to weave through substantial red tape to get necessary and deserved individual or group long-term disability benefits.

Moreover, some intentionally confusing questions on individual or group disability insurance claim applications seem designed to trick applicants into giving incorrect answers. Your individual or group disability insurance company can use your responses to make unfounded accusations that you committed fraud, and on that basis delay, deny, or terminate your benefits.

Every fraudulent long-term disability insurance claim can affect the legal rights of our disabled clients. That’s why the compassionate individual and ERISA group long-term disability attorneys at DarrasLaw offer completely free and confidential policy analysis and free disability claim consultations. We’ll help you navigate the red tape laid out by your insurance company and fight for your legal right to individual or group ERISA long-term disability benefits. Avoid the pitfalls of disability insurance fraud by calling us today at (800) 458-4577 or contacting us online.

What Is Disability Insurance Fraud?

In the broadest sense, disability fraud is defined as when a person “makes a false statement, provides wrong information, or withholds facts for the purpose of collecting [individual or group disability] benefits.” Whether you’re the false claimant or a doctor helping the false claimant, you can face disability fraud charges.

Disability fraud can constitute any or all of the following acts:

  • Hiding your marital status to avoid spousal deductions
  • Hiding income to avoid offsets, such as rental income or dividends
  • Cashing checks of a deceased disability recipient
  • Claiming individual or group disability benefits while you’re employed without prior plan approval
  • Claiming a false disability or exacerbating your symptoms to claim individual or group disability benefits
  • Purposeful infliction of an injury to obtain individual or group disability benefits
  • Forging affidavits and medical records

False individual or group disability claims may arise from those who suffer from legitimate injuries or illnesses. However, they may lie about income, exacerbate their symptoms or misrepresent their ability to work, to improve their chances of increasing or obtaining individual or group disability benefits.

If your long-term disability insurance company suspects fraud, it may send a private investigator to monitor your activities. It will then compare what it sees you doing daily to your individual or group disability claim form listing of restrictions and limitations.

For example, if you claim you are disabled from your occupation of delivering packages because you can’t drive or lift more than five pounds, the investigator may try to catch you driving, lifting a package, or holding your child. You could face both criminal and civil penalties for disability insurance fraud—and certainly the delay, denial, or termination of individual or group disability benefits.

You can’t claim driving or carrying your child are impossible tasks if you can do them, regardless of how much they hurt you. Instead, you need to state the facts—which in this hypothetical means that you should state that you could drive in an emergency, but it’s extremely painful to do so. A top-rated individual disability attorney or group ERISA lawyer from DarrasLaw can try to help you and your treating doctors to present the proper evidence or try to explain what was seen was a “good day” to your individual or group disability insurer.

Preventing Disability Fraud

Although “independent medical examinations” are often far from “independent,” they were originally designed to prevent insurance fraud. An unbiased physician specializing in your injury or illness would periodically examine you, review your medical records, and determine if you were truly disabled.

In cases of medical fraud—if you don’t have the disability, or degree of disability, that you claim—an independent physician may catch this early on. Insurance fraud can be prevalent with the following “self-reported” disabilities, which are hard to treat and test for:

  • Depression, anxiety, PTSD, and other mental and emotional illnesses
  • Fibromyalgia, back pain, and chronic pain disorders
  • Drug abuse and addiction
  • Headaches and chronic migraines
  • Lyme disease and other tick-borne illnesses due to false negatives
  • Eating disorders, including anorexia and bulimia
  • Tinnitus (ringing in the ears)

Circumstantial evidence can often support severe cases of these disabilities—for example, testimony that you can’t get out of bed in the morning due to depression. However, how can any doctor prove you don’t hear ringing in your ears or that you’re not suffering from hallucinations?

Penalties for Insurance Fraud

If you’re charged with insurance fraud, whether you’re the claimant, a doctor, or an accomplice, you could face criminal, civil, and private penalties.

First, if you’re a claimant, your individual or group long-term disability insurance company will likely cut off your benefits and drop you from your plan.

Second, you may face criminal penalties, depending on the nature of the fraud.

Finally, you can face civil penalties. Your individual or group long-term disability insurer may sue you, and this may result in you having to pay the benefits back with interest as well.

Take Advantage of Your Free Disability Case Review at DarrasLaw

Disability fraud is a serious offense. Even a seemingly minor concealment, such as failing to claim rental income, can result in serious ramifications if you’re truly disabled. You may lose your legal right to ever receive individual or group disability benefits again, even if you need them.

Don’t fall into the insurance fraud trap, or let tricky, misleading questions on your claim application trip you up. Even though it seems difficult to get the individual or group disability benefits you need, the award-winning individual and group ERISA long-term disability lawyers at DarrasLaw can try to help you do it the right way. Call us today at (800) 458-4577 or contact us online to schedule your free disability policy analysis and free claim consultation.

Call our experienced, top-rated national disability attorneys at 800-458-4577 or send us an email.

We offer free consultations on all insurance matters, including free policy analysis and free claim help.

Request a Free, Confidential Case Review.