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Disability Insurance Fraud: Prevention and Penalties

Disability Fraud Attorney

Disability Insurance Fraud: Prevention and Penalties

Disability insurance fraud is a serious offense that affects government and private sector insurance programs. The Social Security Administration (SSA) program, worker’s compensation, and private disability insurers face the ever-present risk of fraudulent individuals obtaining benefits through deceit.

Generally, most fraudulent activities are intentional, such as providing false information during the application, exaggerating the extent of injuries, failing to report an improvement in your condition, etc.

However, sometimes claimants may commit the crimes involuntary, mostly due to ignorance of regulations or failing to elaborate facts about their condition. For instance, if you experience discomfort doing specific tasks but can still perform them, claiming you cannot do them may land you into trouble if the insurer finds out.

Nevertheless, no matter how the fraud occurs, a party found guilty of the offense (beneficiary or an accomplice) faces criminal charges and potentially hefty penalties.

Prevention of Disability Insurance Fraud

A purportedly disabled individual might commit insurance fraud independently or with the help of persons in positions of trust. For instance, a doctor may help a disabled individual exaggerate their condition by providing false medical reports. Similarly, a rogue attorney may assist an individual in falsifying documents during the application to increase the chances of acceptance.

Owing to these dangers, SSA has strict controls that safeguard the program against fraudulent applications and claims.

Some measures include:

  • Strict Eligibility Requirements – SSA has strict eligibility regulations that see most applications rejected. For instance, to qualify for the benefits, you must have a severe condition expected to last for more than one year and be unable to perform the duties you used to do before the disability. Besides, you must wait for at least five months to receive the benefits. This added safeguard allows SSA time to establish whether your condition is indeed long-term.
  • Monitoring Disability Decisions – SSA closely monitors the decisions by the disability determination services, which evaluates the claims, and the administrative law judges who handle appeals of rejected claims. This ensures control over their internal processes, thereby minimizing fraud.
  • Continuous Disability Reviews – After SSA approves and awards the benefits, they review the claimant’s condition continuously. This enables them to keep up with their recovery and stop the payments once their condition improves.

Also, as a claimant, you can keep yourself from committing involuntary fraud by adhering to the program guidelines, more so being honest about your condition even if providing the information risks losing benefits.

Penalties for Insurance Fraud

Disability insurance fraud is a criminal offense that attracts stiff penalties. Once found guilty of any of the violations, SSA discontinues you from the program in addition to facing criminal penalties.

The penalties may include jail time for up to five years and a maximum fine of $250,000. Persons in positions of trust who aid a claimant in making fraudulent claims face even stiffer penalties. They may be guilty of felony charges and can serve a jail term of up to ten years.

Consult an Experienced Disability Insurance Claims Lawyer

Due to the prevalence of disability insurance fraud, the government has enacted strict regulations to safeguard the programs from opportunistic claimants. Without knowing these regulations, one can easily fall into non-compliance and be charged with fraud.

For this reason, whenever you have a disabling condition that requires you to apply for disability benefits, it’s essential to consult a disability insurance claims lawyer to help you understand and adhere to the program guidelines.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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