Workers’ Compensation Fraud

Most employers are required to carry insurance. When a person is injured during the course of his or her work duties, he or she can file a claim for workers’ compensation. This kind of compensation provides for medical benefits, lost wages, and other monetary compensation and is governed by Title 65.2, Virginia Workers’ Compensation Act.

When someone lies, however, to financially benefit from a workers’ compensation claim, things can get bad quickly. That lie could be considered workers’ comp fraud, and if convicted, an alleged offender faces up to 20 years in prison as well as fines, restitution, and/or probation.

If you have been charged with workers’ comp fraud, you need the assistance of an experienced fraud defense attorney. Workers’ compensation fraud is a serious allegation for which any Virginia prosecutor will work hard to get a conviction. S.L. England understands the urgency in these types of cases. He believes firmly in upholding the principle that you are innocent until proven guilty beyond a reasonable doubt. Contact his office today to begin your defense.


Workers’ compensation fraud occurs when a person or entity knowingly provides false information about workers’ compensation or otherwise employs fraud to receive financial or other benefits for him or herself from the insurance company. Obtaining money in this manner is typically grand larceny (unless the value is less than $500, in which case it is petit larceny). Grand larceny is governed by Virginia Code § 18.2-95 and is a felony charge.

Virginia takes workers’ compensation fraud seriously. The Virginia State Police Insurance Fraud Program focuses on this offense alone. There’s even a hotline for co-workers, employers, or other persons to leave tips about someone who may be committing the offense in Virginia. And though tipsters can remain anonymous, Virginia is so persistent regarding workers’ comp fraud that it offers up to $25,000 in rewards for tips leading to an arrest. These facts underscore the seriousness of this offense.


Workers’ compensation fraud can be committed by either the employee, the employer, or a healthcare provider. To better understand what workers’ comp fraud looks like, listed below are a few common examples.

  • A worker may see an easy opportunity to exaggerate an injury to collect more benefits and avoid returning to work as soon as she or he may be able to do.
  • Likewise, a worker may heal faster than anticipated and, thus, can return to work sooner than expected, but this person continues to collect workers’ comp rather than return to work.
  • An employee may opt for unnecessary medical treatment even though he or she doesn’t need it.
  • An employee may injure him or herself outside the workplace but report the injury as a workplace injury to collect benefits.
  • An employer may under-report injuries on the job to reduce insurance premiums.
  • Likewise, and employer may improperly categorize employees and/or their injuries to reduce premiums.
  • A healthcare provider may submit falsified medical documentation regarding a worker’s job-related injury to an insurance company.


You can defend against an allegation of workers’ compensation fraud. A few of these defenses include:

  • Lack of Intent. If you didn’t mean to steal the money, then you may have a defense. For example, you may have made an honest mistake in the paperwork to the insurance company and that mistake led to additional benefits that you would have otherwise not been eligible for.
  • Mistake of Fact. If you misunderstood stood the facts of the situation and reported the erroneous information based on this misunderstanding, then the mistake of facts can negate the mental state required in Virginia to be convicted of workers’ compensation fraud.
  • Constitutional violations. If your constitutional rights were violated during the course of the investigation before you were arrested, then any evidence flowing from the violation can be suppressed as evidence. For example, according to the Fourth Amendment, you have a right to privacy and not to be unreasonably searched. If you or your home was searched without your consent and without a properly obtained warrant, then evidence found from that unlawful search can be excluded.

Defenses are not your only option. As mentioned, S.L. England believes in holding the state, the judge, and the jury accountable to the principle you are innocent until proven guilty beyond a reasonable doubt. He will introduce reasonable doubt regarding your involvement in any alleged workers’ compensation fraud.


If you have been charged with workers’ compensation fraud in the District of Columbia / Virginia metropolitan area, reach out to S. L. England today. He is committed to formidable, smart criminal fraud defense. He understands how mistakes are made in workers’ comp cases. And he is ready to help you clear your good name and get back to healing or returning to work. 

Contact S.L. England, PLLC online or at 202-489-0720.

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