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Tragically, a vast number of people have been infected with SARS-C0V-2, the "novel coronavirus" which causes the disease we all know as COVID-19. We have lived through lockdowns, travel bans, roadblocks, mask mandates, testing requirements, vaccination waits, and more. People have lost jobs, closed businesses, been hospitalized, and even passed away. It has been a tough couple of years. You cannot find me someone that has not been impacted by this pandemic.
Notably, Floridians have been less impacted than many others. I am persistently reminded of the value and benefits of living in a free society. As I hear lamentations of the challenges that persist in other jurisdictions such as mask requirements, enforced distancing, vaccination passports, closed schools, and more, I am grateful to live in Florida.
Unfortunately, when there are challenges, it seems there is always some inclination to potential abuse. In the early days of the pandemic our tax dollars or debt was distributed "to help protect the American Dream." ABC reports that over a trillion dollars was distributed. There was reportedly insufficient "due diligence" and "little or no verification of self-reported information" in that process. This, ABC claims, led to "unprecedented fraud."
The news has been replete with examples. One group (including from Florida, South Carolina, Michigan, Illinois, and Georgia) was accused of accessing millions which was improperly used on luxury cars, jewelry, and more. Some have already been sentenced (in Georgia) to years in prison as a result of misrepresentations regarding their need for, and entitlement to, money from these programs. The best wishes of a national government for preservation of jobs and livelihoods at public expense were hijacked by some for their own personal gain. And, some may think that words like "fraud," "millions" and similar make for good headlines.
More recently, there comes a story of much smaller individual proportions. The allegation is of misrepresentation and the inappropriate collection of only $1,700 in workers' compensation benefits. Certainly a far cry from the allegations against "Florida Man" and "Ohio Guy" levelled by Forbes. However, who couldn't use an extra $1,700?
NBC reports on a New York man who faces multiple counts of misrepresentation for "submitting multiple fake positive Covid-19 tests" to his employer. The motivation was essentially "so that he could stay home from work and collect workers' compensation for months." The dollar values are much smaller than the headline-grabbing stories of Payroll Protection fraud, but over time this 23-year-old has allegedly collected $1,700 in worker's compensation. It is admittedly a pittance compared to many of the stories we have seen in the news.
The young man's situation of having to defend the fraud charges is further challenged by multiple charges of "forgery, falsifying business records and worker's compensation fraudulent practices." This illustrates that one action, faking a doctor note for instance, might be grounds for multiple criminal charges. I find students are persistently surprised that one act may break multiple laws. This gentleman's path allegedly all began with a perfectly legitimate allegation that he was exposed to SARS-CoV-2 in the workplace, contracted COVID-19, and was unable to work.
The young man allegedly provided "a physician's note and a positive Covid test," and "began collecting $150 a week in workers' compensation." That weekly figure alone is an indicator that this young man was not a high-wage earner. The maximum rate in New York is over $1,000 per week. It is likely that this young man was earning about $225.00 per week, to result in that $150 per week rate. As time passed, for most who contracted COVID-19, recovery followed. Everyone knows someone who recovered from COVID in days. However, we all likely know someone who has suffered the "long covid" and has striven for weeks to recover, or been repeatedly infected.
This young man is accused of thereafter submitting "seven more positive Covid-19 tests and two more physician's notes" in support of his ongoing absence from work. Based upon those submissions, it is alleged that "the carrier continued to pay benefits" over many weeks. Then, the insurance carrier "noticed that many of the positive test results used the same specimen ID." Certainly, that could be a clerical error. Or, someone may have been altering and reusing an old document.
The investigation allegedly established that some of the tests "submitted in April were real," but that "the rest were fakes," as was one of the "doctor's notes." The story did not make the front pages of the national news. It perhaps lacks the "click bait" value of a headline regarding "millions" or a photo of an exotic car. However, if proven, it represents misrepresentation for the purpose of obtaining workers' compensation benefits, perhaps fraud, and even forgery.
Florida has a reasonably strict view of misrepresentation. Of course, criminal activity is criminal activity, including fraud, forgery, and falsification. However, the Florida workers' compensation law forbids anyone from knowingly "mak(ing), or caus(ing) to be made, any false, fraudulent, or misleading oral or written statement for the purpose of obtaining or denying any benefit or payment under this chapter." Section 440.105, F.S. And, a worker who seeks benefits signs an attestation that they understand this.
Making such false statements may result in the injured worker forfeiting entitlement to any and all workers' compensation benefits. That is an important point. A worker who falsely claimed inability to work, as is alleged in this New York case, might forfeit all benefits including the future medical care required for the effects of a "long covid," for example. The misrepresentation regarding any benefit might result in the forfeiture of all benefits. Section 440.09.
In short, there are consequences for misrepresentation. They may come in the form of workers' compensation impacts or effects like forfeiture of all potential benefits. They may come in the form of criminal prosecution, as is apparently proceeding in this case. In the end, they are not worth the risks that they pose, for New York Man, Florida Man, or Ohio Guy. Perhaps this is a young man that can learn and grow from a relatively minor mistake. Maybe the financial impact of $1,700 will glean some leniency. But, the story supports that it will not be only the big frauds that attract the prosecutors.
By Judge David Langham
Courtesy of Florida Workers' Comp
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About The Author
About The Author
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Judge David Langham
David Langham is the Deputy Chief Judge of Compensation Claims for the Florida Office of Judges of Compensation Claims at the Division of Administrative Hearings. He has been involved in workers’ compensation for over 25 years as an attorney, an adjudicator, and administrator. He has delivered hundreds of professional lectures, published numerous articles on workers’ compensation in a variety of publications, and is a frequent blogger on Florida Workers’ Compensation Adjudication. David is a founding director of the National Association of Workers’ Compensation Judiciary and the Professional Mediation Institute, and is involved in the Southern Association of Workers’ Compensation Administrators (SAWCA) and the International Association of Industrial Accident Boards and Commissions (IAIABC). He is a vocal advocate of leveraging technology and modernizing the dispute resolution processes of workers’ compensation.
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