LEGAL GUIDE
Written by attorney Michael Paul Sullivan | Aug 9, 2011

How Florida Workers' Compensation Works-The Usual Suspects: Common Insurance Company Defenses

Chapter 4

The Usual Suspects: Common Insurance Company Defenses

Employers and insurance companies commonly raise the defenses of fraud and statute of limitations to defeat workers’ compensation claims. If one of these defenses is successful, your claim will be dismissed regardless of whether you require further medical treatment or whether you would be entitled to money benefits based on your work status. Fortunately, you are completely in control of preventing these defenses, which will be explained in more detail below. If you have any questions regarding fraud or the statute of limitations, you should consult your attorney immediately.

The Defense of Statute of Limitations

You must meet two important time deadlines in order to seek workers’ compensation benefits. Your case could be dismissed if you fail to meet either or both of the deadlines. The first deadline is the one discussed in Chapter 1—you must notify your employer of your injury within 30 days of your accident. The second deadline is called the statute of limitations, and it’s equally important.

You or your lawyer must file a petition with the court seeking workers’ compensation benefits within 2 years after the date that you knew or should have known that your injury occurred as a result of work performed in the course and scope of your employment. If you don’t file the petition within 2 years, the employer or its insurance company can raise the defense of statute of limitations, which simply means that you lose because you didn’t file a claim by the deadline. This 2-year period is extended by one year every time you receive money benefits or medical care from an authorized doctor. That’s why it’s so important that you don’t go a whole year without either filing a petition for benefits, getting medical treatment, or receiving money benefits.

You should never place yourself in the position of letting your employer or its insurance company take advantage of the defense of statute of limitations. If you have any questions at all, you should contact your attorney immediately.

The Defense of Fraud

Employers and their insurance companies also commonly raise the defense of fraud. Like the statute of limitations defense, if the employer or the insurance company is successful in proving this defense, your workers’ compensation claim will be dismissed. In addition, if your case is dismissed for fraud, you could be prosecuted criminally for insurance fraud, which means you could be sentenced to prison and/or required to pay restitution and fines.

Workers’ compensation fraud means knowingly and intentionally making a false, fraudulent, or misleading oral or written statement for the purpose of obtaining workers’ compensation benefits. Any false, fraudulent, or misleading statement you make can be used against you, so it’s absolutely critical that you are always 100% truthful in everything you say about your employment, your accident, your medical history, and your current medical condition.

Many employers require every new hire to fill out a pre-employment questionnaire and undergo a pre-employment physical. You should always be completely honest about your medical history during this process because if you are injured at work, the first thing your employer or its insurance company will do is review the answers you gave on the questionnaire and the statements you made to the doctor who did the pre-employment physical. If any discrepancies or inaccuracies are discovered, the employer/insurance company will be looking for other inaccurate or inconsistent statements in your workers’ compensation case.

While you’re getting treatment for your injuries, you should also be completely honest with your authorized doctor about all prior accidents, injuries, and medical conditions. Every accident you’ve ever been involved in, even if it was not an on-the-job accident, should be listed in your medical history. You should fully and accurately describe your accident and your symptoms. You should tell the doctor about all the pain you may be experiencing in every part of your body, no matter how insignificant you might think it is. It is always better to tell the doctor more details rather than leave anything out. However, do NOT exaggerate or falsify your symptoms, your medical history, or any prior accidents you may have had. The insurance company will study your prior medical records carefully in an attempt to discover any inaccuracies or inconsistencies.

You might be required to give a deposition. In a deposition, the employer/insurance company’s attorney will question you under oath about your accident, your background, your medical history, and your current medical condition. You should be absolutely honest and straightforward in your answers, and you shouldn’t guess if you’re not sure. Your testimony will be recorded by a court reporter, and any inconsistencies between your deposition answers and other statements you may have made before that, orally or in writing, will be examined to determine if the inconsistencies could be considered fraud. You don’t want to be accused of fraud because you made a guess that turned out to be wrong!

An accusation of fraud is quite serious, and the consequences could be drastic. If your employer or its insurance company proves fraud, your workers’ compensation claim will be dismissed, and you could face criminal charges. If you have any questions about this important issue, you should contact your attorney immediately.

Additional resources provided by the author

To learn more about Workers' Compensation claims please go to our website at www.sullivanandhepler.com or call us at 1800-295-4193 to discuss your case.

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