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Fraud: I have a videotape of an injured employee, violating doctor′s restrictions. Has the employee violated Missouri′s workers′ compensation laws?

← Workers' Compensation - Fraud and Non-Compliance
Maybe! Violating a doctor′s work restrictions may or may not be a violation of Missouri′s workers′ compensation laws. For example, an injured worker goes to the doctor and indicates that he or she is in a lot of pain. When asked how severe, the injured employee states, "8 out of 10". You have the employee on videotape building a barn. He or she is carrying 4′ x 4′ posts, bags of cement, hammering, climbing a ladder, etc. This scenario would not be fraud! Why? Where is the lie?

Consider the same scenario with the exception of the doctor′s visit. This time, the doctor asks the injured employee, "How has the injury affected your ability to perform daily functions". The injured employee responds, "Prior to the injury I could climb ladders, mow my grass, go horseback riding, and work in my garden. Now, I can′t even pick up a bag of flour." Now you have a possible fraudulent act. Why? You have a lie! The injured employee indicated he or she could not perform at a certain level and there is evidence that this statement is not correct. The fraudulent statement must be made to someone in a position to determine if benefits are paid. That can be the medical provider, the employer, or the insurer.

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