Employee disability benefits fraud

What is disability benefits fraud?

Disability benefits fraud generally occurs when you intentionally misrepresent your situation by concealing information or providing false or misleading information for the purposes of financial gain.

The following are some examples of plan member disability fraud and other situations where there may be direct intentional misrepresentation or concealment of a material fact, medical, financial, and/or functional condition for financial gain.

As a plan member (employee):

• Giving your insurer a false medical form that does not come from your healthcare provider.
• Filling out the medical portions of your forms on behalf of your healthcare provider.
• Asking your healthcare provider to give false information on your functional abilities.
• Not declaring you are working somewhere else while you are collecting disability benefits.
• Not reporting income from self-employment or other employment while you are receiving benefits.
• Not reporting financial benefits from other sources (e.g. other insurers, auto benefits, or government plans).
• Misrepresenting your functionality, or the amount of work you can do to your healthcare provider, employer, and/or insurance company.