Disability Fraud

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 What Is Disability Insurance?

The term “social security” may also refer to a government program which provides financial support for the disabled. Over the course of your working life, you pay a certain percentage of your income to the government in the form of social security taxes.

Once you retire or become disabled, the government sends you monthly payments based on how much you paid into social security taxes while you were working. This is referred to as work credits, and you are required to have a set number of work credits in order to obtain specific benefits.

Generally speaking, such government assistance is referred to as Social Security Disability Insurance. These payments are separate from any private disability payments that are provided by your employer. It is important to note that only those who have specific, “approved” disabilities are eligible to receive social security disability assistance.

Additionally, eligibility is primarily determined by the severity of the disability or illness as it relates to the person’s career. An eligible person may begin collecting social security disability payments, even if they have not yet reached the age of retirement which is generally 65 years of age.

Alternatively, disability insurance refers to coverage that is purchased to protect an employee from wages lost during a period in which they are disabled and unable to work. While disabled, income will be paid to the employee weekly or monthly in the form of disability insurance.

Individual policies commonly define disability insurance in one of the two following ways:

  • General-Disability Insurance: This type provides benefits to a person who cannot perform any job that the person is qualified for, due to sickness or injury. As long as the policyholder can still perform certain jobs that they are qualified for, they cannot recover benefits; and
  • Occupational-Disability Insurance: This type provides benefits to a person who cannot perform their regular job due to sickness and/or injury.

This distinction between the two types of disability insurance can be critically important. An example of this would be how if a surgeon loses their hand, they may not be able to perform surgery. If they have an “occupational-disability” policy, they would be able to recover, even though they can still theoretically work as a doctor but in a non-surgical field. However, if they have a “general-disability” insurance policy, there would be no recovery even if the surgeon’s only possible alternative is an entirely different career path.

What Is Disability Fraud?

In legal terms, fraud refers to an unlawful or criminal act of deception that is carried out with the intention to secure a financial or personal gain. This is generally money. Fraud is considered to be both a civil tort and a criminal wrongdoing. What this means is that a person who commits fraud can be sued for damages in a civil court as well as be tried and sentenced by a criminal court. Whether a fraud case ends up in civil or criminal court will depend on the party who is filing the action, as well as the type of act committed.

Disability fraud is what occurs when a person receives payments from the government or a private insurance agency even though they do not actually qualify for such payments. In general, this happens because the recipient has engaged in some sort of criminal fraud. An example of this would be how the person may be faking an injury, or they may be claiming a condition that they do not actually have. Another common disability fraud method is for a person to continue filing for disability even after they are free from their original qualifying condition.

In terms of receiving institutional or governmental benefits, disability is associated with many “benefits” such as:

  • Paid time off from work;
  • Medical treatment; and
  • Receiving medical equipment and/or prescription drugs.

Because of these perceived benefits, otherwise well and healthy people may sometimes engage in fraud in order to reap the benefits from these types of assistance. However, disability fraud is illegal, and may result in serious legal penalties which will be further discussed below.

Some common examples of ways in which people engage in disability fraud include, but may not be limited to:

  • Lying About Their Marital Status: SSI benefits are often reduced if a disabled person is married. By stating that they are single, a married person could receive more benefits, or receive benefits that they would not otherwise receive. It is important to note that this reflects a system failure, and not a personal failure;
  • Lying About Their Income: Some types of disability benefits are dependent on the recipient’s income. As such, the applicant may purposely fail to report all of their income. Additionally, they may falsify information regarding their spouse’s income;
  • Blindness: This type of disability fraud would be when an applicant claims to be blind when they are not. However, they may be caught if they are seen driving or otherwise acting in a manner that a truly blind person would not be able to do; and/or
  • Changes In Employment: Disability benefits are frequently dependent on a person’s work status. As such, there are some fraud cases involving situations in which the person has already returned to work, but has not declared this to the government or the insurance agency who is paying out their disability benefits.

What Are The Legal Penalties For Disability Fraud?

As previously mentioned, disability fraud is a crime. As such, the act may be punishable by various penalties which include:

  • Criminal charges, either as a misdemeanor or felony, depending on the seriousness of the offense;
  • Loss of eligibility for future disability assistance; and
  • Penalties associated with their employment, such as being terminated from their job.

For repeat offenses, more serious fines and jail sentences may be expected. Additionally, for those who are subject to specific immigration or work visa status, they could lose their immigration rights and may face deportation proceedings.

A misdemeanor is a type of criminal offense that is considered to be more serious than a simple citation, but less serious than felony charges. In most states, the defining characteristic of a misdemeanor is that it is generally punishable by a sentence of one year maximum in a county jail facility and not in a state prison facility, which is usually reserved for felony charges. Criminal punishments for misdemeanor crimes can involve both jail time and criminal fines, which are generally capped at $1,000. However, this may vary from state to state.

Generally speaking, a felony can be defined as any criminal offense that results in a prison sentence of one year or longer. This sentence must be served in a federal prison facility, and cannot be served at a county jail facility. The fines associated with a felony conviction are generally higher than those in a misdemeanor conviction.

Do I Need An Attorney For An Issue Involving Disability Fraud?

Whether you are being accused of committing disability fraud, or if you need assistance with any other legal matter involving disability fraud, you should consult with an experienced and local fraud lawyer.

An attorney can help you understand your rights and legal options according to your state’s specific laws, and will also be able to represent you in court, as needed.

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