WCFIG, as established by §136 of the New York State Workers' Compensation Law, is responsible for investigating violations of the laws and regulations pertaining to the operation of the workers' compensation system.
WCFIG's investigations into violations of workers' compensations laws, rules and regulations may include the analysis of materials such as claim files and medical records, as well as taking of testimony from employers, attorneys, employees, health care providers, and insurance carriers. These investigations result in prosecutions throughout the State, as well as recovery of payments derived from fraudulent activities. Through its investigations and audits, the Workers' Compensation Fraud Inspector General's efforts to identify, investigate and prevent workers' compensation fraud focuses on reducing costs to the workers' compensation system.
Additionally, the Workers’ Compensation Fraud Inspector General provides investigatory oversight of the State's Paid Family Leave program. Signed into law in 2016 by Governor Andrew M. Cuomo, the New York State Paid Family Leave program is the most comprehensive family leave program in the nation. The New York State Paid Family Leave program provides New Yorkers with job-protected paid leave to care for newborn children and loved ones with serious health conditions, or to help families of active duty military personnel.
Occurs when an employee intentionally misrepresents or helps another misrepresent an injury for the purpose of obtaining workers’ compensation benefits to which they are not otherwise entitled.
Occurs when an employer misrepresents facts about its employees in order to obtain workers’ compensation coverage for a premium price or knowingly denies an employee to obtain compensation, lies about entitlement to benefits or discourages an injured employee to pursue a claim.
Occurs when a healthcare provider intentionally submits a material misrepresentation about medical treatment for a workers’ compensation claimant in a bill or invoice. Fraud may be committed by any provider in the workers’ compensation system (i.e. doctors, rehabilitation counselors, pharmacists, or chiropractors).