​Did you know that it can be a Felony for an insurance adjuster to fraudulently deny your workers' compensation benefits?

25 May 2016

Did you know that it can be a Felony for an insurance adjuster to fraudulently deny your workers' compensation benefits?

The Texas Labor code states that if anyone makes a false or misleading statement, misrepresents or conceals a material fact, fabricates, alters, conceals, or destroys a document (other than a government document which is covered by other laws) can be guilty of a felony if the benefits being sought are greater than $1,500.00. The one that is most interesting to me is the fact that misrepresenting a material fact or concealing a material fact can be a crime under the law.  So has any insurance employee ever been prosecuted?  Not that I can find, but that does not mean it has not happened.  Anyway, filing for workers' compensation is a daunting task and workers' compensation is extremely unfair to injured workers.  While it is difficult to find a lawyer to help with workers' compensation it is worthwhile to see a board certified lawyer to find out  what are the rights of injured workers..  In many instances, an employer may actually only have their own separate injury plan where the employer can control the type and amount of medical expense. This is why so many injured workers' find that their claims for medical have been denied or delayed.  While this law may not be used often, it is worth noting because it does give both your employer and the insurance company employee pause before that go to any length to deny your claim.  

Sec. 418.001. PENALTY FOR FRAUDULENTLY OBTAINING OR DENYING BENEFITS. 

(a) A person commits an offense if the person, with the intent to obtain or deny payment of benefits, including medical benefits, under this subtitle or Subtitle C, for himself or another, knowingly or intentionally:

(1) makes a false or misleading statement;

(2) misrepresents or conceals a material fact; or

(3) fabricates, alters, conceals, or destroys a document other than a governmental record.

(b) An offense under Subsection (a) is:

(1) a Class A misdemeanor if the value of the benefits is less than $1,500; and

(2) a state jail felony if the value of the benefits is $1,500 or more.


Roger Davie P.C. El Paso's Board Certified Personal / Work Injury, Wrongful Termination, Workers' Compensation and Employment Lawyer. Free Consultation.