Maryland Workers Compensation Fraud Defense Attorney
Accusations of workers’ compensation fraud carry real consequences in Maryland, ranging from criminal charges to permanent loss of benefits and civil liability. Workers who file legitimate claims sometimes find themselves on the receiving end of a fraud investigation, often without understanding why or how to respond. A Maryland workers compensation fraud defense attorney can make the difference between a resolved allegation and a conviction that follows you for life.
What Maryland Law Actually Treats as Workers’ Compensation Fraud
The Maryland Workers’ Compensation Act and related criminal statutes cover a broad range of conduct that falls under the fraud umbrella. Misrepresenting the circumstances of an injury, claiming benefits while working a second job, exaggerating limitations during an independent medical examination, and failing to report a return to work are all scenarios that insurers and employers flag for investigation.
What many injured workers do not realize is that honest mistakes can look identical to intentional fraud from the outside. A claimant who returns to light-duty work for a family member’s business without reporting it may have no intent to deceive, but that conduct still draws scrutiny. A claimant who describes their symptoms differently on different days may be accurately reflecting how a fluctuating condition actually behaves, but inconsistency in medical records is a classic red flag for investigators.
Maryland law also targets fraud from the employer side. Employers who misclassify workers to reduce premiums, provide false payroll information to insurers, or retaliate against employees who report workplace injuries are themselves subject to fraud charges. The statute is not one-directional, even if investigations of workers tend to generate more public attention.
How Fraud Investigations Actually Unfold Against Workers
Insurers employ special investigation units whose primary function is identifying and building cases against claimants they suspect of fraud. These units use surveillance, social media monitoring, recorded statement requests, and coordination with employers to construct a picture of the claimant’s activities outside of what appears in medical records or deposition transcripts.
Surveillance is more common than most claimants expect. An investigator may photograph or film a claimant performing physical activities that appear inconsistent with their stated limitations. Those images and video clips get sent to the insurer’s medical experts, who may then revise opinions about the claimant’s condition. That chain of events can quickly move a benefits dispute into fraud territory.
If the insurer refers the matter to state authorities, the Maryland Insurance Administration and the Office of the Attorney General both have jurisdiction over workers’ compensation fraud prosecutions. A referral does not guarantee charges, but it begins a formal investigative process that demands a serious legal response. Claimants who try to explain their way through an investigation without counsel often make the situation worse, not better.
Berman Sobin Gross LLP’s attorneys have represented clients through the Workers’ Compensation Commission process and into the courts for decades. That depth of experience inside the system means our lawyers understand what investigators look for, how evidence gets developed, and where the weaknesses in a fraud case typically arise.
Criminal Exposure and Administrative Consequences Running Together
Workers’ compensation fraud in Maryland can be prosecuted as a misdemeanor or a felony depending on the amount at issue and the specific conduct alleged. A conviction can result in incarceration, fines, restitution orders, and a permanent criminal record. Those outcomes exist separately from what happens administratively.
On the administrative side, a finding of fraud at the Workers’ Compensation Commission level can terminate existing benefits, require repayment of all benefits previously received, and bar future claims. An employer or insurer who prevails on a fraud allegation at the Commission level can also pursue civil recovery through the courts.
The two tracks, criminal and administrative, can run simultaneously. A claimant may be defending against benefit termination before the Commission at the same time a criminal investigation is proceeding. Statements made in one proceeding can surface in the other. An attorney who handles only criminal matters or only workers’ compensation work may not fully anticipate how those tracks interact. Our firm operates across both arenas, which positions us to manage that overlap for our clients.
Questions We Regularly Get from Workers Facing Fraud Allegations
Can I be charged with fraud if I filed my claim truthfully?
Yes, charges can still be brought even when the initial claim was accurate. Fraud allegations frequently arise from conduct after filing, such as failing to report changed work status or making statements during an IME that conflict with recorded activities. The original claim’s legitimacy does not insulate you from later allegations.
Someone told me I was caught on video. Does that end my case?
Surveillance video is evidence, not a verdict. Video clips are often decontextualized, edited, or misinterpreted. What looks like a claimant doing prohibited physical activity may be a single good day inconsistent with their overall condition, may show activity within their documented restrictions, or may simply be misidentification. Every piece of surveillance evidence requires careful examination.
The insurer wants to take a recorded statement. Should I comply?
Not without first speaking to an attorney. Recorded statements are used to lock in your account of events and to create material for later impeachment. You are not required to submit to an insurer’s recorded statement outside of specific legal contexts, and agreeing to one without preparation can harm your position significantly.
What happens to my existing benefits during a fraud investigation?
An insurer may move to suspend benefits while an investigation proceeds. That motion goes before the Workers’ Compensation Commission. You have the right to contest the suspension, and a hearing will be scheduled. Benefits do not automatically stop because an allegation has been made.
Will a fraud allegation affect workers’ compensation claims I file in the future?
A formal finding of fraud can follow a claimant into future proceedings. Insurers share data, and a prior fraud finding may be used to challenge your credibility in any subsequent claim. Resolving current allegations as favorably as possible is directly relevant to your ability to pursue legitimate claims later.
What if my employer is the one who made the fraud accusation out of retaliation?
Retaliatory fraud accusations occur. If an employer or insurer initiates a fraud referral shortly after a workplace injury is reported, particularly if the employer had previously indicated reluctance to honor the claim, that timing is worth examining. Maryland law prohibits retaliation against workers who file workers’ compensation claims, and that protection is relevant to how the fraud allegation itself gets evaluated.
My benefits were already terminated. Is there still something that can be done?
Benefit terminations based on fraud findings can be appealed. Maryland’s appellate structure allows cases to move from the Commission to the circuit courts and, when warranted, to both of the state’s highest courts. Berman Sobin Gross LLP has handled appellate work before those courts in workers’ compensation matters and does not treat an adverse Commission decision as the end of the road.
Defense Strategy When a Fraud Allegation Arrives
The first priority is halting any further voluntary disclosure. Workers under investigation sometimes believe they can clear themselves by cooperating thoroughly. That instinct, while understandable, frequently generates new evidence problems. An attorney’s first task is assessing what statements, documents, and recordings already exist and determining what additional exposure further cooperation might create.
The second priority is obtaining and scrutinizing all evidence the insurer or investigative authority has assembled. Surveillance footage, social media captures, recorded statements, medical records, and employer reports all need to be reviewed in their full context, not as the investigating party has characterized them.
Medical evidence is often central to fraud defense. An independent examination by a physician who understands both the claimant’s condition and the specific physical demands being compared against surveillance footage can directly counter the insurer’s narrative. Berman Sobin Gross LLP works with qualified medical professionals who can provide credible opinions grounded in the actual clinical record.
Our firm does not look for easy resolutions at the expense of our clients’ long-term interests. We have taken cases through trial and through appeals when that is what the situation calls for. A fraud allegation that looks damaging on first review has, in many cases, collapsed once the full evidentiary record was properly developed and presented.
Reach Out to Berman Sobin Gross LLP About Your Workers’ Compensation Fraud Defense
Berman Sobin Gross LLP has spent 35 years representing Maryland workers before the Workers’ Compensation Commission, in the circuit courts, and before the state’s appellate courts. Our attorneys have litigated hundreds of workers’ compensation trials and argued precedent-setting appeals that changed how Maryland law operates for injured workers. That accumulated litigation experience is directly relevant when a fraud allegation, with its potential criminal, administrative, and civil consequences, needs a serious response. Workers throughout Maryland, including those in Baltimore, Frederick, Gaithersburg, and the surrounding communities, can reach Berman Sobin Gross LLP to discuss how our attorneys can assist in defending a workers compensation fraud defense matter.
