Workers' Compensation Fraud Defense in Miami

Dennis Gonzalez Jr. is a former Miami-Dade prosecutor who has been defending people since 2012. Our office answers 24 hours a day.

What the State Must Prove

Employer charges (s. 440.105(4)(a)1. and 3.; Fla. Std. Jury Instr. (Crim.) 20.28, Elements):

1. You were an employer.
2. You knowingly either (a) presented, or caused someone to present, a false, fraudulent, or misleading statement as proof that you had workers' comp coverage, or (b) failed to secure workers' comp coverage when the law required it.

For a corporation, the people in actual control, such as the president, officers with broad powers, directors, and controlling shareholders, are treated as the employer.

Fraudulent acts by any person (s. 440.105(4)(b); Instr. 20.29, Elements). The State must prove you knowingly did one of the acts the statute lists, including:

• making a false, fraudulent, or misleading statement to get or deny a comp benefit or payment;
• presenting or preparing a statement for a claim knowing it contained false, incomplete, or misleading information about a material fact;
• lying or hiding required information to get coverage or lower premiums;
• misrepresenting or hiding payroll, worker classification, or loss history to lower premiums;
• using a false statement as proof of coverage or of eligibility for an exemption;
• violating a stop-work order issued by the Department of Financial Services;
• using false identity information to get a job or support a claim;
• knowingly helping, conspiring with, or urging someone else to do any of these.

A fact is material if it has the capacity or natural tendency to influence someone's decision.

Degrees and Penalties

Under s. 440.105(4)(f), these crimes are graded by the monetary value of the violation:

• Less than $20,000: third-degree felony (up to 5 years).
• $20,000 to less than $100,000: second-degree felony (up to 15 years).
• $100,000 or more: first-degree felony (up to 30 years).

Other parts of the law: unlawfully soliciting workers' comp claims at hospitals, courts, or other places is a second-degree felony (s. 440.105(5)). Some employer violations, such as firing a worker for filing a claim, are first-degree misdemeanors (s. 440.105(2)).

Federal Workers' Compensation Fraud

Federal employees' comp claims go to the U.S. Department of Labor. Under 18 U.S.C. s. 1920 (11th Cir. O69, Elements), the government must prove you knowingly and willfully made a false statement or report to the Department of Labor's Office of Workers' Compensation Programs, in connection with applying for or receiving federal comp benefits, about a material fact. Penalty: up to 5 years, or up to 1 year if the benefits falsely obtained do not exceed $1,000.

Common Miami Situations

• A roofer or drywall contractor working under someone else's coverage certificate.
• Payroll reported as a few office workers while crews were on the job.
• An injured worker filmed doing activity the carrier says contradicts the claim.

Defense Themes

• Knowledge. Each of the fraud crimes above requires that you acted knowingly.
• Was there a duty to have coverage? Exemptions, subcontractor arrangements, and who counts as an employee are technical questions.
• Material? A wrong date or a small inconsistency is not the same as a material lie.
• The dollar figure. It sets the degree, and the State's number is often a carrier's estimate.
• Surveillance out of context. A few minutes of video does not show a whole day.

What to Do First

1. Do not give a recorded statement to a carrier investigator or a state fraud detective without a lawyer.
2. Gather certificates of insurance, contracts, payroll records, and medical records.
3. If a stop-work order was issued, do not ignore it. Violating it is its own charge.
4. Call us.

Why Choose Dennis Gonzalez Law, P.A.

• Former Miami-Dade prosecutor.
• Defending people since 2012.
• Super Lawyers recognition and an Avvo Rating of 10.0.
• Bilingual office — se habla español.
• We answer 24 hours a day. Call (305) 209-0384.

Frequently Asked Questions

Can an employer go to prison for not having workers' comp?

Knowingly failing to secure required coverage is a felony graded by dollar value, from third degree up to first degree.

The carrier says my video proves I'm faking. Is that enough?

The State must prove a knowingly false or misleading statement about a material fact. Video is evidence, not a verdict.

Is workers' comp fraud the same as insurance fraud?

They are related. Chapter 440 has its own crimes, and the general insurance fraud law can also apply. See our Insurance Fraud page.