Are your claimants completing the Employee Certificate of Compliance 1025 form? In this post-COVID world, along with the increase of weekly unemployment benefits, we have noticed an increase in claimants receiving unemployment benefits, but failing to report the benefits. Under La. R.S. 23:1225(B) no workers’ compensation benefits are payable for temporary or permanent total disability or supplemental earnings benefit for any week in which the employee has received, or is receiving, unemployment benefits. The Employee Certificate of Compliance makes claimants aware of this provision and warns that, “It is unlawful for you to receive workers’ compensation indemnity disability benefits and unemployment benefits at the same time, except for permanent partial disability benefits.” In addition, it sets forth the possible fines that may be imposed if it is found the claimant willfully made a false statement regarding the receipt of unemployment benefits. The form contains an Employee Certification which the claimant should sign acknowledging that they understand the contents of the documents, and certifying their compliance with the requirements stated in the form. To prove fraud we have to show that the claimant has willfully made a false statement or misrepresentation for the purpose of obtaining benefits. Although it is possible to make a fraud claim for failure to report the receipt of unemployment benefits without the Employee Certificate of Compliance, a much stronger argument can be made for willful misrepresentation if the claimant has signed the Employee Certification.
This form should be part of the initial package of documents sent to each claimant to complete. We recommend that if you have any opened claims in which the Employee Certificate of Compliance has not been sent or returned, that you send a form for the employee to complete. If the form is not returned, follow up with the claimant or his/her attorney. In addition, we recommend that in any case you have with a claimant receiving indemnity benefits, other than permanent partial disability benefits, that an investigation be made into whether they have received unemployment benefits at any time during the claim. You may be surprised at what you find.
Allen & Gooch is providing this legal update for informational purposes only. This article should not be construed as legal advice or a legal opinion as to any specific facts or circumstances. You should consult your own attorney concerning your particular situation and any specific legal questions you may have.