Across industries, employers struggle to identify, attack, and mitigate fraudulent workers’ compensation claims filed by their employees. Nyhan, Bambrick, Kinzie, & Lowry is the only law firm in Illinois with an attorney on staff who is a former investigator with the Illinois Workers’ Compensation Fraud Unit and has an extensive background in law enforcement. Nyhan stands poised to advise and represent clients as they combat these costly threats.

Our workers’ compensation fraud attorneys assist clients in investigating and uncovering fraud, marshaling evidence, and filing fraud complaints with the applicable government agencies. By leading employers through every step in the fraud process, Nyhan enables clients to hold their employees accountable in claims involving workers’ compensation fraud.

By taking a hardline approach in attacking fraud, businesses benefit from the preventative effect that occurs when employees become aware that fabricating misstatements regarding their claim will be aggressively pursued and litigated both at the Workers’ Compensation Commission and in criminal courts.

What We Do

When a client reaches out for assistance regarding a claim that they suspect involves workers’ compensation fraud, our fraud team takes immediate action to assess the situation. This includes:

• Aiding in the investigation of the fraudulent claim
• Uncovering the material misrepresentations regarding the claim
• Formulating a fraud strategy moving forward
• Preparing a formal legal opinion regarding the fraudulent claim

Once we determine there are sufficient facts to pursue the fraud claim, our fraud unit:

• Meets with the client to review the criminal fraud process
• Prepares a formal workers’ compensation fraud complaint with the Illinois Department of Insurance Workers’ Compensation Fraud Unit (WCFU)

As the fraud case progresses, we work with the WCFU and our client to achieve favorable results by:

• Consulting with our client when the petitioner indicates a desire to resolve the underlying workers’ compensation claim
• Assisting the WCFU in investigating the fraud complaint and in preparing their fraud submission to the States Attorney or Attorney General’s office
• Co-operating with the prosecutors in their prosecution of the case
• Drafting settlement documents related to the civil and criminal provisions of the Workers’ Compensation Fraud Act
• Communicating with the employer at each stage of the criminal proceedings from indictment to arraignment to plea or trial
• Assisting in filing related civil lawsuits

Who We Serve

Nyhan works with a wide range of businesses across all industries to combat workers’ compensation fraud. This includes, but is not limited to:

• Healthcare organizations
• Small privately-owned businesses
• Multinational corporations
• Municipalities and other public entities

How We Do It

Combining our years of experience with institutional knowledge of the businesses and industries in which our clients operate, our attorneys carefully evaluate claims to determine the facts and evidence needed for identifying potential links to fraud. Once we uncover fraud, our team mobilizes to quickly provide clients with both the relevant facts and the applicable law so that informed decisions can be made swiftly. This includes engaging the proper governmental agencies to investigate and prosecute the suspected fraud.

In addition, our fraud team works with clients to develop and implement strategies to recognize and prevent future fraud cases within their organizations.

One of our strategies is to recognize older claims with underlying fraud red flags. On all claims open for more than 2 years, NBKL performs a free Fraud Probability Analysis which searches our file for specific words, phrases, medical providers, and medical facilities known to be associated with prior fraudulent claims. We then alert clients to these claims so they can decide whether to move forward with a detailed fraud analysis.