Unemployment accusing me of fraud

[Mja1233]

What is the name of your state (only U.S. law)? California

I got a letter today from unemployment saying that I gave false information which is not the case.

Back in January, I was about to start a new job and became injured and was dealing with neurological issues. I ended up losing my job so I decided to apply for disability. During the next couple weeks, I started to feel better and decided to stop pursuing disability and find a new job. I applied for unemployment, and when they called for an interview I told them this. They ended up approving me in March of this year. During this time I have been applying and attended four interviews. I have the confirmation emails to prove this.

Last month, I ended up re-Injuring myself so I told unemployed that I was unable to look for work due to health and fully expected not to be paid. Once I determined that I needed more medical attention, I told unemployment that I was going to pursue disability. I went to disability and they told me that instead of starting a new claim, they would just go forward with the previous claim, and block out the time I was on unemployment. They told me just to tell unemployment which I did.

I am now being accused of lying to unemployment and they want $4000 plus a $1200 penalty. I never lied to unemployment. I am planning on appealing but do I also need a lawyer? What do I do? Thank you.

 

[commentator]

No, at this point you do not need an attorney. Because of the cross matching between the two programs and because of the necessity of making such examinations on a regular basis, you have been selected for such examination because the fact that you both filed for disability and drew a spate of unemployment benefits looks peculiar. But the LAST thing on this green earth you need to do is lawyer up and act as if you are guilty of a crime. This is not the DA's office, you are not being prosecuted, and you are probably pretty far away from even being found guilty of unemployment fraud yet based on some of what you have said. It's hard for me to say for sure from here.

Your contact letter if it is the first one likely says something about a "possible overpayment of xxxxx dollars" which would be the total amount of claim money you have received. It has been determined that you have been overpaid by xxxx dollars is a bit more serious, but still workable.

Immediately request an appeal of this overpayment in writing if it gives you this alternative anywhere on the letter. Make sure you do this within the time requested on the letter. You do not have to make your argument that you are overpaid on this appeal or why or why you were not overpaid. All it needs to say is "I request to appeal this decision." Get that in there. NOW.

Then, contact the contact information you have for the overpayment/fraud unit, whatever they call it. Make contact as soon as possible. There is a little gap, it appears between "they told me I needed to tell the unemployment system what I was doing" and "Now they say I am overpaid...." Did you continue to file for weeks of benefits at any time after you determined that you were unable to continue working?

When you meet with the department, have with you all the information you possess about your medical condition. Hopefully when you first applied for unemployment, you were, because of health issues, required to have completed a medical form stating your fitness for employment. Did this happen? Then, later, did you see your physician at any time and were then determined to be worse, or did you just make this decision on your own? Would you have been, if you had been hired at any of the jobs your applied for, fully released by your medical provider to work without restrictions?

You applied for weeks of unemployment in good faith, you completed the work searches required, and you were able, available and actively seeking employment as prescribed, and were approved as such by their system. When your condition changed, you informed them and stopped claiming weeks for benefits, we hope. You need to explain this to the fraud investigators, and let them make the determinations whether or not you did so in good faith or were intending to deceive them by applying for benefits while in bad health and with no intention of doing anything but marking time till you got on disability.

I have a feeling there may be some lapse between when you reopened your disability claim and when you had communication with the unemployment system. But either way, do not dodge them any longer. Get that appeal in, talk to them, meet with them, work with them, show them what you have, tell them what happened, and let them determine if you are really overpaid, and if so, if you really did so in a way that was uninformed, or whether you set out to deliberately defraud the system. Many many people do try this, thinking it will work, but few get away with it forever. They won't be surprised. it doesn't matter exactly what you say, whether you admit it or not, they'll have the hard facts about what you've done, how much you've received, what weeks you have applied for.

They'll have to review the situation, determine that your fraud was deliberate, (thus the penalty) then declare you overpaid (if this hasn't already happened, as I say, I don't have all the paperwork before me.)

Then they will start the process to recoup the money. If you cooperate, which may involve requesting a waiver of the overpayment if you are not financially able to repay it at the present time, or paying it from your disability when and if you are approved, or having your wages garnished when you begin work again, there should not likely be any criminal prosecution involved. They are much more interested in getting their money back IF IT WAS TRULY PAID TO SOMEONE WHO WAS COMMITTING FRAUD than they are in sending people to jail.

 

[Mja1233]

Thanks for the response. I understand that people do this all the time but I am truly not lying. The moment I was injured, I told unemployment. I went without payment for a month from them and continue to do so as I am not able to work. The worker who called me to determine what was going on was incredibly rude and said " oh so you magically reinjured yourself? " I felt as if he was already determined that I was guilty.

I had a job interview and was prepared to begin working for them before I re-injured myself. I was not lying about anything and not receiving benefits when I was down. I think the issue is that my disability claim is effective in February-now although the time was blocked for payment until now. Disability just began to pay me effective the day I was injured. If I had just started a new claim maybe this would not have happened. I don't know. My injury is strange (I have episodes of debilitating vertigo related to a neck injury) and so when I went an entire month without anything happening I felt like I could go back to work and my doctor said that was fine even though I guess he put on the disability paperwork that I would be out until October to stabilize my condition with treatment. I was unaware of this since I have never been on disability before. However, I was not pursuing disability at the time I was on unemployment. They had my paperwork but I didn't continue applying until my re-injury. They told me to continue with the old claim and to just notify unemployment and now this is happening.

I am going to appeal and write them a letter explaining all of this. Should I also go into the local office and talk with someone? I have proof of emails with interview dates and also a rejection letter as well as payment history for disability which will clearly state that they began paying me an entire month after I received unemployment.

 

[Mja1233]

Also, I continued being treated and probably will for the rest of my life or a good portion of my life as a preventative measure and to keep my neck in shape. My treatment is chiropractic. However, when I was ready to go back to work, I wasn't going in as much. It was determined that I was better and stable. We didn't know it would be that soon. My doctor told me it was fine to go to work if I felt like I was better which I did.

When I first applied for unemployment, I told them I had been injured and that was why I lost my job. The first two weeks of certification I even told them when I had the flu and didn't get paid for that. They never asked for any sort of medical release.

I truly felt like I was doing everything right by telling the truth. I could have just waited for disability to approve me even when I didn't feel disabled but I didn't. I wanted to do the right thing and get in the correct program. I also didn't want to lie about being able to work when I'm not which is why I am switching now. The letter unemployment sent me was a determination of overpayment and was very aggressive.

 

[commentator]

Okay. I just told you, do not write a letter explaining all this. Just get the appeal set up, and they will tell you the next steps. Of course the letter was VERY aggressive. You are sounding VERY defensive. You may not like the tone of the person on the phone that you dealt with. However, you need to keep dealing with them either in person or on the phone. They don't want a fifty page letter explaining yourself, because the questions they are wanting the answers to are not the ones you are stressing in your postings here, and very likely would not be the ones they would get answered in your letter.

Some of the things that they will want to know, and what is not at all clear to me from what I am reading is questions like What was your medical status at the time you filed the claim? Was this a work related injury? What do you mean about how you were "about to start a new job" and then you ended up losing your job. This is totally confusing. What did you tell them was the reason you were no longer working at the job? Did you mention your health issues while applying for unemployment benefits? What treatment did you seek while you were receiving unemployment benefits? Were you applying for disability benefits at the same time?

And I don't mean you need to come back here and explain all this to me, I just mean that these are the questions they are going to be homing in on and will need to talk to you about, specifically. You must deal with a living person, you can't just write a letter. And yes, those folks aren't going to be especially understanding or considerate or helpful toward you while you are explaining. Don't take it too personal. It's just business to them. As I said, they're not going to be impressed or surprised if you tried to defraud the system. It happens very frequently.

While it is totally possible that you simply did not understand exactly what your health and ability to work had to be in regard to unemployment insurance, it is also possible, (and they don't know either way at this point) that you may've been trying to double dip fully aware of what you were doing.

 

[Mja1233]

Thanks for your reply. I understand what you're saying and I have not been defensive until I received this letter. I am just a bit stressed out right now. I appreciate your help.

 

[commentator]

I have had experience with this from the other side. Please don't be terribly upset. I understand that this is an upsetting experience. But do remember, most of the people they deal with in the fraud unit have actually done something funky, either deliberately or accidentally. And they want to scare you enough to make sure you cooperate with them. Now we sometimes have a tendency on the boards to go all "law and order" on people over unemployment overpayments, as in "You did the crime you will do the time!!!" or "Lawyer up and shut up!!!" which is, of course, very good advice if you are dealing with a criminal investigation.

But at this point, you are in an agency fraud investigation. They would have to recommend you for prosecution to the DA's office, and as I have said many times, they don't usually do this if you are cooperative with them and are not somebody they really want to make an example of. If they prosecuted everyone who was fraudulently overpaid, there would be no room in the jails for criminals who had done something else. If they prosecuted everyone who was overpaid, well, it isn't happening.

As I have said, the system crossmatches and correlates with other systems to a degree that most people do not begin to realize. And most people are not complete experts on the rules and regs of unemployment insurance. They don't expect you to be. It really may be that you were overpaid. It may not be. You'll have to let them look at everything that happened, which they have access to, pretty much, except for your medical records, which you can provide to them. You'll answer the questions they want answered truthfully. You either did or you didn't do this, that and the other. This is the date you did it. This is the date you filed. This is what you received.

There's really not anything you can do at this point except cooperate with the investigation, and give them all you have. your best defense if they believe you drew benefits you were not eligible for is that you did NOT intend to commit fraud. You were told, or you received the impression based on what you were told, that you were entitled to benefits at this time. You did this, this or this in your effort to follow the guidelines and draw the money correctly.

You still may have made a mistake, you may have misunderstood, things may have happened in a manner that it turns out you may end up being overpaid. The best possible outcome would be if you were determined not to have been overpaid at all, of course. They will look and make this determination. Second would be the determination that you were overpaid, but not fraudulently. So you owe back the money, but not the penalties. You didn't set out to do something you knew was dishonest.

This is what you need to get across to them. This is most effectively communicated by working one on one with your investigator and cooperating fully. Try to avoid being snappish and defensive, even if he/she is. They don't meet the nicest people in this job, it's a relief to work with a reasonable honest claimant. They're much more likely to see your actions as a genuine mistake if you are polite and professional with them.

Many times people draw benefits, and then are approved and backpaid for disability from a much earlier date, and these people, though they drew unemployment in good faith and followed all the rules while drawing, are now overpaid, because they have been determined to have been actually disabled at the time they were receiving the unemployment benefits. Happens all the time.

The good side of this is that they're not really harsh about getting the money back if it is not a fraud overpayment. Your state offers waivers of such overpayments if you apply for one and are determined to be low income and unable to pay the money back. You may also have it deferred, or any of the repayment programs they offer.

Get the appeal in, and then work with them. What has happened has already happened. Don't agonize about it. Just work with them and tell the truth. Good luck to you.

 

[Mja1233]

Thank you for all of your advice. I'm truly just confused about all of this because I felt like I was doing everything correctly. I even talked with disability about all of this and they never back paid me at all because I was not disabled. I assumed when I talked to unemployment that they understood and it was all fine.

I will follow your good advice and hopefully this will all be taken care of. Thank you.