$97 Million In Fraud: 2012’s Top 10 Workers’ Compensation Fraud Cases

Today’s post comes from guest author Leonard Jernigan from The Jernigan Law Firm.

Over the past few years, many states have aggressively gone after workers’ compensation fraud (whether it’s the employee or the employer) and the amount of employer fraud being discovered continues to be staggering, notwithstanding these efforts. Legitimate business owners that pay for workers’ compensation, as required by law, are at a competitive disadvantage with those who cheat the system, and when people suffer a workplace disability and have no insurance local businesses that provide goods and services feel the pain along with health care providers who cannot get properly paid for their services. The cost of medical care and disability ends up being shifted to the taxpayer through Social Security, Medicare and Medicaid, and in states where compliance is not vigorously enforced a culture of cheating continues. The top ten cases for 2012 are listed below.

2012 TOP TEN WORKERS’ COMPENSATION FRAUD CASES Total Fraud: $97,466,500.00

1. ‘Operation Dirty Money,’ Stings Workers’ Comp Fraud Check Cashing Scheme

Florida: July 27, 2012

Multiple arrests were announced in Florida’s joint task force’s ‘Operation Dirty Money,’ which led to the arrest of alleged ringleader Hugo Rodriguez, owner of the Oto Group, Inc., and seven other individuals. Mr. Rodriguez was the facilitator of 10 known shell companies that funneled in excess of $70 million in undeclared and undetected payroll through different money service businesses. By using shell companies, Rodriguez was able to run a large construction operation and avoid paying the cost of workers’ compensation coverage, leaving employees at risk and scamming legitimate businesses.

 

2. Firms Face Charges for Skipping Workers’ Comp Payments

Ohio: May 13, 2012 Thousands of Ohio companies violated state law by not paying their most recent workers’ compensation premium, which can drive up insurance costs for businesses that follow the rules, a Dayton Daily News analysis found. The bureau identified about 41,247 private employers in the state that failed to report their payroll data and submit premium payments by the deadline. As of May, more than 12,200 accounts remain outstanding, and those companies owe an estimated $5.6 million in premiums.

3. Case Proves Employee Leasing too Good to be True

Texas: July 10, 2012

$4,466,500.00 was awarded in a Texas court against a staffing agency and its workers’ compensation insurance company. Jackson Brothers Hot Oil Service hired Business Staffing, Inc., (BSI) in 1999 and required BSI to have workers’ compensation insurance for its leased employees. BSI had 150 client companies with 2,000 employees. BSI bought a policy from Transglobal Indemnity for a total premium of $4,100.00 to cover all its employees. After failing to pay the medical bills of a 27-year-old oil field worker who was in an explosion and had 18 surgeries, the employee and Jackson Brothers sued BSI and Transglobal for fraud. Neither Transglobal (who had its corporate headquarters in the Turks and Caicos Islands) nor BSI had a license to conduct insurance business in Texas.

4. Business Owner Faces Insurance-fraud Charges

California: May 2, 2012

Construction business owner George Osumi of Irvine, California was indicted on numerous felony counts of misrepresenting facts to the State Compensation Insurance Fund, among other charges. From December 2001 to March of 2006, Mr. Osumi committed workers’ compensation premium fraud by reporting his payroll to SCIF at just over $1 million, under-reporting over $3.5 million in payroll. This fraud resulted in a loss of over $814,000.00 in premium owed to the insurance fund.

5. Watertown Roofing Company and its Owners Plead Guilty and are Sentenced for Labor Violations

Massachusetts: January 11, 2012

The Massachusetts Insurance Fraud Bureau discovered that the company, Newton Contracting Company, Inc., owned by Shaun Bryan and Antoinette Capurso-Bryan, misclassified half of its workforce as subcontractors, as well as failing to disclose to auditors more than $3.4 million of their company’s misclassified subcontractor payroll during its annual workers’ compensation audits.

6. 7-Year Sentence in $3.1 Million Fraud Case

California: November 30, 2012

Steven Morales, 65, of Wildomar, CA was convicted and sentenced to seven years in prison for his part in a $3.1 million workers’ compensation scheme. His son Brian was also convicted and sentenced to 4 years in prison. Morales and his son had set up a sophisticated system of shell companies to hide payroll and avoid paying workers’ compensation premiums.

7. Construction Company President Accused of Payroll Fraud

Florida: March 29, 2012

Randall Seltzer, president of Navarre Industries, Inc., was charged with multiple felony counts, including workers’ compensation fraud. An investigation by Florida’s Department of Financial Services’ Division of Insurance Fraud revealed that Seltzer systematically and intentionally under-reported his corporation’s true payroll to his insurance carrier. The department’s Division of Workers’ Compensation issued the company two stop-work orders within a five-year period. Seltzer allegedly established a shell corporation in 2011 to intentionally violate the stop-work orders and continue operating his construction business illegally. If convicted, Seltzer could face up to 30 years in prison and pay over $2.8 million in restitution.

8. CFO Jeff Atwater Announces Arrest of Owner of Fake Company for Creating Fraudulent Insurance Certificates and Avoiding Millions in Premiums

Florida: April 13, 2012

Yucet Batista was arrested for allegedly creating more than 250 fraudulent certificates of insurance to help uninsured contractors avoid $2.1 million in workers compensation premiums. Batista created the company and obtained the workers’ compensation insurance policy for the purpose of “renting” it, or making it available to dozens of uninsured subcontractors for a fee.

9. Audits Uncover Almost $1.2 million in Workers’ Compensation Violations at Boston Marriott Project

Massachusetts: September 4, 2012

In 12 audits conducted by the Joint Enforcement Task Force on the Underground Economy and Employee Misclassification and the Executive Office of Labor and Workforce Development, it was discovered that there were $584,249.00 in misclassified 1099 wages and $584,287 in unreported W-2 earnings, for a total of $1,171,536.00 in unreported wages by subcontractors on the Marriot renovation project. Six companies misclassified workers as contractors rather than employees, and seven companies failed to report wages. Among the worst of the offenders were one company that misclassified 28 workers and failed to report over $410,000.00 in wages; another failed to report $462,081 in W-2 wages.

10. Inn Owners Facing Workers’ Compensation and Insurance Fraud Charges

California: June 13, 2012

Owners of the historic Brookdale Inn and Spa are facing trial on charges of falsifying wage information to obtain lower insurance premiums.

The owners of historic Brookdale Inn and Spa, Sanjiv and Neelam Kakkar, are facing trial on charges that they falsified wage information to obtain lower insurance premiums. According to records, the couple paid approximately $800,000 less in insurance premiums than they should have over a period of several years.

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Why Injured Workers Should Deactivate Their Social Media Accounts

Today’s post comes from guest author Nathan Reckman from Paul McAndrew Law Firm.

Recently, it seems as though everyone is connected through social networking sites such as Facebook and Twitter. These tools have become a great way to keep in touch with friends and family scattered all over the world. Unfortunately, the information you or your connections post on your social networking sites can cause your workers’ compensation claim to be denied.

The Commission denied further benefits in part based on pictures obtained from Zack’s MySpace and Facebook pages.

For example, Zack Clement suffered a hernia when a refrigerator fell on him while he was working at a warehouse in Arkansas. After undergoing three surgeries and receiving work comp benefits for a year, Zack took his case back to the Arkansas Compensation Commission to get an extension of his benefits. The Commission denied further benefits in part based on pictures obtained from Zack’s MySpace and Facebook pages. The Arkansas Court of Appeals upheld the Commission’s decision, noting Zack’s claims of excruciating pain were inconsistent with the pictures of Zack drinking and partying.

In Iowa, the Workers’ Compensation Commission has also relied on Facebook posts to deny an injured worker benefits. Jody McCarthy had a debilitating back condition that she claimed was aggravated by her work. The deputy commissioner noted that Continue reading →

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Bangladesh Garment Factory Fire: Another Triangle Shirtwaist Fire?

Today’s post comes to us from our colleague Tom Domer of Wisconsin.

A garment fire in Bangladesh killed 112 workers last week, harkening back to the tragic Triangle Shirtwaist fire 100 years ago on March 24, 1911, which claimed the lives of 146 young men and women, mostly immigrant garment workers. The Triangle fire galvanized a broad spectrum of reformers and reforms, one of which was worker’s compensation. In the aftermath of the Triangle fire, many states adopted worker’s compensation laws. (Wisconsin’s was the very first constitutional law in 1911.) Other reforms included workplace safety regulations, child labor laws, and enhanced fire inspections, among others.

There is a growing effort by worker groups to demand safety reforms in Bangladesh where factory fires have killed hundreds of workers in recent years.

An additional tragedy in the Bangladesh fire, whose products are sold here in America Mart, was the revelation that managers may have lowered gates to prevent employees from leaving because they thought it was a false alarm. There is a growing effort by worker groups to demand safety reforms in Bangladesh where factory fires have killed hundreds of workers in recent years. Photos taken by workers showed labels for Wal-Mart’s private label Faded Glory in the remains, along with clothing for a number of other United States labels including work wear brand Dickies.

The analogies to the Triangle Shirtwaist fire are striking. In that fire, people on the 10th floor, mostly in administrative offices, were able to escape to the roof of an adjoining building. Workers on the 8th floor fled using the stairs, the fire escape and elevators. However, Continue reading →

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Insurance Companies Join Coalition to Mitigate Natural Disaster Risks

Today’s post comes to us from our colleague Jon Gelman from New Jersey.

As weather patterns have changed, and 100 year storms seem to be occurring across the nation every year, insurance companies are joining others in a coalition of other voices to speak out on mitigating damages and presenting harm to workers.

The dangers to first responders and rescue workers have become enormous. NJ Governor Chris Christie spoke out on Saturday Night Live about the unnecessary increased risk, when even city mayors of costal communities defy evacuation orders, and unnecessarily put  workers in harms way. He called those who defy evacuation orders “idiots.”

Name-calling doesn’t solve problems, but reasonable action does. SmartSafer.org was established to support and advocate for smarter, more effective policies to help people in need, promote disaster safety and preparedness, and foster sounder environmental stewardship of our fragile coastal ecosytems.

“We simply can’t go on subsidizing enormous numbers of people to live in areas that are prone to huge natural disasters.” Eli Lehrer a member of SmarterSafer.org, a Washington-based coalition, on subsidies for rebuilding coastal communities.

Read the complete article in the NY Times: As Coasts Rebuild and U.S. Pays, Repeatedly, the Critics Ask Why

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Read more about Hurricane Sandy

NJ Provides Workers’ Compensation For Hurricane Recovery

Nov 12, 2012

As Hurricane Sandy recovery workers descend on NJ by land, sea and airlift, by the thousands, energized and fueled by caffeine, to work long and tiring hours, to do treacherous and hazardous tasks, they need to understand …

http://workers-compensation.blogspot.com/

OSHA urges hurricane recovery workers to protect themselves

Nov 05, 2012

The U.S. Department of Labor’s Occupational Safety and Health Administration is urging workers and members of the public engaged in Hurricane Sandy cleanup and recovery efforts in New York, New Jersey and the New …

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Workers’ Compensation: Hurricane Sandy Relief: US Resources

Nov 06, 2012

Safety is a primary issue when you’re recovering from a disaster. Follow these tips to help ensure your safety and cope with the disaster. If you aren’t able to return home, states, tribes, localities, and the Red Cross continue to …

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Deadly Asbestos Exposure Threat Left by Hurricane Sandy

Nov 04, 2012

The path of destruction to buildings caused by hurricane Sandy has created a potential threat of deadly asbestos exposure. Many structures destroyed and damaged by the storm contained asbestos fiber and those were …

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NJ Urges That Volunteers & Homeowners Protect Themselves During Storm Clean Up

Today’s post comes to us from guest author Jon Gelman of New Jersey. For more information about have your Superstorm Sandy-related insurance claim reviewed by our firm, please read our blog post.

Recently Health Commissioner Mary E. O’Dowd urged those engaged in Hurricane clean up activities to make sure they protect themselves against environmental hazards that may be present in storm damaged homes and buildings. 

Mold, materials containing asbestos and lead-based paint may all be potential hazards in storm damaged buildings. Homeowners and volunteers conducting clean up or remediation work should ensure their safety by wearing protective equipment appropriate for the work they are doing. Protective equipment may include waterproof boots, gloves, goggles and a respirator.

“Homeowners doing clean up work and the volunteers assisting them are critical assets in New Jersey’s recovery efforts, but making sure they protect themselves is equally important,” said Commissioner O’Dowd.

“Homeowners and volunteers may not be familiar with the environmental hazards that may be present in storm damaged buildings or what the appropriate protective measures that are needed,” the Commissioner added.

Those involved in clean up activities should also check with their health care provider to determine if they need a booster shot or tetanus vaccination. Everyone should be immunized with a tetanus, diphtheria, and pertussis-containing vaccine. Individuals should receive a tetanus booster if they have not been vaccinated for tetanus during the past 10 years.

People who sustain a wound should check with their healthcare provider to determine if they need to be vaccinated, as the decision will depend on an assessment of the wound and the person’s past immunization history.

Below are some do’s and don’ts for clean up work:

DO’s:

  • Call a professional if you feel the work is too extensive
  • Talk to an environmental health professional about safety and working in a building that has been damaged by the storm
  • Wear appropriate protective equipment including gloves, hard hats, goggle, and boots
  • Wear the appropriate respirator. A single respirator may not protect you against all of the hazards that may be present. A dust respirator will not protect you against vapors from oils or fuels
  • Make sure you are fit to wear a respirator and to conduct the work. Remediation and clean up work can be very strenuous and breathing through a respirator can add additional stress to breathing. Talk with a healthcare professional if you are uncertain about the risks of wearing a respirator
  • Take frequent breaks and remain hydrated
  • Wash hands and any areas where your skin contacts debris

DON’Ts:

  • Do not enter the building if you are uncertain about the buildings stability or of any hazards that may exist
  • Do not conduct any work without Continue reading →

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Superstorm Sandy: How To Be Compensated For Your Damages

Pasternack Tilker Ziegler Walsh Stanton & Romano LLP hopes that you, your family and your neighbors are safe. As we work through the Hurricane Sandy recovery process we want to make sure that you have important information on what steps to take in order to be properly compensated for any damage to your home and/or business.

Property Insurance Claims

 

We urge homeowners who have experienced property losses from Hurricane Sandy to file insurance claims with their insurers promptly.

  • Document losses as best as possible through both photos and videos before cleaning up damage.
  • Make only necessary repairs to prevent further property damage, like covering broken windows. Permanent repairs should not be made until after the insurance company does an inspection.
  • Write down your claim number and keep a log of all your conversations with your insurance agent and claims adjuster, including their names, dates and visits and calls.

Business Interruption Claims

 

If you have suffered any business interruption as a result of the storm, you should also contact your insurance company promptly and inform them of your losses.

  • Documents the losses as best as possible through both video and photo evidence before clearing the damage.
  • Document all of your business losses with your accountant.
  • Contact us for your free evaluation to determine whether your claims are covered by your insurance.
  • If you claim was denied or if you were underpaid, call us for a FREE evaluation of your claim

Call Us Toll Free

(855) 2-STORM-LAW

(855) 278-6765

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Do I Qualify For Social Security Disability Benefits?

Today’s post comes from guest author Roger Moore from Rehm, Bennett & Moore.

[youtube http://www.youtube.com/watch?v=BCLGoBE1Mks]

In order to qualify for Social Security disability benefits, you have to prove that you have one or more physical and/or mental impairments that are severe and that prevent you from engaging in substantial gainful activity. 

Substantial gainful activity is measured by the amount of money per month that you can earn. 

The Social Security Administration will take into account your educational background, job history, and the skills you have acquired in determining whether or not you meet this standard. The fact that you cannot go back to the job you have done for most of your life does not necessarily mean that you can qualify for Social Security disability payments.  

I am licensed in Nebraska and Iowa and handle workers’ compensation, personal injury, and Social Security disability appeals for the firm. If you have questions about Social Security disability benefits or the appeal process in another state, I can refer you to another expert attorney.

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If You’re Going Out To Eat Check Out “Behind The Kitchen Door”

Today’s guest post comes from Jon Gelman of New Jersey.

For many celebrating the holiday season is inggo out to eat for an enjoyable experience. Unknown to many restaurant patrons are the problems of restaurant workers and include:  low wages, occupational stress and lack of medical benefits that requires restaurant workers to go to work sick.

Behind The Kitchen Door exposes the working conditions in the restaurant industry.

“How do restaurant workers live on some of the lowest wages in America? And how do poor working conditions—discriminatory labor practices, exploitation, and unsanitary kitchens—affect the meals that arrive at our restaurant tables? Saru Jayaraman, who launched a national restaurant workers organization after 9/11, sets out to answer these questions by following the lives of ten restaurant workers in cities across the country – New York City, Washington DC, Philadelphia, Houston, Los Angeles, Houston, Miami, Detroit, and New Orleans. Blending personal and investigative journalism, Jayaraman shows us that the quality of the food that arrives at our restaurant tables is not just a product of raw ingredients: it’s the product of the hands that chop, grill, sauté, and serve it, and the bodies to whom those hands belong.

“Behind the Kitchen Door “ is a groundbreaking exploration of the political, economic, and moral implications of eating out. What’s at stake when we choose a restaurant is not only our own health or “foodie” experience, but the health and well-being of the second-largest private sector workforce—the lives of 10 million people, many immigrants, many people of color, who bring passion, tenacity, and important insight into the American dining experience.

Download the 2012 National Diners Guide – See how your favorite restaurant ranks

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