Tag Archives: fraud

New York’s Newest Budget Shortchanges Injured Workers

A couple of weeks ago Governor Cuomo signed the New York State Budget that contained some potentially detrimental provisions for injured workers. Big business interests are taking their victory laps as they continue with their campaign to dismantle the Workers’ Compensation system by further reducing benefits to injured workers.  See this for what it is- a relentless attack on the working men and women of this state.

If you believe that the majority of those on Workers’ Compensation are frauds, faking an injury, or taking advantage of taxpayers, then you are probably content with the changes in the law. That also probably means you were swayed by the alternative facts that the Business Council was promulgating, including the proposition that Workers’ Compensation benefits are to blame for the high cost of doing business in New York and that many injured workers are not deserving of the benefits they receive.   

My colleague Len Jernigan from North Carolina issues an annual report of the top 10 Workers’ Compensation fraud cases. In 2016, those top 10 fraud claims were against employers – not workers – and totaled more than $400 million! Much of the fraud involved misclassification of employees in order to circumvent payroll taxes and Workers’ Compensation insurance. In fact, very few workers would voluntarily subject themselves to a system that has become so bloated by bureaucracy and is more concerned about precluding medical treatment because a form is not filled out correctly or penalizing counsel for being too overzealous by submitting numerous requests for their client’s day in court. 

Injured workers do not have much political clout. They do not get rich off of Workers’ Compensation benefits. Their weekly benefits can be reduced if they are considered partially disabled without regard to their socio economic status, their educational level or whether or not they are still being treated for their injuries.   Many of them who were union workers now are no longer able to pay union dues; some cannot pay for medical insurance for themselves or their families as Workers’ Compensation insurance only covers the injured worker for the injuries sustained on the job.

Workers’ Memorial Day takes place annually on April 28.  It is a day to remember those who have suffered and died on the job. Each year there are symposiums, panel discussions, acknowledgements, and speeches paying tribute to the men and women who have lost their lives at work. Many of our politicians will issue statements or attend rallies to stand in solidarity with workers’ groups. We will hear how their deaths should not be in vain and how we must make our workplaces safer. We will be saddened to hear the list of names of those who went off to work never to return.

Many of the politicians giving these speeches are the same politicians who voted to reduce benefits to injured workers in order to appease big business interests. It is difficult to comprehend the hypocrisy involved, but we are told this is politics as usual. While it may be too late regarding the further limitation for lost wages, there is still an opportunity to let the Governor know that any further reduction for permanent injuries to limbs is just not acceptable. While honoring those who died on the job is laudable, properly compensating those who have suffered permanent injuries is equally important and ensures that we value both the dead and the living.

Catherine M. Stanton is a senior partner in the law firm of Pasternack Tilker Ziegler Walsh Stanton & Romano, LLP. She focuses on the area of Workers’ Compensation, having helped thousands of injured workers navigate a highly complex system and obtain all the benefits to which they were entitled. Ms. Stanton has been honored as a New York Super Lawyer, is the past president of the New York Workers’ Compensation Bar Association, the immediate past president of the Workers’ Injury Law and Advocacy Group, and is an officer in several organizations dedicated to injured workers and their families. She can be reached at 800.692.3717.

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Workers Can’t Wait to Cash In?

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

It’s not uncommon in the workers’ compensation arena that we hear allegations of malingering or workers being hurt on purpose to reap the monetary rewards of a work injury. Some employers refuse to settle a case as long as the worker is still employed by the company, fearing a large monetary settlement will encourage other workers to get injured.  The limited benefits of a workers’ compensation claim make these assertions ridiculous.  Specifically, no benefits are paid for the pain and suffering.  Additionally, the reality is that many states compensate a permanent injury for only a matter of weeks or years.  The worker and his or her family are left to deal with the ongoing effects of these injuries for the balance of their lifetime. 

The Insurance Journal listed the top 10 leading causes “of serious, nonfatal workplace injuries” from “2012 claims data for injuries lasting six or more days and ranked the injuries by total workers’ compensation costs,” according to a recent article.

Not surprisingly, horseplay or purposefully getting injured was not among them. In fact, the leading cause of workplace injuries is ironically enough – overexertion! Overexertion and other exertion-related injuries made up almost a third of all workplace injuries. So much for the theory of money-hungry workers playing around or purposefully getting injured. Falls comprise two of the top 10 leading causes of workplace injuries, making up a total of just over 24 percent of all injuries.  Being struck by or striking objects combined for around 15 percent. Motor vehicle accidents (5.3 percent) and repetitive movements (3.1 percent) round out the top 10 list. The full list is detailed below. In total, the 10 most common work injuries accounted for almost 84 percent of all injuries.     

  1. Overexertion 25.3 percent
  2. Falls on same level 15.4 percent
  3. Struck by object or equipment 8.9 percent
  4. Falls to lower level 8.6 percent
  5. Other exertions or bodily reactions 7.2 percent
  6. Roadway incidents 5.3 percent
  7. Slip or trip without fall 3.6 percent
  8. Caught in or by equipment or objects 3.5 percent
  9. Repetitive motions 3.1 percent
  10. Struck against object or equipment 2.9 percent

The Occupational Safety and Health Administration (OSHA) reports that workplace deaths have decreased from 38 per day in 1970 to 12 per day in 2012, according to the article. Additionally, OSHA reports occupational injury and illness rates have declined 67 percent since 1970, all while employment has almost doubled.

Despite these accomplishments, insurance companies and large employers continue to lobby state legislatures about the injustice and cost of workers’ compensation benefits. In reality, workers and their families continue to bear the real burdens of workplace injuries.

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Workers’ Compensation Basics: Are You an Employee?

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

Here’s the second blog post in a series on the basics of workers’ compensation.

As its name suggests, workers’ compensation compensates employees for on-the-job injuries. About 95 percent of time, the question of whether an injured worker is an employee is a simple “yes.” If you are paid a regular salary or by the hour via a regularly scheduled paycheck where your employer takes deductions out for Social Security, unemployment, Medicare, etc., you are most likely an employee.

But sometimes the issue of whether you are an employee isn’t as simple. Some states may exclude household and farm workers. Some states may exclude employees performing work for the business outside of the regular course of business hours. An employer might try to exclude an employee from workers’ compensation benefits by alleging the employee is an independent contractor.

If you are hurt on the job and your employer or their insurance company is claiming that you aren’t covered by workers’ compensation, you need to contact an experienced workers’ compensation attorney. Laws about which employees are covered by workers’ compensation are very specific and vary by state. You need an attorney who can tell you whether you are in fact covered by workers’ compensation, and, if not, what other possible ways there would be to compensate you for your injuries.

Read the first blog post in the series by clicking on this link: What is Workers’ Compensation?

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Injured Worker Stakeouts: Do Private Investigators Commit Fraud?

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

Have you noticed a suspicious vehicle lurking in your neighborhood lately, or is there a stranger that seems to be everywhere you go? If you have an active workers’ compensation claim, then you may not be imaging things. More and more, we are seeing insurance companies willing to spend thousands of dollars to hire private investigators to conduct clandestine surveillance of an injured worker’s daily activities and documenting these activities with video cameras. This type of surveillance often comes as a shock to our clients.

When these situations arise, the question we hear most often is, “Can they do that? Is this legal?” The answer is yes. Private investigators may photograph or video people in their private residences so long as they are clearly visible to the general public and there is no expectation of privacy. They can also conduct a full background investigation and obtain information about any other claims you made for personal injuries or if you have ever been charged with a crime.

While there are honest private investigators in the field, there are also those who will cheat. One investigator deflated an injured worker’s tire and then videotaped the person “working” to fix the flat tire. Another investigator reported talking on the phone to someone who told him that an injured worker was working while also receiving workers’ compensation benefits. A follow up done by our firm proved that the person with whom the investigator claimed to have talked has a serious hearing impairment and could not use the telephone.  

Injured workers need to be aware that surveillance can happen in any case. It has become part of the workers’ compensation system. By the way, if you do notice a suspicious car parked near your home, call the police.

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Misclassification – Department of Labor Recovery

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

The U.S. Department of Labor has recovered more than $1 million in back wages and liquidated damages for 196 employees of Bowlin Group LLC and Bowlin Services LLC out of Ohio and Kentucky. Bowlin Services installed cable for Insight Communications, a cable, telephone and Internet provider in Kentucky. The defendants misclassified 77 employees as independent contractors and violated the Fair Labor Standards Act (FLSA) by denying these workers access to critical benefits, including minimum wage, overtime, family and medical leave, unemployment insurance, workers’ compensation and failing to maintain accurate payroll records.

Misclassifying employees negatively impacts our economy, generating losses to the U.S. Treasury, Social Security and Medicare funds, state unemployment insurance, and state workers’ compensation funds. It also leads to unfair competition because businesses that play by the rules are at a disadvantage.

This problem has become so acute in Tennessee that last month the legislature passed Senate Bill 833, which has been signed into law and imposes penalties on construction companies for misclassifying workers in an attempt to evade workers’ compensation premiums. A Tennessee study in 2012 revealed losses of up to $91.6 million in workers’ compensation premiums. North Carolina has identified the problem but has yet to take any action. Until states aggressively prosecute misclassification, this fraud will continue.

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Private Investigators in Workers’ Compensation

Corporations sometimes hire private investigators to verify that your claim is not fraud

Corporations sometimes hire private investigators to verify that your claim is not fraud

Today’s post comes from guest author Leonard Jernigan of North Carolina.

As a workers’ compensation attorney I find it interesting that many people in the public question the disability status of injured workers. Let’s assume for the moment that you have sustained an injury on the job and you’ve been out of work for 5 months after back surgery. When you are unable to return to work quickly, the insurance industry has a lot of tools at its disposal to verify your disability status. They can pour over your medical records, pre- and post-injury, looking for any piece of evidence to deny your claim. They can send your file to lawyers who review medical records and recorded statements to potentially attack your credibility and honesty. They can hire a nurse to attend your appointments and speak with the physician and the staff, as well as obtain information directly from you. They can do background searches on you to see if you have a criminal or civil record. Obviously they will check to see if you ever filed a workers’ compensation claim before. They will also do social media and Internet searches on you and your family members (Facebook, Twitter, LinkedIn, etc.). They also can hire private investigators to follow you and your family around and take video recordings of your activities. With all these resources at the disposal of the insurance company, it’s hard to believe that many cases of employee fraud slip through the system.

A private investigator pretended to be a potential buyer and spent an hour or more going through the house.

We have one client recently who was followed by several private detectives for more than a year. They not only followed him around, but also followed his wife and son, who have no workers’ compensation claim. Another client had to sell his house because of his disability. A private investigator pretended to be a potential buyer and spent an hour or more going through the house. Does the concept of “Big Brother” come to mind? Are you concerned about invasion of privacy, particularly for family members, friends, and others who may be seen in such videos? We always tell our clients such activity may occur so don’t be alarmed by it, but that isn’t too comforting to people who are struggling through health issues, who have depression and anxiety problems, and who are sensitive to privacy concerns.

It would be interesting if the roles were reversed and employers who underpay premiums by misclassifying the status of their employees, who fail to purchase insurance required to protect their workers, and who don’t follow proper safety regulations that cause injury, were followed this closely by employees or regulators who administer the workers’ compensation program. I have no doubt that these employers and insurance representatives would be outraged.

 

 

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Workers Beware Questionable (Fraudulent) Employer Tactics

It’s time to start talking about employer fraud.

Today we have a guest post from our colleague Tom Domer of Wisconsin. 

Over the course of 35 years representing injured workers, I have heard some whoppers – Employers’ questionable tactics that make even my jaw drop. With all the insurance company generated blather about “employee fraud” incidences of employer fraudulent tactics abound. Workers beware of the following:

  • Recorded statements taken by worker’s compensation carrier adjuster while employee is under medication or in the hospital still suffering from the injury. Questions such as “It’s true you had (low back pain, arm pain, fill in the blank pain, etc.) before your work injury, correct? You’ve had lots more pain from (your motor vehicle accident, sports injury, etc.) than you’re experiencing from your work injury, correct?
  • Employer “channeling” a work to its “Return to Work Clinic” (doctors on company payroll whose opinion is “like some athletic coaches, ‘rub some dirt on it and get back in the game’.”
  • Telling employees to take sick leave rather than claim worker’s compensation.
  • Telling employees to file medical bills under their group insurance, not worker’s comp.
  • Nurse Case Manager who initially befriends the employee but later makes every attempt with the worker’s doctor to prematurely return the worker to the job before a healing occurs.
  • Employer paying worker in cash with no payroll stub (or gives workers a Form 1099 rather than a W-2). Continue reading →

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$100 Million Fraud in New Hampshire

New Hampshire Local Government CenterOur good friend and colleague Jon Gelman posted this recent piece of news on his blog the other week:

A New Hampshire insurance group has been charged by the State with improperly appropriating millions of dollars of taxpayers’ funds to a workers’ compensation insurance plan. The improper allocation is described in a petition filed by the State.

To provide a bit more detail, the amount of misappropriated funds is actually estimated at upward of $100 million. The, or LGC, is a non-government, non-profit organization that provides a range of services to municipal governments. LGC is an umbrella organization with subsidiaries that offer services in areas such as finance, personnel, and legal. They also provide a range of insurance programs that municipalities and their employees may buy into.

In this case, the municipal employees thought that they were paying for LGC’s HealthTrust and Property-Liability insurance programs. Instead LGC used the funds to pay for a completely separate workers’ compensation insurance program.

LGC asserts that they did nothing inappropriate, even though what they did is clearly illegal and they used some very tricky tactics to circumvent the law. Continue reading →

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