Tag Archives: fraud

New York’s Newest Budget Shortchanges Injured Workers

Today’s post comes from guest author Catherine Stanton, from Pasternack Tilker Ziegler Walsh Stanton & Romano.

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.

Why an Obscure Securities Law Case Could Affect SSDI

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

Social Security Disability Insurance (SSDI) cases are largely decided by administrative law judges (ALJs). A decision questioning the role of ALJs in another area of the law could cause some major complications for SSDI applicants and SSDI beneficiaries.

The 10th U.S. Circuit Court of Appeals recently set aside a conviction for securities fraud by the Securities and Exchange Commission (SEC) because the ALJ who decided the case should have been appointed under the Appointments Clause rather than hired by the SEC. The 10th Circuit’s decision directly conflicts with a recent decision made by the District of Columbia  Circuit Court of Appeals, which means the U.S. Supreme Court could take up the issue.

This matters to SSDI applicants, their attorneys and even present SSDI beneficiaries because the vast majority of administrative law judges, roughly 1,200 of 1,400, have been hired by the Social Security Administration to hear Social Security Disability appeals. Similar to ALJs from the SEC, ALJs who hear SSDI appeals are hired on merit and are federal employees.

If the U.S. Supreme Court followed the recent 10th Circuit decision and applied it to ALJs who heard Social Security Disability appeals, at least 1,200 ALJs would have to be appointed by the president and confirmed by the Senate. This could lead to further delays and uncertainty related to SSDI appeals. If the 10th Circuit decision were applied to SSDI judges, it is uncertain as to whether awards of disability would still be valid if they were made by unconstitutionally chosen ALJs. In 2014, in National Labor Relations Board v. Noel Canning, the Supreme Court held that the NLRB’s decision made by commissioners who were appointed by constitutionally invalid recess appointments was invalid.

The Social Security Administration has recently moved to abolish the treating physician rule in an effort to decrease claim payments. Uncertainty over whether the awards of SSDI benefits are constitutional would add additional hurdles to those needing SSDI benefits. If you are applying for Social Security Disability or thinking about it, contact an experienced attorney. Also, contact your lawmakers to express your concerns about the SSDI system to them.

Workers’ Compensation Fraud – North Carolina Statistics for 2014 – 2015

Today’s post comes from guest author Kristina Brown Thompson, from The Jernigan Law Firm.

Several months ago, the North Carolina Industrial Commission published their Annual Report for 2014 – 2015. Based on the Annual Report, employer fraud was by far the overwhelming majority of investigated fraud in the North Carolina workers’ compensation system.

 

The Annual Report tracked investigations of suspected fraud and violations related to workers’ compensation involving employees, employers, insurers, health care providers, attorneys, and rehabilitation providers. The total figure of fraud investigations for 2014 – 2015 was 1,474 cases. Of those 1,474 cases, 1,336 cases related to employer fraud. That means that 90.64% of the investigated workers’ comp fraud was fraud on the part of the employer.  Whereas there were 129 cases of suspected employee fraud (i.e. 8.75% of the total investigated fraud cases).

 

The silver lining? Of the employer fraud that was prosecuted, the State of North Carolina was able to collect nearly $1,000,000 in revenue just in 2014 – 2015 in fraud penalties paid by noncompliant employers. 

Insult to Injury: ProPublica’s Series “Demolition of Workers’ Compensation” Focuses on Ongoing Workers’ Comp Woes Faced by Injured Workers Nationally

Today’s post comes from guest author Kristina Brown Thompson, from The Jernigan Law Firm.

Recent years have not been favorable to injured workers. States across the nation have enacted “reform” measures curbing injured workers benefits. Disability caps have been introduced, medical care restricted. In our last blog, we discussed Oklahoma’s Opt Out provisions as an example of the court system declaring that the legislature had legislated away too much of the injured worker’s protections. A couple years ago, Florida workers’ comp laws were declared unconstitutional by a judge. Although the decision was later reversed, the Florida judge (Judge Cueto) expressed concerns regarding the loss of an employee’s right to wage-loss benefits after an accident.  

 

NPR and ProPublica have been authoring an in-depth series on national workers’ compensation issues. ProPublica reviewed “reams of insurance industry data” and their findings confirmed what many workers’ compensation attorneys suspected for years:  insurance companies are increasingly controlling medical decisions, workers are unable to pick their own doctor in many states, and insurers are denying medical care based on internal “guidelines.”

 

As an example, ProPublica’s article talks about a case in California where the insurance company reopened an old case and denied medical care based on the opinion of a doctor who never even saw the patient. “Joel Ramirez, who was paralyzed in a warehouse accident, had his home health aide taken away, leaving him to sit in his own feces for up to eight hours.”

 

The article also brings up a good point about workers’ comp fraud. Repeatedly studies show “most of the money lost to fraud results not from workers making false claims but from employers misclassifying workers and underreporting payroll to get cheaper insurance rates.”

 

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.

Bad Time to be a Disability Lawyer

Today’s post comes from guest author Thomas Domer, from The Domer Law Firm.

I passed through Customs after a trip to Europe this week and explained to the Customs official that I represented injured workers.  His first comment to me was “How ‘bout those guys that are scamming the system?”  I attempted to provide the disclaimer to his notion that “At least one out of every three is a fraud.” by explaining that in a long term study of fraud in Wisconsin, the incidence of fraud was literally one in 5,000.

Nonetheless, that notion persists.  I read with interest today the speech of Professor Jon C. Dubin accepting a Distinguished Service Award.  I sent Professor Dubin a congratulatory note and obtained his permission to reprint it in an upcoming issue of the Workers First Watch (the magazine of the Workers Injury Law and Advocates Group (WILG) which I edit.  He noted

“Sometimes it seems like the only thing less popular than a disability benefit claimant these days is a disability benefit claimant with a lawyer. But it bears remembering that you are the first line of defense against these stereotypes and misperceptions and against the insidious drumbeat of atypical anecdotes and calls for draconian policy change. You are also the only ones who can communicate your clients’ true and heartbreaking counter-narratives to those fraud stories. You are the ones who can describe the terrible injustices that routinely occur in assembly line administrative decision-making especially when there is a cloud of political pressure lurking above that process.”

References made to Social Security representation are also applicable in our worker’s compensation arena.  Congratulations again to Professor Dubin on his well-deserved award and his accurate perceptions of disability claimants and their representatives.

Pierce County, WA Landscaper Charged with Skipping Out on Workers’ Comp Coverage

Today’s post comes from guest author Kit Case, from Causey Law Firm.

          A Pierce County, WA landscaper has been charged with failing to pay workers’ compensation insurance after one of his employees was injured on the job.

           Kenneth Ivan Winters, 49, faces one count of doing business without workers’ comp insurance and seven counts of making false reports to the Department of Labor & Industries, according to charging papers. Each charge is a Class C felony with a maximum penalty of five years in prison and a $10,000 fine.

           The Lakewood man pleaded not guilty to the charges Wednesday, February 19, 2014 in Pierce County Superior Court. His trial was set for May 1.

           According to charging papers filed by the Washington Attorney General’s office, authorities were alerted to the case when an employee filed an on-the-job injury claim while working for Winters’ business, Executive Lawn Care, in October 2012.

           The worker told an L&I investigator that Winters, who was on site when the employee was hurt, threatened him and his family if he filed a claim with L&I, charging papers said. The employee said he had worked for Winters from 2002 until the day he was injured.

           Winters’ workers’ comp coverage had been revoked eight months earlier for failing to pay premiums. However, charging papers allege, he continued to employ the worker full time until the injury. Winters told an L&I investigator he started the business in 1990, and at one time had up to six employees. He said business slowed and his main employee was the worker who became injured, and occasionally the worker’s brother.

           As of Jan. 7, 2014, the employee’s claim has cost L&I more than $67,000 in medical expenses and lost wage payments, charging papers said.

           Businesses that don’t pay workers’ comp insurance gain an unfair advantage over companies that pay their fair share. A 2007 study found that an estimated 55,000 employers skipped out on paying $34.5 million in workers’ comp insurance in Washington state in 2006, causing legitimate employers to pay higher premiums.

         Washington state is one of the few states in the nation where employers and workers both pay a share of the workers’ compensation premiums.  The press release from the Department of Labor and Industries did not indicate whether this worker’s payroll deductions had continued even when his workers’ compensation coverage had lapsed.  If this was the case, this employer’s fraud would represent wage theft, as well.

         

Private Investigators in Workers’ Compensation

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

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

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.