California Worker’s Comp Fraud – part 5

May 16, 2014

California Worker’s Comp Fraud – part 5

Overall Summary:

 

Definition: Fraud All Workers Comp

In elementary terms, fraud occurs when someone knowingly lies to obtain some benefit or advantage to which they are not otherwise entitled, or to deny some benefit that is due and to which someone is entitled, or to obtain a workers’ compensation insurance policy at less than the proper rate, cost, or premium.

The Most Common Workers’ Compensation “Red Flags”

  1. The injured worker is a new hire.
  2. The applicant took unexplained or excessive time off prior to claimed injury.
  3. The alleged injury occurs prior to or just after a strike, layoff, plant closure, job termination, completion of seasonal or temporary work, or notice of employer relocation, and so on.
  4. Applicant reports an alleged injury immediately following disciplinary action, notice of probation, demotion, or being passed over for promotion.
  5. Applicant has a history of personal injury, workers’ compensation claims, and/or of reporting “subjective” injuries.
  6. Applicant’s job history shows many jobs held for fairly short periods of time.
  7.  The alleged injury relates to a preexisting injury or health problem.
  8. Applicant uses addresses of friends, family, or post office boxes; has no known permanent address, and frequently moves.
  9. Applicant’s family members know nothing about the claim.
  10. Applicant was experiencing financial difficulties and/or domestic problems prior to submission of claim.
  11.  Applicant has a high-risk activity, such as skydiving, as a hobby.
  12.  The applicant’s version of the accident has inconsistencies; is not credible.
  13. There are no witnesses to the accident or witnesses to the accident conflict with the applicant’s version or with one another.
  14. Applicant fails to report the injury in a timely manner.
  15. Accident or type of injury is unusual for the applicant’s line of work.
  16. Facts regarding accident are related differently in various medical reports, statements, and employer’s first report of injury.
  17. The Social Security number provided does not belong to the applicant.
  18.  Applicant refuses to or cannot produce solid or correct identification.
  19. Applicant avoids use of U. S. mail; hand-delivers documents.
  20. Applicant cannot be reached at home during working hours although he claims to be disabled from working; or the message taker is vague and noncommittal. Applicant is otherwise unavailable and elusive.
  21. Applicant’s lifestyle does not coincide with reported/known income.
  22. Several of applicant’s family members are receiving workers’ compensation, unemployment, Social Security, welfare, etc.
  23.  Income from workers’ compensation and collateral sources (unemployment, Social Security, long-term disability, etc.) meet or exceed wages after taxes.
  24. Applicant refuses diagnostic procedures to confirm injury, or refuses to attend a scheduled defense medical exam.
  25. Applicant’s co-workers express opinion that injury is not legitimate.
  26. Alleged injuries are all subjective; i.e., soft tissue, pain, and emotional issues.
  27. Applicant changes version of accident after learning of inconsistencies; misrepresentation or fabrication by any party.
  28. Applicant frequently changes physicians, or does so after being released to return to work.
  29. Physical description of applicant indicates muscular, well-tanned individual, with callused hands, grease under fingernails, or other signs of active work.
  30. Medical treatment is inconsistent with injuries originally alleged by employee.
  31. Applicant undergoes excessive treatment for soft tissue injuries.
  32. Treatment as reported by applicant is different from doctor’s statements in medical report.
  33. Applicant is examined by several doctors when one doctor could have taken all the information and reached a diagnosis.
  34. Applicant reports seeing a doctor for a very brief period of time; however, reports and billing indicate a lengthy visit.
  35. Applicant’s description of treatment indicates nonmedical personnel rendering medical treatment.
  36.  Applicant sends in medical reports that appear to be altered.
  37.  Applicant lives far from medical facility, yet receives frequent treatment.
  38.  Surveillance shows applicant’s activities are inconsistent with physical limitations related in medical reports and disposition.
  39.  Surveillance or “tip” reveals totally disabled worker is employed elsewhere (especially suspicious if employment conflicts with work restrictions given by treating doctor).
  40. Applicant cannot describe either diagnostic tests or treatment for which employer was billed.
  41. The doctor ordered diagnostic testing that is not necessary to determine extent of applicant’s injury; or, diagnostic testing is performed, yet there is no request by doctor in medical files.
  42.  Diagnostic tests are performed by a vendor not in close proximity to doctor’s office or applicant’s home, vendor uses post office boxes on all documents, or cannot supply diagnostic records.
  43. Doctor or medical clinic has ownership share in diagnostic group.
  44. Various reports by a doctor on different applicants’ cases read identically or similarly.
  45.  Post office box used for a clinic/doctor address instead of a street address.
  46. Medical reports appear to be second- or third-generation photocopies.
  47.  Physician cannot be located at address shown on documentation.
  48. Doctor’s report never identifies claimant by gender or gets gender wrong.
  49.  New or additional medical problems are alleged and attributed to the    original injury.
  50. Specific “soft tissue” injury develops psychiatric overtones.
  51.  Medical reports contain inaccurate terminology, spelling errors, variations in physician’s signature or are rubber-stamped with the doctor’s name.
  52. Medical facility uses multiple names or changes name often.
  53. RVS/CPT (Relative Value Scale/Current Procedural Terminology) codes show evidence of upgrading level of services.
  54. Billings are received for unnecessary or not rendered services.
  55. Medical facility has consistently billed the workers’ compensation, auto, health, and other insurance carriers and has received payments from more than one.
  56. Applicant is unable to define medical ailments as listed on claim form.
  57.  Lawyer’s letter of representation or letter from medical clinic is first notice of claim.
  58. Lawyer’s letter is dated the same day as the reported incident or shortly thereafter.
  59. There is a repeated pattern of doctor/attorney referrals; the same doctor and attorney work together on a large volume of claims
  60.  Applicant states that a “friend,” whose name is no longer remembered, provided referral to attorney/clinic.
  61. Applicant filed for unemployment or disability benefits before visiting attorney or clinic.
  62. Applicant alleges doctor or clinic was found through a “hot line.”
  63. Applicant is overly pushy, demanding a quick settlement, commitment, or decision.
  64.  Applicant is unusually familiar with claims-handling procedures, workers’ compensation rules, laws, and proceedings.

A long list, which is not all the red flags of WC fraud, but the most common ones.

Keep in mind that fraud is only perpetrated by a small number of those throughout the entire system. For the most part, the system works as it is supposed to, without a hitch.

I will end this week on a lighter note.

This is a true story of a WC Injury I handled as the employer liaison between the employee and the insurance insurance carrier. Not a fraud situation, but one of those claims that that leaves a forever memory.

One afternoon I received a panic stricken call and had to ask the caller to please slow down so I could understand her.   “THE CAT IS DEAD” is what I was hearing on the other end of the phone.   When the story was finally unraveled, it turned out a high school counselor was working at her desk when PLOP from the ceiling a cat had fallen through, landed on her desk right in front of her.  Not only that, but the poor kitty landed on the counselor’s spiked letter holder and had impaled itself.   Both the counselor and the cat screamed bloody murder. As the cat jumped down from the desk, frantically running around and out of the office and down a corridor of classrooms, another counselor sprung up and started chasing the cat in an attempt to catch it and help the poor kitty who was still attached to the letter holder.   He did finally catch the cat but didn’t expect such a fight.  The cat scratched the heck out of counselor’s arms and face, before it succumbed to death.

Carrying the poor dead kitty back to the office, all bloodied and scathed, was a sad situation, bringing others in the office to tears.
I told the secretary who initially called me that we needed to fill out a WC claim form and get the guy counselor medical attention.  We also needed to call animal control to pick up the deceased cat, and have it checked for disease.   Everything turned out ok, and the guy counselor was fine after first aid was administered and band aides were applied.   End of story, but for some reason when I think back on this case I can’t help but chuckle at the scenario.  One for the books!

HAPPY FRIDAY EVERYONE!

Image | Posted on by | Tagged , , | Leave a comment

California Worker’s Comp Fraud – part 4

May 9, 2014

California Worker’s Comp Fraud – part 4

Legal Provider Fraud and Insurer Provider Fraud: 

The California Dept. of Insurance definition of Legal Provider Fraud – Legal provider inflates billing or materially misrepresent the facts.

California’s Special Investigation Unit has identified Red Flags in Attorney Fraud and Insurance Claims Adjuster Fraud as:

“Red Flags”: Attorney Fraud

  1. The majority of claims in which a law firm is involved are of a highly questionable nature;
  2. A letter of representation is received, but the applicant denies representation or meeting with the attorney;
  3. In what is referred to as solicitation fraud, several employees from the same employer have reported similar injuries and are represented by the same law firm.

“Red Flags”: Adjuster Fraud

  1. Inconsistent application of cost-containment measures or agreement to pay above the fee schedule;
  2. Sloppy observance of procedure for referrals to outside vendors, or increase in the use of a particular vendor, to the exclusion of others;
  3. User of vendors outside the preapproved vendor panel;
  4. Assignments made to vendors where the need for the assignment is questionable;
  5. Adjuster has social relationship with the applicant’s attorney or doctor;
  6. Adjuster is overheard soliciting, or is observed receiving, tickets or other gifts from vendors;
  7. Adjuster’s lifestyle grossly exceeds apparent income.

Two types of attorneys are involved in a litigated case.

Applicants attorney: A lawyer that can represent you in your workers’ compensation case. Applicant refers to you, the injured worker.

Defense attorney: A lawyer that represents your Employer and works with your Employer or its’ Insurance Company, opposing you in a dispute.

Adjusters are not attorneys, but they work with attorneys if your case is litigated, or directly with the claimant if the case is not litigated.    

Claims administrator: The term for insurance companies and others that handle your workers’ compensation claim. Most claims administrators work for insurance companies or third party administrators handling claims for employers. Some claims administrators work directly for large employers that handle their own claims. Also called claims examiner or claims adjuster

In my opinion, it’s best not to litigate a workers comp claim if possible. But with that being said, it is now nearly impossible to not litigate with the complexity of worker’s comp here in California.   The exception would be first aid only injuries, or when you get to a point that you feel overwhelmed and need help.

The good news is I couldn’t find any recent published cases for fraud perpetrated by either attorneys or claims adjusters.

However, I didn’t want to leave this section out because fraud does occur in the legal arena of workers comp, but not nearly as much as with employees, employers, or providers.

Folks, I’m getting a little bored with this subject so we’ll wrap it up with a summary next week and move on.   Hope everyone has a wonderful weekend.

Happy Mother’s Day this Sunday!

 

 

Posted in Workers Comp | Tagged , , | Leave a comment

California Worker’s Comp Fraud – part 3

May 8, 2014

California Worker’s Comp Fraud – part 3

Employer Fraud:

 

Employer As defined by the California Division of Workers’ Comp:

Employer: The person or entity with control over your work activities.

Employers – The Real Problem Behind Workers’ Comp Fraud

The California Dept. of Insurance defines Employer Fraud in five separate categories;

  1. Employer Defrauding Employee– Employer committing illegal act against employee(s).
  2. Misclassification– Misclassifying the type of workers to obtain workers’ compensation coverage at a lower premium. (Example: classifying roofers as clerical, etc.).
  3. Under Reporting Wages– Misrepresenting payroll to obtain workers’ compensation coverage at a lower premium. (Example: Over-reporting wages as if employees are experienced journeyman with less likelihood of injury and thus allowing for lower premiums or under-reporting payroll to keep premiums lower.).
  4. X-Mod Evasion– Misrepresenting claims history by not reporting reportable injuries or by creating shell companies to give the impression of a non or low claims history to obtain workers’ compensation coverage at a lower premium.
  5. Uninsured Employer– Uninsured Employers. –Employers who fail to secure workers’ compensation insurance hurt not only their employees, but also hurt honest employers through unfair competition. 

California’s Special Investigation Unit has identified Red Flags in Employer Fraud as:

“Red Flags”: Employer Fraud

  1. Occupations in claims file don’t match the type of business being insured;
  2. Addition of many DBAs (doing business as) on a small policy;
  3. Policyholder claiming “independent contractor” status of employees;
  4. Employees reporting wages paid in cash or by personal check;
  5.  Policyholder appears to be “hiding” injuries: Paying medical bills or not reporting the claim;
  6.  Employee has difficulty getting claim form from employer;
  7.  Employer denies all claims.

A Couple of California Recent Cases: (April 2014)

–Owner of Security Company Gets 120 Days for Fraud: He was sentenced to 120 days in jail and fined $18,000 for making a false statement to obtain lower WC premiums, according to the Monterey County DA’s Office. He plead guilty and will serve five years of felony probation and perform 200 hours of community service .The owner of ESA International never registered or reported employee wages to the state Employment Development Department. He is also accused of misclassifying his security guards as independent contractors when purchasing policies from State Compensation Insurance Fund. The investigators on this case were tipped that the owner was operating without workers’ compensation insurance.

–Owners of a Sunnyvale construction companies were charged with felony workers’ compensation for underreporting their employees to insurance carriers.   The Santa Clara District Attorney’s Office said between 2009 and 2013 they “grossly underreported their payroll to four different insurance companies” and paid $200,000 less in premiums than they should have. They both face a maximum of 18 years in prison if convicted on all charges.

It doesn’t surprise me that Employer Fraud is the highest percentage of the $7.2 Billion workers comp fraud committed annually, and growing.  This figure is reported as nationally by the NICB (National Insurance Crime Bureau).   Whew! . Obviously a huge Nationwide problem!

Workers’ Comp Fraud is the fastest growing segment of insurance fraud, with Employer Fraud leading the way.  I think the reason is obvious.  Employers look for ways to cut costs and this can occur on so many levels of Workers Comp, as described above.

Also noted here is that Employers who commit WC Fraud are much more subject to committing other types of law breaking activities. One lie typically leads to another…………in any situation I might add.

Any solutions that haven’t already been tried?  What’s abuzz now is using a fairly new concept in Auditing of all phases of the claim process.  There is a lot of development in what’s called a Predictive Modeling System, that reviews workers comp applications, employer payrolls, employee classifications, and other factors that determine premiums.

The system will generate a score that may indicate whether a business is falsifying information to reduce premiums.   This whole concept is very interesting to me and I hope to blog on the subject at a later date.  Aggressive accountability is needed in this very complex system.

Posted in Workers Comp | Tagged , , | Leave a comment

California Worker’s Comp Fraud – part 2

May 2, 2014

California Worker’s Comp Fraud – part 2
Pharmacy Fraud, Medical Fraud and Politicians:

Happy Friday! It’s been a whirlwind of a week. Doesn’t that happen every time we try to start a new project? Hope the weekend is restful for everyone.

The California Dept. of Insurance defines Medical Provider Fraud as – Medical provider inflates billing, knowingly submits bills with improper medical codes and misrepresents facts.

Pharmacy Fraud is defined as – Pharmacy inflates bills or falsifies codes.

Shady Politician Fraud doesn’t have a separate definition, but in my opinion it should. So let’s use Embezzlement Fraud, which is defined as Embezzlement of funds. I think this category could fall under other areas of WC fraud as well.

California’s Special Investigation Unit has identified Red Flags in Provider Fraud as:

”Red Flags”: Provider Fraud:

1. Medical treatment that is inconsistent with the injuries originally alleged by the employee:
2. Employee reports that non medical personnel took medical history or rendered medical treatment;
3. Diagnostic testing performed by a mobile diagnostic service;
4. Various reports by a doctor on different employee cases read either identically or similarly;
5. Medical bills that appear to be second or third generation photocopies.

Some Recent Cases in the News:

–The largest case of Insurance Fraud in department history led to Michael Drobot in Southern California. He built a conspiracy amounting to over $500 million consisting of billing 150+ insurance companies for medical procedures over a five year period.

Since this was first made public, Drobot has recently pleaded guilty and agreed to cooperate in the ongoing investigation.

“Insurance fraud is a multi-billion dollar drain on California’s economy, which results in higher insurance premiums for California businesses and consumers. The co-conspirators lined their pockets by ripping off insurance companies to the tune of hundreds of millions of dollars,” said California Insurance Commissioner Dave Jones. “This is one of the largest workers’ compensation fraud cases in the history of the Department of Insurance-our successful investigation of this complex criminal scheme underscores our commitment to bring law breakers to justice regardless of who they are.”

Drobot was the owner/operator of Pacific Hospital in Long Beach and used the hospital to perform his fraud scheme that involved illegal kickbacks in exchange for thousands of patient referrals from other medical professionals. He targeted the workers’ compensation system with nearly 90 percent of the medical billings for workers’ compensation cases.

Drobot paid other medical professionals as much as $15,000 in kickbacks for each lumbar fusion surgery and $10,000 for cervical fusion surgery. The kickback payments were concealed through bogus contracts with the doctors, chiropractors, and other medical professionals and funded by inflating prices for medical equipment and establishing shell companies to hide his actions, while billing insurers for the inflated equipment and implants and medical procedures. The investigation revealed Drobot inflated prices by as much as ten times the actual price. This was reported by the California Dept. of Insurance. http://www.insurance.ca.gov.

With Drobot’s plea bargain, he could be sentenced to up to 10 years in federal prison.
As part of the scheme, Prosecutors also said that Drobot paid $28,000 in bribes to California Sen. Ron Calderon, D-Montebello, to support legislation delaying or limiting changes in workers compensation laws relating to the amount of money medical providers are reimbursed for performing spinal surgeries

The U.S. Attorney’s Office has charged Senator Ron Calderon and his brother, former state assemblyman Tom Calderon, with political corruption. connected to Drobot’s case and an FBI sting operation where agents posed as filmmakers to bribe the senator to introduce favorable legislation.

Pacific Hospital was sold, and is now named College Medical Center Long Beach.

I wonder if the Calderon’s will get more than a slap on the wrist when all is said and done. Calderon has pleaded not guilty on 24 charges, including bribery, money laundering, wire fraud and filing a false tax return. He faces up to 400 years of imprisonment if convicted of all the charges. He is free on bail and taking a PAID leave of absence from the Senate. He doesn’t seem worried.

Just think of all those needless spine surgeries that were performed at Pacific Hospital during that 5-year period. This case is outrageous, putting people’s lives on the surgery table all for the sake of the mighty dollar.

And who were the doctors involved? I think we will be hearing about this case for a long time.

I do hope and pray justice prevails here.

— A North Hollywood woman was sentenced six years in federal prison and ordered to pay nearly $10 million restitution to the IRS. Midvalley Medical Supply of Van Nuys had submitted nearly $25 million in bogus bills to Medicare, according to the U.S. Attorney’s Office.

The scheme also involved physician’s assistants at three Los Angeles medical clinics who signed prescriptions and orders for unnecessary tests, services and equipment. Over $35,000 was laundered by writing checks from Midvalley to three corporations who had never provided them business services.

–A doctor accused by Farmers Insurance of billing for services he never provided to auto accident victims and injured workers earned $1.1 million treating Medicare patients in 2012, placing him among the top 1% of all California providers who billed the federal government for health care services that year.

There is so much more going on with fraudulent Medicare billing that I cannot list it all in one sitting. This comes out of our pockets folks. Why do the rich steal from the poor and the reportedly nearly defunct funds? GREED, plain and simple!

Smile, it’s Friday. 

Posted in Workers Comp | Tagged , , , , | Leave a comment

California Worker’s Comp Fraud

California Worker's Comp Fraud.

Posted in Workers Comp | Leave a comment

California Worker’s Comp Fraud

California Worker’s Comp Fraud

In a five-part blog, I am going to talk about WC fraud, a subject that makes my skin crawl when I read about a new case exposed. Sometimes I just want to reach out and wring someone’s neck, but sometimes I cry. Every situation is different yet the same question always lingers in my mind, why?

In part 1, we’ll see what fraud occurred in California this past month with regards to Injured Workers. Part 2 will include Pharmacy Fraud, Medical fraud and in some cases, politicians. Part 3 will explore some recent Employer fraud. Part 4 will include Legal Provider Fraud and Insurance Provider Fraud. In Summary, in part 5, I’ll try to wrap it up, summarize my thoughts, and possibly deviate a bit about the rampant fraud in California.

California Worker’s Comp Fraud – part 1
Injured Workers:

    While researching this topic, it becomes apparent to me that the media likes to profile the fraud cases involving workers. I believe the reason for that it is not so much that workers commit the majority of fraud in the system, and definitely not the highest dollar amount, but they are the easiest players to prosecute.

    First off, let’s refresh what the basis for worker’s fraud is.

    The California Dept. of Insurance defines Worker’s Comp Claimant Fraud as a suspicious employee applicant claim.

    As I’m reading this brief definition, I see that there’s not much reason needed to investigate any employee claim. However, occasionally a claim of injury may be considered questionable.

    California’s Special Investigation Unit has identified Red Flags in Claimant/Applicant Fraud as: (a much longer list of all aspects of WC Fraud will be listed in part 5.)

    (1) Employment Background: When an injured worker reports an alleged injury immediately following disciplinary action or notice of probation, demotion, or being passed over for promotion;

    (2) Personal Background: The injured worker recently purchased private disability policies;

    (3) Facts relating to the Accident: The accident allegedly occurs early on a Monday morning or was unreported the previous Friday;

    (4) Interactions with the Claimant: When speaking with the claimant by phone, the background noises are inconsistent with a residence, or the phone is answered by a business. An answering machine is used to screen all calls. Claimant uses a post office box as a residential address.

    Note also that it is required by law that employers post information frequented by employees on many workplace issues, including one entitled: Notice to Employees—Injuries Caused By Work. The last paragraph reads “False claims and false denials. Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers’ compensation benefits or payments is guilty of a felony and may be fined and imprisoned.”

    This sounds pretty serious so why do employees, even good employees, sometimes commit fraud? Several articles I came upon point to what is called “The Fraud Triangle” but defined in many variations. All include three key elements which are opportunity, motivation, and rationalization.
    Opportunity is the ability to commit fraud. An employee may think they can get away with faking, malingering, or defrauding their employer so they seize the opportunity. He/she believes that they can get away with it.

    Secondly, motivation comes from a need felt by the employee such as financial gain to pay debts, buy things they otherwise could not afford including materials, hobbies, habits, or even addictions to drugs or gambling. Motivation to commit fraud can also come from inability to perform one’s job as required.

    And then there’s the rationalization that makes one believe it’s OK. I would say someone with high moral standards and a good work ethic would have a hard time with this. But if the other two components of opportunity and motivation are present, even a good person might be able to rationalize excuses for committing comp fraud.
    Maybe some do get away with defrauding the system, for whatever reason they do it. It is and always has been my theory in life that what goes around comes around. Or your sins shall find you out, or you are going to get caught and/or have to live with the knowledge of what you’ve done for the rest of your life. Plain and simple, it’s not worth it!

    Here’s a summary of some very recent employee comp fraud cases in California from media reports during the month of April 2014:

    –A 40 year old garbage collector in Fresno was charged with five counts of insurance fraud after investigators learned he had participated in a jiu jitsu competition two days before he filed a WC Claim.
    Didn’t this guy think someone would figure this out? Just for my own entertainment purposes, I googled this guy’s name In a matter of minutes I had his facebook page open with several pictures and posts displaying his many metals won in jiu jitsu competitions prior to and following his date of injury in 2013. Not only that, but he denied participating in these competitions during two separate depositions. Opportunity – Motivation –Rationalization

    –A woman in Southern California working as a janitor was arrested and charged with two counts of identity theft after she filed a WC Claim using a Social Security number that wasn’t hers. The article didn’t say whether the WC Claim was fraudulent, or being investigated, but certainly red flags sprung up in this case, and definitely her credibility has all been shot to pieces. Not the brightest crayon on the box, I would say.

    –In Torrance, a U.S Postal Service employee was arrested on WC fraud working as a massage therapist while on TTD (Total Temporary Disability) with a claim of a shoulder injury. In the State of California, U.S. Postal Service employee fraud is so prevalent that a Postal Inspection Unit task force was set up by the Office of Inspector General. I wonder if this task force had to get massaged before arresting this man. I bet there was a line of volunteer investigators for this case.

    –A Teacher’s aide in Southern California was exaggerating her injuries with the help of her boyfriend. He pushed the wheelchair that she didn’t need. This was a 2009 ankle injury that never seemed to get any better. Under surveillance, on one occasion, the boyfriend pushed her in a wheelchair into a doctor’s office and then they walked together into a restaurant showing no signs of injury and without assistance. Needless to say, they were both arrested, and plead guilty to WC Fraud.

    –A Northern California bus driver claimed she suffered injuries to her head during a robbery in 2012. A video shows she was away from the bus taking a break when the bus ticket robbery occurred. The bus had a surveillance camera. A San Francisco District Attorney said she was trying to take a paid vacation at the expense of San Francisco taxpayers. The bus driver has withdrawn her comp claim and is currently free on bail and faces up to eight years in prison if convicted.

    –Southern California driver reported that he was injured while moving a machine, leaving him in severe pain and unable to work as a driver. Investigators videotaped him driving, shopping, walking, carrying items, dining, stretching and bending. Soon after, he testified in a deposition that he was unable to do any of those things because of severe pain. He has been on TTD since February 2012. He is currently in custody in lieu of $25,000. He was previously convicted for felony drug charges and served prison time. He faces up to five years in prison for the fraud charge.

    –A Southern California Police Officer was accused of filing a false claim for a knee injury he said occurred while working. What he didn’t say was that he received the knee injury during off hours at a physical agility test while applying at another Southern California Police Dept.

    I might add that WC employee fraud amounts to less than 2% of total WC fraud. This isn’t saying the number of cases is just 2%, but that the dollar volume of WC fraud overall is less than 2%.

    Don’t these stories just irritate you, or do you find them somewhat humorous?

    Hope everyone has a nice day.

Image | Posted on by | Tagged , , | 1 Comment

Dedication

Dedication.

Posted in Workers Comp | Tagged | Leave a comment