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The Truth about Workers’ Compensation Fraud

Eric Abes on January 16, 2015

Many media sources speak to the existence of workers’ compensation fraud. The emphasis is normally on fraud perpetrated by injured workers. Unfortunately, the big picture is rarely discussed in our traditional media.

The dollar value of fraud perpetrated by employers and medical providers dwarfs that perpetrated by other players in the system. Of the ten largest workers’ compensation fraud matters in 2014, the only one involving an injured worker was a nurse in Georgia who filed a fraudulent federal workers’ compensation claim. The other nine of the top ten all included employers or medical professionals.

The largest case involved a California medical equipment company which was indicted with multiple felony counts of over billing for therapy machines in the amount of $36 million dollars. The second largest fraud scheme involved medical professionals who were charged in a $25 million dollar workers’ compensation fraud. This fraud involved the creation of a pain relief cream and kickbacks to doctors who agreed to prescribe it.

When you see information about individual workers engaging in fraudulent activity in the traditional media, remember you are getting only part of the story. For more information, see the following articles:

Lowe’s Settled Independent Contractor Misclassification Case for $6.5 Million

Medical Equipment Company Overbills $36 Million

15 Medical Professionals Indicted in $25 Million Scheme – Small Child Dies

Paving Company Cheats System of $4 Million

False Insurance Certificates Check Cashing Scheme Defrauds Insurance Company of $1 Million

Man to Pay $806,000 for Underreporting Payroll to Workers’ Comp Carrier

Paul Johnson Drywall Inc. Agreed to Pay $600,000 in Back Wages, Damages and Penalties

Summit Drywall, Inc. Ordered to Pay $550,000 in Unpaid Wages and Damages to 384 Workers

Drywall Company Owners Arraigned on $420,000 in Fraud Charges

Lawsuit: Police must release protest videos

Eric Abes on January 15, 2015

Today’s post was shared by The Workers’ Injury Law & Advocacy Group and comes from www.citizen-times.com

Mountain Moral Monday drew an estimated 2,500 to 3,500 people to Pack Square Park in August. The Rev. William Barber, president of the North Carolina NAACP, was the featured speaker.(Photo: Citizen-Times photo)

ASHEVILLE – The Citizen-Times is asking a judge to order police to make public dozens of video recordings of political gatherings and demonstrations, according to a lawsuit filed Monday.

The newspaper, in the lawsuit, says keeping the recordings secret will have a “chilling effect” on the First Amendment right of the public to demonstrate.

The lawsuit alleges the videos — made since 1980 — are covered by North Carolina’s public records law. Police are not using the records as part of ongoing criminal investigations, according to the lawsuit.

Police have gathered no actionable criminal evidence from recording public gatherings, a city spokeswoman has said. Police have about 60 recordings.

They range from the Mountain Moral Mondays rally in August to a gun rights rally in November to environmental protests last year and eight Occupy Asheville events.

Police have also recorded tea party tax rallies, immigration protests, street preachers at Bele Chere anti-war rallies and abortion protests. The earliest recordings are from KKK rallies in the 1980s.

“We feel it’s the public’s legal right to have access to these video archives,” said Dave Neill, president and publisher of the Asheville Citizen-Times. “The newspaper is committed to…

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120 and 3—The Two Most Important Numbers in Workers’ Compensation

Eric Abes on January 9, 2015

Everyone makes mistakes. Thousands throughout our lives. Most end up causing little to no harm. These mistakes are often beneficial as the damage caused is outweighed by the lesson learned. Some mistakes are more severe. Some can never be undone. In Pennsylvania, if you are injured at work, 120 days and 3 years are two mistakes that cannot be fixed.

If you are injured at work in Pennsylvania, you have 120 days to report the injury to your employer. If you do not report the injury to your employer within this period, you will likely not be able to obtain any Workers’ Compensation benefits.

Reporting an injury is usually simple. You are at work, you slip and fall and break your wrist. You tell your boss what happened and that you are going to the ER. You just satisfied notice. In order to be safe, never assume that just because your boss was there when you got hurt that she knows you are hurt. Make sure you tell her. Email is a great way to ensure you satisfied notice, and it gives you a record of when you provided notice and what you said.

Besides 120 days to notify your employer of an injury, you have 3 years from the date of injury to file a claim with the Pennsylvania Bureau of Workers’ Compensation. This is called a Statute of Limitations. This is a fancy way of saying there is a limit to how long you have to pursue some legal action. This is to ensure that things are done without delay; records will be easily obtainable; and witnesses’ memories are fresh.

The best thing you can do to protect yourself is to contact Abes Baumann as soon as you are injured. That very day. There is no charge to talk. A few minutes of talk now, can save you a lifetime of pain later.

Independent Medical Examinations

Eric Abes on January 9, 2015

Many recipients of Workers’ Compensation benefits will be required to submit from time to time to a so-called Independent Medical Examination with a physician selected by the Employer/Insurance Carrier. Injured workers should understand that the examinations are in no way independent. Many of the regular providers of these examinations are paid hundreds of thousands of dollars a year by insurance companies to conduct these evaluations. Given the lucrative nature of such a practice, the providers obviously know where their bread is buttered.

Injured workers receiving Workers’ Compensation benefits can protect themselves when they attend such exams. Each worker should time the examination, including how much time they actually spend in the room with the doctor. The worker should, immediately upon the conclusion of the examination, make notes regarding what happened during the exam. After receiving a copy of the report of the examination, the workers should compare the information in the report to the note taken following the exam. He should then discuss any differences between the two with his counsel.

Under Pennsylvania Law an injured worker can have a health care provider of his or her own choosing present at the insurance evaluation. As defined under the Pennsylvania Workers’ Compensation Act, this can include a nurse. If the injured worker has a nurse in his or her family, the worker would be wise to ask that person to attend with them. On occasion, with some of the more egregious providers of insurance medical exams, our firm will hire nurses to attend the examination.

The so-called Independent Medical Examination is one of the pressure points placed on injured workers. If the worker has not talked to an attorney before such an exam is scheduled, our firm recommends a call be placed at that time.

“Idiopathic” Falls Are Compensable in PA

Eric Abes on January 5, 2015

“Idiopathic” in medical terms means “unknown cause.” But in the workers’ compensation field, “idiopathic” means “unique to the individual.”

Pennsylvania is one of the few states that find an employee who suffers an “idiopathic fall” while on the job, can collect PA workers’ compensation benefits. The two leading cases in PA that granted benefits for an “idiopathic fall” did not have similar fact patterns.

In one case, the employee fell while on duty at her work station. She sustained a serious head injury when her head struck the linoleum floor. As a result of the fall, she suffered frequent seizures and underwent two brain surgeries. It was unclear how the fall occurred: if the employee had tripped or if she had fainted. The Court held that it did not matter. The Court accepted the conclusion that the employee’s head injury, resulting from her fall at work, caused uncontrollable seizures that rendered her disabled. Workers’ compensation benefits were properly granted.

In another leading case, the employee had an epileptic seizure while driving his car in his employer’s parking lot prior to the start of his workday. The employee lost control of his car and crashed into a few cars before hitting a concrete abutment on employer’s premises. He was killed in this tragic accident. The PA Court found this accident compensable and the employee’s widow was awarded workers’ compensation benefits.

Pennsylvania is in the minority in granting workers’ compensation benefits for idiopathic falls. A majority of the states hold that if a employee has a personal condition that causes the employee to lose consciousness and faint or fall, the resulting injuries are compensable only if the work conditions contributed to the injuries sustained.

DHS hit with immigration lawsuit

Eric Abes on January 5, 2015

Today’s post was shared by The Workers’ Injury Law & Advocacy Group and comes from www.washingtonpost.com

Anibal Fuentes came to the United States illegally years ago, faced deportation proceedings in December and was ordered to leave the country. Now, he is among a group of people suing the Department of Homeland Security.

An advocacy group filed a lawsuit against DHS Wednesday, alleging that the agency failed to respond to a rulemaking petition filed in February that asked the agency to suspend deportations of undocumented workers and their families and expand the deferred action for childhood arrivals program. A number of people who came to the country illegally, including Fuentes, are plaintiffs in the lawsuit.

The National Day Laborer Organizing Network claims that the agency is in violation of the Federal Administrative Procedure Act. “DHS’s failure to respond constitutes an effective denial that is arbitrary, capricious and void of any legitimate explanation,” the group said in the lawsuit.

“What the law says is, they have to respond in a reasonable amount of time,” said Jessica Karp Bansal, a staff attorney at NDLON. “In a case like this where peoples’ lives are at stake, nine months is clearly unreasonable.”

The Department of Homeland Security did not respond to a request for comment on the suit.

The rulemaking petition was filed earlier this year as President Obama was mulling whether he should act alone on the issue. Fuentes and five other people who came to the United States illegally signed on. Now that the…