Insurance Carrier Fraud

By: Douglas A. Williams

You’ve probably heard stories about people who have received workers’ compensation benefits but aren’t really injured.  Local news programs sometimes report such stories.  Certainly, workers’ compensation insurance companies do everything in their power to create the perception that all recipients of workers’ compensation benefits are lazy, shiftless cheats who are out to defraud the system.  It is certainly true that some people do try cheat the system.  Such people are justifiably condemned as they bring suspicion on the overwhelming majority of injured workers who have legitimate injuries.  These workers, as well as their families, have suffered immensely – both physically and mentally.  Having often endured extensive medical treatment, the loss of a job, and great economic hardship, it is the ultimate insult to question their integrity.   

What is less publicized and less well-known is that, sometimes, workers’ compensation insurance carriers try to cheat the system.  Below is a link to an article published in Courthouse News Service.  This article documents a recent class action suit filed in California against several different workers’ compensation insurance carriers, one law firm, and a number of individuals.  In the law suit, Hector Casillas, an injured worker in California, alleged that workers’ compensation insurance companies hacked into a website utilized by the law firm who represented him and stole his confidential information as well as the information of thousands of other individuals.   Casillas further claims that the confidential information that was stolen was used by the insurance carriers to gain a litigation advantage. 

It’s important to note that Casillas’s allegations haven’t yet been proven.  Nonetheless, the case serves as a poignant reminder that insurance companies are constantly striving to get an upper hand against injured workers. 


NFL Concussion Settlement

A Federal Court has approved the Settlement of the Class Action Lawsuit filed by former NFL players against the National Football League. These former players, now retired, filed suite accusing the NFL for damages for not informing them that they may have possible brain injuries and consequences of same. The settlement discussions were long and tense and, at times, included dissension within the Plantiff’s own ranks.

The final settlement provides for players to receive the following three benefits:

1. Medical exams for symptoms of concussion syndrome for all retired NFL players so that if conditions later develop or deteriorate there will be a baseline for same.

2. Financial awards for diagnosis of brain injury diseases, such as Alzheimer’s, Parkinson’s, Dementia and certain cases of Chronic Traumatic Encephalopathy (CTE) which may not be diagnosed until after a player dies.

3. Educational programs and various initiatives to make the game of football safer.

These claims for injuries and medical treatment resulting from concussions will be paid in full for up to 65 years.

Of note, the retired players or their legal representatives or their family members do not have to prove that the player’s injuries were caused by playing NFL football. They simply have to prove the conditions exist.

Separately, these players theoretically could have filed individual claims against their respective teams for Workers’ Compensation benefits. However, because the players were not made aware of the harm and the statute of limitations for a work injury would have run, the above settlement for a vast majority of them is their only alternative.

Today’s players are now more aware of the consequences of a concussion. They can also avail themselves of Workers’ Compensation benefits pursuant to their individual state Workers’ Compensation laws.

Of course, concussions are not limited to professional athletes. Many combat Veterans have suffered severe concussions. However, professional athletes are more likely to have multiple concussions. Of course, anyone in any occupation could suffer a concussion whether it be from an automobile accident while in the course of their employment or some other traumatic event.

Today’s worker, whether it be a Pittsburgh Steeler or a Pittsburgh steelworker has become far more educated as to the benefits to which they may avail themselves if they suffer such an unfortunate injury.


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