Monthly Archives: April 2012

Premium Fraud: North Carolina Man Sentenced on Workers’ Compensation Insurance Scam

Today we have a guest post from our colleague Jon Gelman of New Jersey. As we have discussed many times before on this blog, in our experience workers’ compensation fraud is rarely committed by employees. This case is no exception. 

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Dan Anderson, Director, Department of Financial Services, Division of Insurance Fraud, announce the March 3, 2012 sentencing of defendant Carl Dale Fuller, 52, of Wake Forest, North Carolina.

U.S. District Court Judge Donald L. Graham, sitting in Ft. Pierce, Florida, sentenced Fuller to five years in prison, to be followed by three years of supervised release. In addition, Fuller was ordered to pay $2, 859,067 in mandatory restitution.

Fuller previously pled guilty to mail fraud in connection with a scheme to defraud National Employees Services (NES) of more than $2.8 million in what the company believed were insurance premiums for workers compensation insurance. NES, a Florida Corporation located in Avon Park, Florida, is a provider of cost-effective services for businesses that out-source employee insurance, including workers compensation insurance.

To execute his scheme, Fuller used the name David Walters in e-mails and phone calls and held himself out to NES as an insurance broker. Fuller falsely claimed that he would obtain workers compensation insurance policies for NES and the companies they represented. Instead, Fuller kept the payments and never provided insurance coverage.

From mid-2005 through September 2008, Fuller received more than $2 million of NES premium payments, which he used to fund his extravagant lifestyle in Wake Forest and Pinehurst, North Carolina. NES sent the premiums to Fuller under the name of Southeast Services, a company created and controlled by Fuller. The checks were deposited into numerous accounts all controlled by Fuller. Continue reading

Temporary Employees Cannot Be Excluded From Workers Compensation

Temporary employees are eligible for workers' compensation benefits.

Today we have a guest post from our colleague Paul McAndrew of Iowa.

According to a recent decision by the Texas Supreme Court, a temporary employee cannot be excluded from an employers’ workers’ compensation policy.

In 2005, Rafael Casados was killed on his third day at work at a grain storage facility owned by Port Elevator-Brownsville L.L.C. Because Casados was a temporary employee of Port Elevator at the time of his death, he was initially awarded a liability ruling of $2.7 million directly from Port Elevator. However, according to the latest Supreme Court ruling, Casados’s family should receive remedy under Port Elevator’s workers’ compensation policy instead. Port Elevator’s insurance provider is liable for Casados’s death benefits, despite the fact that Port Elevator never paid workers’ compensation insurance for any of their temporary employees.

According to the decision: “If Port Elevator’s policy had set out certain premiums solely for temporary workers and Port Elevator had not paid those premiums, Casados would still have been covered under the policy and the failure to pay premiums would be an issue between Port Elevator (their insurance provider).”

 

 

Photo Credit:sixninepixels / FreeDigitalPhotos.net

“Open for Business” In Wisconsin Does Not Mean An Option To Provide Workers’ Comp For Workers

Companies are trying to cut costs and demand more productivity in these bad economic times. Unfortunately, one way “start up” and other employers are attempting to cut costs is by not insuring their workers under workers’ compensation. It is simply not acceptable to allow these employers to forego this fundamental protection for their employees. We field calls daily from workers whose employers do not have workers’ compensation, who tell their employees to file claims under group insurance policies (which are shrinking) or Medicare or Medicaid. This “cost shifting” to some kind of public assistance is simply not acceptable.

Failing to hold employers accountable for not having workers’ compensation coverage puts workers at risk. It also violates fundamental fairness. It would be like not holding drivers who have basic liability insurance accountable, because uninsured drivers put everyone else on the road at financial risk. Many states (North Carolina, Texas, California, Michigan, to name a few) are undergoing fundamental workers’ compensation “reform” in the name of cost saving. One of those “cost savings” should not be the failure to purchase workers’ compensation for their employees. Every employee in Wisconsin that employs even one person who is paid $500 in a quarter must have workers’ compensation insurance, and any employer who employs at least three employees( regardless of what they are paid) must have workers’ compensation insurance.

It is simply not acceptable to allow these employers to forego this fundamental protection for their employees.

Wisconsin has an “Uninsured Employer’s Fund” for those employees whose employers should have insurance but do not. Although the Fund pursues these scofflaw employers vigorously, many employees fall through the cracks, and we all pay the price through medical expense filtering down to Medicaid, Medicare, Badger Care, or some other public assistance.

NIOSH Acts To Prevent Lifting Injuries For Home Healthcare Workers

Today’s post comes to us from my colleague Jon Gelman of New Jersey.

The National Institute for Occupational Health and Safety (NIOSH) has published educational information to prevent musculoskeletal injuries at work. Injuries caused by ergonomic factors have been a major issue of the Federal government for decades and have been the basis for repetitive trauma motion claims for workers’ compensation benefits. While the Clinton-Democratic administration had advocated strongly for ergonomic regulations, the Bush-Republican administration took action to reject the reporting of ergonomic injuries to OSHA.

A work-related musculoskeletal disorder is an injury of the muscles, tendons, ligaments, nerves, joints, cartilage, bones, or blood vessels in the arms, legs, head, neck, or back that is caused or aggravated by work tasks such as lifting, pushing, and pulling. Symptoms include pain, stiffness, swelling, numbness, and tingling.
Lifting and moving clients create a high risk for back injury and other musculoskeletal disorders for home healthcare workers. Continue reading

How do we earn your trust?

Earning your client's trust is a crucial part of being an attorney.

Today we have a guest post from our colleague Roger Moore of Nebraska.

In its most basic form, trust is defined as “reliance on the integrity, strength, and ability of a person”.

Trust can also be defined as “a person on whom one relies”.

I was reminded of this earlier this week when a client for whom I had settled a case dropped by our office. This client had been a truck driver and lived out of state. While we were working on his case we never had the opportunity to meet in person, yet he came to trust me to look out for his best interests and advise him along the course of his workers’ compensation injury. He came by to thank me for the work I had done for him which had been completed over a year and a half ago.

As I spoke with him I began to understand how stressful it must be to trust someone who lives halfway across the country and with whom you may never meet in person. This is a unique aspect of trucking cases we handle which isn’t found in other types of work-related injuries.

Due to his injury he was unable to return to trucking. However, were been able to negotiate a settlement which allowed him to live his life Continue reading

My Injury Was My Fault. Does This Mean I Can't Collect Workers' Comp'?

If you were not following your employer's safety rules, you can still collect workers' comp', but staying safe is always your best bet.

Workers’ Comp is “No Fault” (even if it is the worker’s fault).

Workers may be reluctant to file a workers’ comp claim is they feel the injury is due to their own fault. Sometimes they feel that the injury was due to their own violation of a safety rule. In some states, this could bar a workers’ comp, recovery—but not in Wisconsin. An injury caused by the employee’s failure to use a safety device or adhere to a safety rule results in a 15% decrease in workers’ comp benefits, to a cap of $15,000, but the worker can still claim benefits. A worker earning $600/week, with a $400/week disability rate would only lose $60/week.

A worker’s failure to use a safety device causing injury will not reduce benefits if the device isn’t adequately maintained or easily accessible, nor will a worker’s rule violation reduce benefits if the safety rule is unreasonable or not reasonably enforced.

Employers and insurers sometimes deny claims that involve a worker’s intoxication or use of non-prescription drugs. This is inappropriate. However, the benefits can be reduced by 15% if the injury is due to intoxication or drug use.

Does Going Back To Work Ruin My Comp Case?

Today we have a guest post from our colleague Todd Jones of New York.

Does returning to work ruin your workers’ compensation case?

Not at all! This question comes up a lot in workers’ compensation cases. When someone is injured they have to balance their personal and professional obligations while including their injury as a new variable.

This is completely understandable. Often times people want to try to get back to work but are not sure if their body will hold up. This uncertainty can cast a shadow over everything a person has to consider when they have a work injury.

First and foremost you should speak to your doctor and find out what you are physically capable of. While your injury may be improving, you may not be able to return at 100%. If you can only work part-time or in some other lesser capacity, you may be entitled to an award for reduced earnings.

For example, Joe made $900 per week before he was hurt, but because of his injury can only work in a limited capacity and make $600 per week now. If it is found that the injury is the cause of that reduced wage, then Joe may be entitled to 2/3 the difference – or a $200 award – while his injury causes that reduction.

If your doctor clears you to return to work in at least a limited capacity, you should be sure to keep track of the paperwork provided to you by both your doctor and your employer. “If you have questions about reduced earnings, and whether this might be an issue on your case, be sure to consult with an attorney.”

Finally, there are a number of issues that can continue to arise on any claim. One of them is the potential for a “reduced earnings” award that is the result of a person’s returning to work, but not at full duty or full time.

A Return To Work Checklist

  1. Doctor’s note and limitations.
  2. Letter from employer about your return to work.
  3. Paystubs and tax information following your return to work.
  4. Continued reports from your doctor.

And most importantly, if you return to work but find that your condition is getting worse or your symptoms increase, see your doctor immediately and further discuss how you should proceed.

Loss of Health Insurance Access: The Personal Toll on the Unexpected Uninsured.

Access to health insurance is under attack. President’s Obama’s comprehensive health care reform law, intended to increase health care coverage for millions of Americans, faced extreme scrutiny by the U.S. Supreme Court last week. Congressman Paul Ryan’s federal budget plan is a cynical and careless proposal that would slash Medicaid programs, while providing tax cuts for the wealthy. In Wisconsin, Governor Walker and his fellow Republicans also propose gutting funds to the state’s vital Medicaid program. The ultimate goal is hard to deny: certain politicians and interest groups actually want a country with more uninsured citizens.

The personal toll on the uninsured is devastating, especially for those dealing with work injuries. As a worker’s compensation attorney, the following scenario plays out on a daily basis: A hard-working individual—who is lucky enough to have health insurance through the employer—is injured at work through no fault of his own. The injury is severe enough to not allow a return to work or the employer simply terminates the employee (this insidious action happens far too often with far too little publicity). After termination, the injured worker is offered federal COBRA rights to continue paying the health insurance premiums at the full 100%, which of course, is near impossible when you are off work without income. Thus, the worker loses health insurance for himself and for his family. On the flip side, the worker’s compensation insurance company is supposed to pay for reasonable medical treatment expenses related to the injury; however, the carrier usually hires an “independent” medical doctor to deny the worker’s compensation claim. The injured worker is then left out in the cold with an injury that requires medical treatment, but he has no ability to get that medical treatment without health insurance or worker’ compensation coverage. The worker then calls me and asks the emotionally-laden question: “What do I do?”

This situation is not hyperbole. It happens every single day, and I field this question multiple times a day—usually from a crying client or spouse. If these individuals do not have access to health insurance or health care, a vicious downward spiral can occur. They are injured without the ability to get fixed and reenter the job market. Without income from a job, homes and savings are lost. Marriages dissolve. Mental health issues arise. Chronic pain conditions exist. An otherwise hard-working individual effectively becomes an unproductive, potentially drain on society.

Access to health insurance alters this equation. If the worker had adequate access to health insurance, especially Medicaid, he could obtain the medical care that could allow a return to work, regardless of whether the worker’s compensation insurer accepted or denied the claim. Whether work-related or not, injured individuals should have the opportunity to get healthly in our country. The attack on universal health care coverage and Medicaid coverage only exacerbates the problem.