Tom Domer recently spoke at the SEAK National Worker’s Compensation and Occupational Medicine Conference, July 2014 in Cape Cod, MA. The talk centered on fraud in worker’s compensation—by employees and by employers. Not all “fraud” is created equal. According to Tom, “The actual incidents of employee fraud is miniscule relative to employer fraud.”
An interview with Tom on the topic of fraud in worker’s compensation can be found here:
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.
Today’s post comes from guest author Leonard Jernigan, from The Jernigan Law Firm.
The U.S. Department of Labor has recovered more than $1 million in back wages and liquidated damages for 196 employees of Bowlin Group LLC and Bowlin Services LLC out of Ohio and Kentucky. Bowlin Services installed cable for Insight Communications, a cable, telephone and Internet provider in Kentucky. The defendants misclassified 77 employees as independent contractors and violated the Fair Labor Standards Act (FLSA) by denying these workers access to critical benefits, including minimum wage, overtime, family and medical leave, unemployment insurance, workers’ compensation and failing to maintain accurate payroll records.
Misclassifying employees negatively impacts our economy, generating losses to the U.S. Treasury, Social Security and Medicare funds, state unemployment insurance, and state workers’ compensation funds. It also leads to unfair competition because businesses that play by the rules are at a disadvantage.
This problem has become so acute in Tennessee that last month the legislature passed Senate Bill 833, which has been signed into law and imposes penalties on construction companies for misclassifying workers in an attempt to evade workers’ compensation premiums. A Tennessee study in 2012 revealed losses of up to $91.6 million in workers’ compensation premiums. North Carolina has identified the problem but has yet to take any action. Until states aggressively prosecute misclassification, this fraud will continue.
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.
Employer fraud is far more common than worker fraud.
I read this headline in the Insurance Journal while ago. My assumption, even though I represent injured workers, was that the headline concerned an employee who had defrauded an insurance company. Why did I immediately jump to that conclusion? Because most of the headlines screaming about worker’s compensation fraud are headlines aimed at employees who are defrauding the system, even though the vast majority of worker’s compensation fraud involves employers.
The $2.7 million fraud case involved a North Carolina man, Carl Dalmus Fuller, who scammed a Florida based employment services company into purchasing a fake worker’s compensation policy. The employment company’s records showed it paid Fuller over $2.7million in premiums. The insurance company listed had no agent, and the business address was Fuller’s post office box.
Most of the headlines screaming about worker’s compensation fraud are aimed at employees who are defrauding the system, even though the vast majority of worker’s compensation fraud involves employers.
Fraud cases like this involving substantial seven-figure numbers involve insurance companies or employers who mischaracterize actual employees as Independent Contractors, miscategorize Continue reading →