Workers’ Comp Fraud—The Other Side of the Coin

There’s an insurance industry radio ad campaign currently running, containing the following warning: Don’t commit Workers’ Comp insurance fraud or you’ll end up in jail and you will shame your family. It’s clearly aimed at injured workers. I get it.

What the public generally does NOT see is the other side of the coin…when insurance companies overstep their bounds and infringe on injured workers’ rights (happens all the time—sometimes with bad results, especially when injured workers are unrepresented .)
This happened to my client and me YESTERDAY:
My client, a nurse’s aide, was receiving weekly Workers’ Comp checks for a severe back injury (she now needs surgery for it) that she incurred at work. At the last hearing, the insurance company attorney for the employer accused my client of fraud and told the Judge they were stopping her benefits because they have a private eye who followed her and videotaped her doing something bad (presumably, working while collecting comp checks.) They were ordered to produce the investigator and his evidence. My client flatly denied committing fraud. A mild-mannered woman, she has been beside herself with stress because of this fraud allegation. She could not understand it. Luckily, in this country, you get to face your accuser in court, face-to-face. At the next hearing (yesterday) , I made a simple request: call in both my client and the investigator into the courtroom and let the investigator look at my client, face-to-face. When they were called in, the Judge asked the private eye: “Is this the woman you have been following?” The investigator turned red. ” No, Your Honor, it isn’t, “we must have been following the wrong person.”
You simply can’t make this stuff up. I got my client’s benefits reinstated (she was crying with relief, she could not understand what she had done wrong) but unfortunately there is no penalty against an insurance company for such shoddy work and behavior……………
Call us if you have questions about Workers’ Comp or Social Security Disability benefits!

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NY Workers’ Comp—“Re-engineered” ?

I am one of 15 attorneys state-wide who have been selected to participate in a “Focus Group” in an apparently ambitious project to “re-engineer” the entire Workers’ Comp system in New York. Here is the official announcement from the State Workers’ Compensation Board about the plan:

Business Process Re-engineering (BPR) BPR@wcb.ny.gov. is an agency-wide endeavor to evaluate and rethink the workers’ compensation system in New York. More than an attempt to improve specific processes, it’s a sweeping effort to examine the workers’ compensation system in New York as it exists today, assess how well it meets its goals, and re-create a system that effectively serves the needs of injured workers and employers.

Large, well-run organizations periodically conduct a BPR to ensure they’re performing well. Imagine it’s 1911, just days after the Triangle Shirtwaist Factory Fire. As a result of that tragedy, the New York workers’ compensation system was created from the ground up. Today, with the benefit of 100 years of experience, the participation of stakeholders, stronger laws and great advances in technology, we have a more sophisticated understanding of what works and what doesn’t. We again have the opportunity to examine the system and the role of the Board in it. The goal is to create a roadmap of change from where we are now to a better system.

Working with Deloitte the Board will begin outreach to our community of stakeholders through interviews, open forums, and on-line interaction. We’ll collect information to analyze and understand how we serve injured workers and employers, how we serve our other stakeholders, and how the entire community works together and communicates.

The first phase began Aug. 26, 2013. Over the ensuing 28 weeks, a team comprised of Board executive management, Board staff and Deloitte professionals will collect information and interview representatives of stakeholders throughout the state.

Next year, workers’ compensation begins its second century in New York. Now is the time for a comprehensive system review. Over the years, the Board has taken strides and made targeted improvements to enhance the system. This project will focus us on the future of the workers’ compensation system and improve the experience for injured workers and employers.

So, I’m not sure what this all means. Perhaps it’s all just window-dressing for “same old dysfunctional Workers’ Comp Board.” Perhaps meaningful change will soon come about in a system that does not, in my opinion, serve injured workers particularly well in many ways.

Stay tuned. I will keep you informed—-from the inside of the project itself.

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In New York, Injured Workers Have the Right to Choose their M.D.!

In New York, injured workers have the absolute right to choose their own medical provider for their work-related injury. The only requirement is that the doctor or other health provider accept Workers’ Comp (WC) insurance. I regularly advise injured workers who come into my office the following:
* Don’t treat with a doctor your employer send you to. More often than not, the employer’s doctor does not have your best interests in mind.
*Choose a doctor you are comfortable with. If you see a doctor who you feel isn’t helping you, switch! You can switch doctors as often as you like, under WC.
* DO NOT SEE YOUR FAMILY DOCTOR IF YOU ARE INJURED AT WORK. FAMILY OR GENERAL DOCTORS ARE RARELY IF EVER FAMILIAR WITH THE WC SYSTEM… SEEING YOUR FAMILY DOCTOR CAN SCREW UP YOUR CASE!
*Instead, see a specialist. These include: Orthopedists, Physical Medicine and Rehab doctors, Neurologists, Chiropractors, and/or Pain Management Doctors. You can see more than one specialist at the same time!
*Since Workers’ Comp pays the doctor 100% of their bills, for as long as the treatment is allowed, see the very best specialist you can. Hospital clinics and walk-in clinics are also no-no’s for TREATMENT of a work-related injury!
*The Law Office of Morrin & Sands PLLC can help injured workers find the right doctor for their injury and their case!

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