Workers Compensation Wrongdoing: Part II

In my previous blog about what people think about when they hear the words “Workers’ Compensation,” (fraud is part of the thought process of many,) I mentioned attorney Leonard Jernigan’s “Top 10 Fraud cases.” (They are employer fraud cases.)Well here is a recent blog of his that complements my earlier piece on the subject of “comp fraud.” It is so good that I repost it here verbatim (Note: The tactics described by Jernigan below are used by insurance carriers every day. They are a routine experience for injured workers.)

“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.”

Workers’ Comp Wrongdoing: What comes to mind?

When one brings up the topic of wrongdoing in a Workers’ Comp setting, many (especially here in Long Island) will first think about the infamous Long Island railroad case where many LIRR retirees filed claims for disability that were described, in a word, as fraudulent. Mention the words Workers’ Comp fraud, and most people think first, I believe, of phony claims FOR Workers’ Comp. But what about the many employers who fail to cover their employees for Workers’ Comp each year, or underreport payroll, misclassify workers or do other bad things?

What I never understand is why, and correct me if I’m wrong, stories of phony claims by workers are always given the headlines and come to mind more readily than cases of employer fraud. (An attorney named Leonard Jernigan comes out each year with a blog called “Top 10 Workers’ Compensation Fraud Cases” of the previous year. Jernigan’s #1 in 2012, for instance, is the “Operation Dirty Money” case in Florida where a construction company—an employer— scammed $70,000,000 from the Workers’ Comp system in Florida.)

It just seems to me that for some reason, worker fraud is somehow “sexier” news for the newspapers and other media, than employer fraud when in fact, both exist, both are bad and both should be equally condemned. Just thinking aloud, but I’m still not sure why this imbalance, I believe, continues to exist in people’s minds .