Fraud In the Workers’ Compensation System

fraud, the injury, attorneys, workers' compensation

This blog is dedicated in revealing fraud in the workers’ compensation system. It’s objective is to expose the conspiracy and complicit behavior between the insurance carriers and their defense attorneys in denying claims to injured workers. This is not to say all carrier’s and attorney’s commit fraud, they don’t. But with 2,700,000 claims filed each year in America alone, insurance carriers face increased financial losses due to the rise of work-place injuries. As a result, carriers and attorneys are crossing the legal boundaries by playing the float, in order to protect their bottom line. In the meantime, while injured workers wait for claims to be established; medical treatments and money from lost wages are denied and many injured workers are evicted, become homeless and thousands die waiting.  For the most part, the fraudulent actions by these entities have caused this disparity in the laws protecting the injured workers. Additional legislation is needed to modify existing laws to end the corruption.

In response to this growing problem, on October 20, 2015, U.S. Representative Robert C. Scott and 9 others wrote a Letter to the U.S. Department of Labor voicing their concern to the “detrimental changes to state workers’ compensation laws and the resulting cost shift to public programs…”.

What this letter did not address, is the carriers motivation this cost shifting. The carrier denies nearly every claim made because it’s cost effective to fight a claim. By Playing the Float, the Carrier reduces the short term financial losses while making interest which adds to its bottom line. The carriers use slick defense attorneys who’s sole job is to fight purported claims of liability by the injured worker to any extreme necessary… they will and do commit fraud!


The History to Deceit Statures.
On Page 2

The Alleged Claim of Fraud

A Hypothetical Case and background

In this first discussion

For discussion to this Blog and the hypothetical case presented, the injury takes place in New York State. Therefore, laws cited, pertain to New York State Workers’ Compensation Laws.

We’ll address the issue of whether the insurance carrier and its attorneys conspired a scheme to cast negative credibility on the claimant. Questions discussed are, did the insurance carrier and their defense attorney’s falsify documents?  How did documents disappear from the case records and who ordered it? Finally, did the attorneys present false and misleading documents and lie to the trial and senior judges? The law pertaining to this behavior is provided under NYS Workers’ Compensation Law, section 114.2 , and is a class E felony.

Our discussion will also address if there was a misrepresentation made by the claimant in reporting his work status. By law, section 114.a (1) states, if the claimant is found to have committed fraud, he/she will be disqualified from receiving any compensation and faces loss to all potential medical treatments and recovery to wages lost.

Background to the Injured Worker
On Page 2

Playing the Float

Playing the Float is the lag between the time that an insurer establishes a reserve for a claim that has occurred and the time that the claim is fully paid and closed. In a workers’ compensation industry, it’s the opportunity to earn increased investment income as the lag between the filing of a claim and payment of a claim increases, thus insurers have an incentive to delay or even deny claims. The use of fraudulent tactics to delay payment on a claim, increases with each day passing. As in the hypothetical case presented in this case, that “lag” extended over 7-years.