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Off The Record – Workers’ Comp – Fraud

Video Transcript

Hi, I’m Bill Turley from Turley Redmond & Rosasco. I wanted to say a word or two today about Workers’ Compensation and insurance fraud. A matter which the Workers’ Comp Board takes very seriously. And insurance fraud in the workers’ comp system can come in many forms. The most common one, of course, is when you have somebody who’s collecting benefits because they claim to be disabled, and they are working somewhere off the books, and not reporting that income to the insurance company, okay? That is one of the major areas they look for in fraud. And, you know, the thing is that people are under this misconception that if they work, they’re not allowed to collect benefits. And that’s not entirely true. If you take on a job that is less physically demanding and pays less money than what you were making before you got hurt, you still might be entitled to collect a Worker’s Compensation benefit. It might only be a partial benefit, but you still may be able to collect that benefit. It’s what they call reduced earnings, okay?

So, in other words, let’s say that, you know, when you were working full-time and you were working as a carpenter, you made $1,500 a week. But after your injury, you can only work at Home Depot part-time helping customers, not doing any heavy lifting. And you only make 500 a week. That’s a case of reduced earnings. But nevertheless, you do have to report those earnings to the insurance company. And whether it’s for cash or whether it’s on the books. The other area that insurance companies focus on is individuals who are engaged in activities that are not consistent with their claim for disability. So, in other words, you’re claiming that you’re not able to do a lot of physical activities and yet, they put you under surveillance, and they catch you doing those activities.

So, I always give my clients the example of, say the person who says they have a bad shoulder. And they can’t lift their arm any higher than this. If they do it, they are in excruciating pain. So, the person’s out on worker’s comp, and they’re claiming this shoulder injury. And they put them under surveillance, and they follow the guy to the local golf course. And he’s down there on the driving range, and he’s swinging the club like Phil Mickelson, okay? He’s not working, he’s not working off the books and not declaring his income, but he is doing something that is not consistent with his claim for disability, and that would be considered insurance fraud. I’ve seen many a case torpedoed over videos like that. Fortunately not too often. Another area too that insurance companies look at, and also the Workers’ Compensation Board, is failure to disclose or concealing a prior medical condition.

So, when you fill out that claim form for worker’s comp, it’s called the C-3 form, one of the final questions they ask you is, if you’ve ever had a prior injury to the same body part or a similar illness? And, you know, you have to answer yes or no to that. And if you answer yes, you do have to provide some details about the prior injury or illness. And most of that is, you know, the name of the doctor that you treated with previously. So, let’s say, you know, you have a back injury at work and you’re claiming benefits. And you come to this question and you say to yourself, “Well gee, 10 years ago, I was having some back issues, and I went to a chiropractor for a couple of adjustments.” Yeah, you should put that down on the form, you should mention that.

And by the way, the insurance company can uncover all kinds of things by just putting your name and, you know, your social security number into a database. They can find out about prior car accidents and all kinds of prior treatments, lawsuits, things like that. So, it really is best to just be upfront and, you know, tell them about your previous injuries. And, you know, it really is kind of a big mistake to say, “Oh that was nothing.” Or, “Oh, they’ll never find out.” Because, you know, chances are they will. Sometimes you can maybe neglect to talk about something or mention something that, you know, was maybe minor. But it is kind of hard to backpedal on that and say, “Oh, I forgot. Yeah, I do remember, I went to, you know, see a chiropractor, you know, 10 years ago.” Or whatever. But you know, there are a lot of pitfalls in the fraud area. It’s always good to talk to an attorney at the very beginning of your case just so you know how to avoid these pitfalls and what things to avoid claiming and not claiming. Okay? So, you can get in touch with us at, or give us a call at (631) 582-3700. This is Bill Turley, and thank you for listening.

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