Workers compensation fraud

Submitted by dreamer on Thu, 12/20/2007 - 19:56

1. Your neighbor has been on compensation for years, but does all the household chores that would aggravate a true injury. Compensation companies are sending investigators out to keep an eye on people who they feel may have committed workers compensation fraud through some frivolous claims.

2. If you have a claim, then physically you should not cut your grass, get on a ladder, be on the roof replacing shingles, other laborious jobs that is defined as able body.

3. This is bad because it makes people assume that a legitimate claim is bogus

4. How long can a person stay on compensation?

Posted: 21 Dec 2007 06:22 Post Subject:

Just because you can do the chores around the house doesn't mean that you can work. I once got really bad pains in my tendons when I did an administration job due to excessive overtime typing up documents, and I had to take a few days off because it hurt too much to type.

These kind of things should be investigated with caution, because with a pair of tendons that hurt like crazy after 30 minutes of typing, there was no way I could send out memos and spreadsheets at a normal rate. As long as my fingers were still, I was fine. I could do my housework no problem.

People can be psychologically damaged as well as physically damaged, I bet several policemen are on workers comp after walking into the remains of a brutal murder scene. That kind of thing can't be seen, and people can lead normal healthy lives as long as nothing sets them off.

Back during the world wars, some soldiers came home suffering from shellshock. They may look normal on the outside, but a trigger could reduce them to a total wreck.

I'm not sure about how long you can stay on workers comp though. I think as long as the doctors say that you cannot work, you're on it. Otherwise it could be regarded as workers compensation fraud.

Posted: 21 Dec 2007 11:35 Post Subject:

Quenin you make some valid points, however, workers comp is one of the most abused systems...dependant upon what this OP's neighbors injury is....(bet cha it's a physcial one, and likely a back injury) sounds like some workers compensation fraud going on to me....

Re: how long? I don't know either but I do know some people that have road that train for years then got SS disability some deserved it some did not.....

OP it irritates the crap out of me too when people use the system that is set up to help those that are truly hurt...some insurance companies do survail insureds (I did a little of this on the side once) so if he's gaming it I hope he gets caught...

Posted: 21 Dec 2007 04:13 Post Subject:

well, I have seen some legit cases, the one that irritates me is the one that has a back issue, but is on the roof doing shingles, should not be happening, if your back it truly hurt then can you physically climb that tall ladder with shingles on your shoulders? I am thinking probably not.

ss quenlin, this is the type of case I was referring to, not the everyday house chores, sorry for the confusion.

Posted: 22 Dec 2007 01:38 Post Subject:

I'm certain that he can't do it safely, doing something thats dangerous is different from physically impossible. If he in genuinely injured, then he is putting his health, and his life, at serious risk. If not, he's just a con.

You should report him for it before he finishes that roof, so they can catch him in the act. A nice yelling at in court will sort him out.

I wouldn't take pictures though, there's a lot of legal issues around taking photos of people while they're on their own property. Even if you have spades of evidence, it just takes one bang of a gavel to render them worthless.

Posted: 22 Dec 2007 02:51 Post Subject:

He is a fraud, he has frauded everything from welfare, food stamps to redevelopment money from the county. If it is there, he will find a way to get his grubby little fingers in it. He drinks all the time, can't get a little hairy, I figure some day it will all come back to bite him, you know where. I would not even know who the insurance company is that is paying his compensation.

I can't believe these companies don't invest in investigators on some of these workers compensation fraud cases. You would think a good investigator would pay for him/herself by busting false claims.

It just seems like every time there is an add on television someone gets the new disease or injury around here. Especially the hard to diagnose diseases. Some may be legit illness or injury, but a lot of them around here is not.

Posted: 24 Dec 2007 03:16 Post Subject:

It just seems like everytime there is an add on television someone gets the new disease or injury around here. Especially the hard to diagnose diseases. Some may be legit illness or injury, but alot of them around here is not.



Perfectly true, I'm currently suffering from Icantputsomefreakingpastaintoacolanderwithoutspillingitaritis. I realized that I had a severe case after seeing a pasta cooker on TV, I'm on leave from my job as a cook just now.


Alright, seriously now, it's pathetic that people suddenly come down with these things as soon as they hear about it, and usually with an unqualified diagnosis. It's always funny some fool phones the boss and he says "I can't come in today, I'm suffering from {insert any disease only women get}.", then he gets a nice pink slip on their desk next time they come in. It's easy to screw up on these things.

Most adverts showing disease or injury are run through filters to reduce the cheery colors, have people screaming and yelling from a stubbed toe, and wheelchair bound for life after cutting their fingers. Just to make it look worse than it actually is. The result? They get business.

Next time you see an advert that shows a more conveinent way to do something simple, or people suffering a minor injury, watch it carefully. The person doing it the "hard" way is having a really tough time with a simple task that a 9 year old can do. Also, those who are injured are completely crippled from a bruised shin, which would bring tears to a little boy until you kissed it better.

People in adverts are just drama queens. Every last one of them. And guess what? It works, thats the sick part.

Wow, long post.

Edit: Just saw a TV show about Endoftermaritis, I need to go lie down...

Posted: 24 Dec 2007 11:39 Post Subject:

oh Quenlin honey, you are a jewel........great post!

Posted: 26 Dec 2007 05:55 Post Subject:

I think I have that too Quenlin, when did yours start, so I can get it all right when I see my doctor, Hee, Hee. You have one heck of a sense of humor. I had to read that four times to even get what it was, lol.

Posted: 29 Dec 2007 12:22 Post Subject:

LOL, dreamer, Quenlin always has a great sense of humor. I know what you mean about the adds on television, omg, so many people had bipolarism after that ad came out for the new drug. I wonder how many doctors just roll their eyes when people come through their doors with all these new symptoms.

Posted: 05 Jan 2008 12:52 Post Subject:

I think I do have that too. I have the arthritis that makes your joints enlarged. My feet hurt to bad to be on them for long periods of time. I don't go to Drs because I have no health insurance. I cannot get disability although I should be able to get it except I don't work outside the home. I have know about 3 people personally who have been on ripped off workers com or disability and still work all the while. I'd always consider this to be workers compensation fraud. I think it stinks and raises the rates and causes the rest of us not to be able to afford the rates.

Posted: 05 Jan 2008 10:41 Post Subject:

I think it stinks and raises the rates and causes the rest of us not to be able to aford the rates.

that is exactly right and one of the biggest reasons that rates across the board are so high!

Posted: 05 Jan 2008 02:49 Post Subject:

We have auto insurance and home owners policy on one home and one policy on a home my hubby is building .Thats about all we can afford financially .The health insurance for self employed is to high for us to afford. Maybe we will win the lottery and then we can afford health insurance too.

Posted: 06 Jan 2008 02:09 Post Subject:

I think the health insurance industry is in very sad shape, I will be eligible here in a few months for a low term health insurance. I don't have any right now and have not for years. I deal with any illness that I have on my own, recently I had to go to the emergency room because I had a nose bleed that would not stop, they had to cauterize the blood vessels inside my nose, well that night at work they busted loose and I ended up in the hospital for a three day stay. I have no insurance, they had me fill out a form for what they call I care, I don't really know what it is but it did pick up the bills, I am very grateful for that. But I do think if I had regular health care and could have at least a yearly check up that my health would be better. I am down to 22 hours a week at work, I haven't had a mamogram for 7 years, my daughter did find me a program that provides them for free for women, I hope it comes back clean, because what would I do if it didn't, it would devistate me mentally and financially. I just think there should be something out there for people who can not afford the regular health insurance, I am willing to pay. I will be eligible here in a few months after being on a two year waiting list for a program, I will pay a monthly premium, but I am willing to do this to have that care available, I am not getting any younger and need at least the yearly check up.

Posted: 06 Jan 2008 04:02 Post Subject:

You are right erb, the industry is in big trouble. Are you okay now? I hope so.

Posted: 06 Jan 2008 11:02 Post Subject:

The health care (ins) in this country is a mess...we all know that....politicians all claim differing ideas of perfection....

I glad erb that you found a way to get your hospital stay handled...our daughter was caught owing a hospital (she had ins) about 2k, well she paid and paid on it, then lost her job....she owed about 800 still...so then i was paying on it (she was pregnant too...by now what a mess)...anyway it occured to me....so i called them and ask to cash it out...you know 'i'll pay you half of the total to wipe this debt out'' which generally they will jump on it cause it wasn't affecting me...and the girl didn't have a pot, or a window to throw it out of...by this time it had made it to the collection agency (different topic, but that pissed me off...that she didnt' tell her dad and i before it got there)...anyway the collection agency said no...so i called the hospital explained everything...and they wiped the debt out! damn wish i'd have done that before i'd paid a few months on it!

So there are some that do help out...such as your situation erb...re: the mammograms...there are many free programs......plllllleaaaaaaaaaaaaaaasssssssssse! take advantage of this.....

Posted: 06 Jan 2008 01:53 Post Subject:

My daughter got me the mamogram information, so I will go get that taken care of. thanks Lori

I know how you feel, I guess I was lucky to have my oldest daughter with me who did all the admissions paperwork at the registration desk, she asked all the right questions. We had to apply for public assistance first and get turned down, I was mad because I knew they would say no, but when she explained that the I care comes from donations made, I understood that trying to get it paid by the state would free up some money for someone else in my situation, it made the paperwork more bearable, I just get so frustrated with the system. Some people abuse the crap out of it and get everything.

Did you read in my other post about my furnace, I about fell on the floor when I got this news.

Posted: 06 Jan 2008 07:56 Post Subject:

You should not mess around when it comes to your health, if you have the opportunity to get the mamogram, get it done. The majority of them come back clean and at least you would have that peace of mind.

You mentioned that you will be eligible for a health care plan in a few months, what type of healthcare is it, make sure that it is not a fraudulant company, make sure it is creditable.

Posted: 06 Jan 2008 08:28 Post Subject:

I know that feeling. I have not had a pap smear in 5 yrs and never had a mamogram.Wish I could find a program like you did in my area. There used to be things like that here but no more. There isn't even a obgyn in our town.I also pay for any health expenses myself. Right now i am paying monthly for some stitches I had put in at the ER a few months ago.

Posted: 09 Jan 2008 11:49 Post Subject:

Where are you from hummingbird, there is probably something funded there for a free mammogram, the http://www.nationalbreastcancer.org/about-nbcf/our-mission has raised a lot of money to make sure that every women get a mammogram.

I hate to go for them, every time, I have to go back for a second reading, they always see a cyst and have to reexamine and they say it is fine everytime.

I just had a friend die after four years of a hard struggle, it was so sad to see her decline, she was a beautiful woman and the cancer was systematic, it moved from here breast to her lungs, from her lungs to her liver, from her liver to her brain and from her brain to a mass tumor around her aorta, it was a sad case. Hated to see her go through this, she would have given anything for one more healthy day.

So, go get this done and monitor your health if not for yourself, do it for your kids, if you need help finding a place, let me know where you are from and I will run a google search and try to help you find one.

Posted: 10 Jan 2008 01:20 Post Subject:

These long term comp cases leave me just astounded, how can these companies afford to have these claims open for 15 to 20 years? Why don't they try to settle out sooner to get these off the books? Does the employers mind having these guys collecting for these long periods, would they not push for settlements sooner? I have been seeing quite a few of these but don't want to approach the attorneys to ask them about these cases. They just rent space for hearing use and it is none of my business, they just get so loud sometimes that you can't help overhearing the conversations. Just curious about this, any compensation specialists on the forum, please answer?

Posted: 10 Jan 2008 11:49 Post Subject:

Where are you from hummingbird

I'm pretty sure I remember from prior posts she's from KY...

would they not push for settlements sooner?

Well, it would kind of be like you as an insured wanting the other party (that you hit) that you owe a BI settlement to to push for settlement...you can want it all you want, but the adjuster is the one that has the power...or decision atleast when it is time to try and settle it....and believe me adjusters 'want' to settle claims, just can't some times....injuries in particular....and work comp, another animal of it's own!

how can these companies afford to have these claims open for 15 to 20 years?

It's actually their work comp insurance carrier that is paying the bills, just like your auto policy...granted though their rates will go up and you think that auto home and health coverage are high! you ought to see what some of these companies pay in workers comp insurance! yow-zer!

Posted: 12 Jan 2008 04:43 Post Subject:

I guess then there is no incentive for the employer to try and get the person back to work or off comp right, do the companies rates go up the longer a person is on comp? Do thier rates go up if they have a lot of people going on comp? Surely this has to affect the companies some how?

Posted: 12 Jan 2008 11:25 Post Subject:

I think work comp policys work similarly to all policys (except life of course) high claims volumn will drive up premiums...I know (or think) this because I've been hurt on the job before (when I worked for a body shop, as opposed to now working 'in' many shops but for insurance company) anyway freakin' a/m hood laid my finger open...and owners wanted to pay doc to stitch up themselves rather than turn in the claim, which was fine and dandy with me!

Posted: 13 Jan 2008 12:53 Post Subject:

I once worked in a factory, I used air tools alot and ended up having carpal tunnel surgery on both of my wrists, I could not do that type of work today because it would make it come back, at least that is what the doctors advised. I was on compensation for about a year, lots of down time, absolutely hated it, hated it, hated it. Today I work in a personal care home which is a lot easier on my joints. I could not stand to be on comp that long, drove me nuts sitting around like that.

Posted: 13 Jan 2008 01:10 Post Subject:

erb, carpal tunnel can be so aggrevating and painful, our clerk got it at work from doing so much word processing. Your wrists are like your back, you use them in almost every situation. She has not had surgery yet but probably will end up having it done, she has been saving up her time, so maybe she knows something that she is not sharing with us, LOL.

I am glad that you are away from the air tools, the constant vibration must have been so irritating to your condition. Glad to hear that you are back to work in a different field all together. Some people just stop dead in their tracks and never work again when they are told they can not do their current occupation, good for you that you have moved on.

Posted: 13 Jan 2008 04:32 Post Subject:

Yes, Goodnaturted ,I am from Ky. The last remaining obgyn left after 1 month . I think it has something to do with our hospital. If we need one now we have to travel at good 30 miles or more one way. If you can come up with something local for a free momogram ,I would be happy to take it. The last obgyn I had told me the hospital where they do them in my town may be willing to work out a payment plan. I never asked though ,we have enough PAYMENT PLANS.

Posted: 14 Jan 2008 09:49 Post Subject:

hummingbird, tell us the town or county you're in, the stuff i've looked up, no way for me to know if it's local or near you...traveling 30 miles for a free mamogram (if we can find one) should'nt be a problem for you though right?

Posted: 14 Jan 2008 11:24 Post Subject:

If they find you a resource you definately should try to go get it done. You will need to give more information about where you are from to get you the information.

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