Another backlash from fraudlent claims is that often money has been paid out and reported to NCCI thus impacting a policy holders Experience Mod rating. I have seen a mod get amended when there was some recovery through subrogation, but in a case of fraud if money is not paid back and the person committing the fraud goes to jail I feel that there should be a way to have that experience removed from the mod calculation.
Fraud is not always committed by the claimant, however the impact still goes to the holders, the system and the state. I’m involved in a WCB case where the attorney’s and the carrier have committed fraud and a total of 14 felonies are being filed against them. Seven have already been filed and seven more are expected by the end of next week. Imagine, you as the judge or opposing counsel in a case and the attorney for the carrier has evidence removed from the files without permission from the Board or opposing counsel and when a decision is made not in their favor, they cry foul!
I wish there were a way to have these non violent offenders serve “jail” time by continuing to work, supervised, but at the end of each work day they go back to the pokey. Their pay would be used to pay the cost of their incarceration and anything left over would go to the victims of their crimes.
That would work in some small way, however, their pay would not offset the cost of paying for their incarceration.
In the New York State workers’ compensations system, when an attorney or carrier or their representative commits fraud, it falls under a §114.2. This fraud is a class E felony and under the penal code §70 for a first time offender, non-violent, non-drug related offense, it carries a minimum of 1-3 years.
This white-collar offense, I think should have no jail time but rather carry a more lucrative un-incentive approach to the problem.
In a case I’m involved in, the attorney for the insurance carrier has committed fraud upon the court and opposing counsel. The NYS WCB Fraud Inspector General’s office has filed several felonies against them and the Insurance carrier in this case. It’s now in the hands of the DA. I have asked for vicarious liability against the firm where this attorney works due to the company wide allegations of misconduct and deceit upon the court.
My suggestion if this attorney is found guilty… which is a no brainer, is as follows.
The attorney’s punishment should be;
1) She should have her licenses suspended for 6-months. The firm she was working for, must pay her a weekly salary @ 50% her normal salary. This is so no burden is placed on the state.
2) She should be ordered to 100 hours community service working in a shelter or food-kitchen. This is to let her see what her misconduct and fraud has caused the injured worker in this case.
3) She should be required to retake the ABA ethics class and retake the Bar.
4) Upon passing the Bar with a 80% average or better, her licenses should be reinstated on a restricted bases for a period on Two-years.
5) During this time, she must return to her employer and her salary raised to 75% what it was at the time of the incident and she must donate 10% gross to a fund designated by the Bar for the areas homeless where the injured worker lives or where the injury occurred.
6) Upon completion of this two-year restriction, she is under the watch of the Bar for an additional 2-1/2 years. At which time her salary is now raised to 100% and her donation is raised to 20% gross, during this time.
7) At the end of this final 2-1/2 years (5-years total) The attorney should be reevaluated and her restrictions lifted and her recorded sealed for an additional period of 5-years. At the end of this period, should no further actions have commenced, her record should be expunged.
8) The Law Firm during this time, should be ordered to pay a punitive-non-judicial damage award in the amount of $100,000.00 per year for 5-years. This money should also go to the areas homeless where the worker lives or where the injury occurred.
9) In addition, the Law Firm must continue to pay the attorney’s benefits of medical coverage and other such benefits. The Law Firm is not obligated to provide special considerations such as bonuses until such time that the attorney is fully reinstated.
10) The Law Firm is prohibited in laying off or firing the attorney without cause during the attorney’s probationary period.
11) The damages paid by the Law Firm should be secured by the partners, preventing them of leave of liability.
12) In the event of additional charges filed under §114.2 during the five-year probationary period, this assessment should be raised for an additional five-year period.
13) In the event the Insurance Carrier is found guilty in the collusion or conspiracy of the fraud, they too must contribute a matching punitive-non-judicial damage award in the amount of $100,000.00 per year for 5-years in the same manner as the law Firm.
We could only wish. Injured workers commit fraud less than 1% of the time per federal data, but the insurance company corruption for Workers Compensation is rampant.
I would be willing to bet NONE of these people are UNION MEMBERS.
It has been my experiance that the most egregious fraudulent claims seem to be perpetrated by Union members – encourged by the Unions themselves.I would be shocked if any of these people were in Unions.
Griff
18 people? Some of the well known WC & PIP mills in Queens treat that many phoney claimants in an afternoon. This has been going on for decades. NYS will not touch them, except when they have to, because they are protected by both parties in the NYS legislature.
Why aren’t you up in arms regarding employer fraud? I would imagine that it effects the premiums even more.
The bottom line is that we should be appalled by all insurance fraud whether its the worker, employer, doctor orlawyer
The entire system is relying of the doctors to be honest . . . But they are financially motivated to make the claim bigger than they would have under any other situation – The injured workers are financially motivated to be more injured than they really are and The claimant’s Attys are all financially motivated to make the most out of every claim . . .
The WC system was established so that if someone got injured on the job – they could have treatment without having to sue – But thanks to lawyers always expanding the laws . . . Injured workers make more in a WC Claim than if they did sue!
Now a days; employers offer health insurance (as opposed to when the WC Laws got started) – There is no need for many things to even be considered work related!
Until the system is corrected – the US will continue to lose jobs in this country because we are “Competing” against countries that do not reward liars . . .
You must be smoking something. Injured workers can barely get enough money to eat and fight for years for benefits. The facts are that worker fraud is less than 1% nationally. The fraud is by the insurance companies who stall a $2.00 prescription for 10 months, double the premiums of the employer, and deny benefits to the injured worker, who winds up on welfare. The woman attorney on my case spends more for her Laboutins than I’ve gotten in a year.
Fine put all the crooks in jail; including those insurance executives like Fremont Compensation’s former executives that wrote $2.163 Billion dollars in accepted but unfunded Workers’ Compensation polices, and bribed State legislators, and Insurance Commissioners.
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Please Note on: Page (8 of 22) Net Assets (Deficiency) …….. $(2,163,667,131.00)
. http://www.caclo.org/perl/index.pl?document_id=bdaba3c9f9bf349333e6af0cc2a3386a
.
.
What about arresting some of these crooked insurance company executives who write insurance, but don’t cover honest Workers’ Compensation claims and then leave the state employers, employees and taxpayers “holding the bag” on the costs of honest claims.
.
$60 Million of Fremont’s Unpaid claims were those “Holding the bag” in the State of Alaska alone.
. http://www.legis.state.ak.us/basis/get_jrn_Page.asp?session=23&bill=HB403&jrn=2415&hse=H
.
But who exactly is commiting the most fraud the injured workers or the insurers?
=============================
Public Fraud Unit Favors Those Who Privately Fund It
SUNDAY REPORT D.A.’s workers’ comp section is paid for with money from employers that is doled out by insurers. Prosecutors tend to ignore both but go after workers. Courts see no problem.
August 06, 2000|TED ROHRLICH and EVELYN LARRUBIA |LA TIMES STAFF WRITERS
In that regard, California Applicants’ Attorneys Association (CAAA) refers to statistics indicating that in 1998, there were 358 fraud arrests, three-quarters of which were injured workers, and that amounted to “less than one-tenth of 1% of claims.”
[actually 3/100s of 1% of all Calf. WC claims resulted in a conviction up to 1999]
========================================
Is it the “fear factor” or just plain intimadation and insurance company corruption that works?
Fighting comp fraud: ‘Fear factor’ works
May 18, 2009 by Jim Giuliano
Workers-comp fraud costs employers $30 billion a year, according to insurance-industry estimates. So someone is cheating. Your best approach to the problem: Stop it before it starts.
Most of your company’s employees probably are honest people who wouldn’t fake an injury to collect workers compensation. Keep in mind, however, that it just takes one cheat to cause your comp bills to go up and – not incidentally – hurt the morale and productivity of good people.
The best way to stop the problem? Call it the “fear factor.” Warnings, when they come from the right source, really do help, according to the National Insurance Crime Bureau.
During the course of tape-recorded conversations, Jackson offered Robbins a $250,000 bribe. (Unknown to Jackson, Robbins had already been caught and had agreed to wear a wire in consideration for a reduced sentence.) Jackson promised this substantial reward if Robbins could bring under the jurisdiction of Robbins’ friendly insurance committee an upcoming workers’ compensation measure that would abolish the minimum rate law. Over a period of months, Jackson and Robbins discussed the outlines of the deal.
Jackson promised to raise the money from the small insurance companies he represented, and who would be wiped out if the workers’ compensation minimum rate law were abolished. Jackson solicited donations from several insurance executives, telling them that the money would be used to establish a coalition of similar companies backed by a political action committee.
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FEAR NOT WHEN REPORTING INSURANCE FRAUD
Reporting insurance fraud – even if done in bad faith – is protected, according to Fremont Compensation Ins. Co. v. Superior Court (Gopinath) 44 Cal.App.4th 867 (1996). The protection of California Civil Code §47, which provides absolute immunity for a report to the police, has been found to extend to insurance companies.
Insurance Code §1877.5 affords insurers only qualified immunity in reporting insurance fraud to the District Attorney or Department of Insurance, and only applies to reports made in good faith. This section limits immunity to reports made without malice and exempts insurers from “any civil liability in a cause of action of any kind where the insurer … acts in good faith, without malice, and reasonably believes that the action taken was warranted by the then-known facts”.
However, insurers are no longer limited to qualified immunity, and no longer to reports made only in good faith. Absolute immunity fosters “utmost freedom of communication between citizens and public authorities whose responsibility is to investigate and remedy wrongdoing”, which when balanced, outweighs the “occasional harm that might befall a defamed individual”. (See Imig v. Ferrar (1977) 70 Cal.App.3d 48.) However, any defamed individual retains the remedy of malicious prosecution against the prosecuting government agency.
Freedom of communication between victims of crime and law enforcement agencies is particularly important in the insurance industry because costs of crime are borne by all consumers, employees, and businesses in the form of higher rates. “Insurers and their policyholders ultimately pay the cost of fraudulent insurance claims”, as noted in Insurance Code §1875.10(b).
This case, then, extends absolute immunity to claims made even in bad faith. It concluded that Civil Code §47 gives everybody, including insurers, the right to report crimes to the police, the local prosecutor, or the appropriate regulatory agency, even if the report is made in bad faith.
Re: Rampino’s Rampage 11-Mar-10 10:56 am Was Rampino Little and McIntyre opposed to deregulation and “free-market” competition, Abe?
Sure seems that way!
“What everybody seems to lose sight of here is the concept that there are some broader issues associated with this industry, where it’s been and what it’s been through.
“When you eliminate the minimum rate law in the State of California that’s been in place for 75 or 80 years and put into place with the wisdom of a lot of people who wanted to make sure the insured workers were protected and that the companies were there to pay the claims and . all of sudden you take that regulatory control away, that’s a fundamental structural change to the industry. It’s tough to get your arms around managing a business for profitability when a whole world has changed on you.”
-by Lou Rampino
and note:
In Clay Jackson’s attempted $250,000 bribe of California Senator Alan Robbins who was the Chairman of the Senate Insurance Committee
B. Racketeering Act 5 – Workers’ Compensation
“During the course of tape-recorded conversations, Jackson offered Robbins a $250,000 bribe. (Unknown to Jackson, Robbins had already been caught and had agreed to wear a wire in consideration for a reduced sentence.) Jackson promised this substantial reward if Robbins could bring under the jurisdiction of Robbins’ friendly insurance committee an upcoming workers’ compensation measure that would abolish the minimum rate law. Over a period of months, Jackson and Robbins discussed the outlines of the deal. Jackson promised to raise the money from the small insurance companies he represented, and who would be wiped out if the workers’ compensation minimum rate law were abolished [deregulated].
Jackson solicited donations from several insurance executives [including Fremont’s James Little], telling them that the money would be used to establish a coalition of similar companies backed by a political action committee.”
from:
U.S. 9th Circuit Court of Appeals
USA v JACKSON
UNITED STATES OF AMERICA, No. 94-10095
Fraud by claimants is less than 3% in the US and less than 1% in NY. However the media always report the “guestimates” promoted by crooked insurers as claimant fraud being the largest. When NY started going after employers who were lying in Workers’ Compensation, they found the most costly fraud was being done by employers. My bet would be if NY went after fraud by the insurers especially by the “Responsibility” insurer they would find rampant fraud. I’ve seen numerous insurers come up with fake medical reports that they wrote themselves, claim’s examiners harassing employee’s physicians into not treating them and lies by insurers claiming they never got medical reports so they can delay the claim for decades hoping the employee gives up and dies. We need badfaith regulation in NY and the abolishment of “exclusive remedy” in a corrupt WC Board. I feel the whole system should be
amended to allow the employees an option of being able to sue their employers. Only the ignorant or true liars can say you get more on WC than you would in a straight lawsuit. Insurers have used the media to brainwash the ignorant with lies of high payouts and high settlements. Most of the cost in WC is for high CEO salaries and high litigation fees to fight and delay claims for years. The “responsibility” people have spent over 2 million dollars fighting one serious injury claim for 23 years when it would have only cost them 1/2 a million to step in immediately and treated the injured worker and for them back to work. However insurer’s own lawyers are raking in the dough litigating. As far as claimant lawyers? Most of them are useless and defend the insurers better than they defend the claimants. As far as union employees? I too have seen the vast majority of true fraud being committed by union people. Lucky for employers, unions only represent less than 6% of the nation’s work force. Unions in NY recently sold out the state’s work force by agreeing to cut benefits to all workers except union workers. They then got the maximum benefit levels indexed which only help union higher ups.
The stupid and corrupt insurers agreed to it like the fools they are. Employers really should be demanding an investigation into what the insurers are doing. I’m even sure many injured worker groups would actually help the employers expose the fraud by insurers and where their premiums are going.
WHEN does an agency or a commission ever go after insurance companies & any of its folks who lie to criminally cheat people out of their workers comp claims. The answer is NEVER! It’s a perverted systemic injustice starting with the denial of claims to our soldiers via the U.S Govt/military. When the govt can do it so can other employers both private & public. That is an unmitigated fact. The insurers will do anything criminally to deny a claim & leave workers destitute, ill or dead. Then shift the cost to federal, state & local programs like SS & Medicare. Tell me why? Because its monetarily profitable for Wall st.
Dina Dina Dina . . . While I do understand where you are coming from and I agree with you that there may be a small percent of legitimately injured workers who are denied a claim – I MUST STATE THAT YOU ARE DESCRIBING A VERY SMALL PERCENT OF THE WC CLAIMS!!! THE VAST MAJORITY OF CLAIMS ARE NOT ONLY ACCEPTED MANY CLAIMANTS ARE COLLECTING FOR ROUTINE AGING . . . WHOSE BACK ISN’T WORSE THAN WHEN WE WERE 18??? THE SYSTEM IS THROWING THIS COUNTRY INTO BANKRUPTCY – WILL BE HAPPIER WHEN WE ALL LIVE IN TENTS AT THE WALL STREET PARK???
But why are there no investigations and prosecutions of corrupt insurance companies and corrupt Insurance Commissioners?
“In 1999, the most recent year for which statistics are available, 1.6 million workers’ compensation claims were filed. Investigators are probing only 989 of those cases.”
That means .0006 or only 6/100s of 1% of all workers’ compensation claims are being investigated!
WORKERS’ COMPENSATION CRISIS / FRAUD INVESTIGATOR / Expert sees fraud by bosses, not workers, as a new twist
March 29, 2004|John M. Hubbell
Steven Begley works in a 22-person office in Benicia, where he investigates insurance fraud for the Department of Insurance. Premium scams by employers are a big problem, he says. Chronicle photo by Michael Maloney
Credit: Michael MaloneyAsk Steven Begley to tell of the dumbfounding scams he’s exposed in 17 years as an insurance fraud investigator, and he’ll start with the “worker” he nabbed going from job to job using slightly different names and Social Security numbers, filing fraudulent injury claims along the way.
“He tried to do it four times — four times that I caught him on,” Begley said.
But ask the former Solano County deputy sheriff what the hot rip-off in the insurance racket is these days and he’ll provide a real shocker: premium fraud.
Not cases of employees gaming the system — but employers.
“I did one in San Francisco where the (employer) admitted that, ‘Not only do I not have workers’ comp insurance, I do withholdings from my employees — and I’m keeping them,’ ” Begley said from his 22-person Benicia office, where he supervises a team of seven. “His employees thought they were covered.”
Last month, Begley’s team had 85 open cases of potential workers’ compensation fraud, along with 16 of alleged auto insurance fraud and four property-casualty cases. Cases that could be prosecuted are sent to district attorneys.
To be sure, he said, employee fraud makes up a fair amount of the caseload. But left out of the public debate this year seems to be the cheating ways of their bosses.
Their scams, he said, include “not reporting all the claims they should be claiming, or running a shell corporation: changing the officers of the company on papers to lie and say you’ve never had experience running a business before. Or misclassifying your employees.”
Reinforcements for his team don’t seem to be on the way. In a system derided for allegedly abundant fraud, expanding fraud units hasn’t been a hot topic.
“It’s not uncommon for me to say we can’t open a case because we don’t have resources,” Begley said. “It doesn’t happen a lot, but it’s not uncommon.”
Steven Begley, 49, Benicia
Title: Fraud investigations supervisor, Department of Insurance
Role: Supervises seven of 142 investigators statewide who probe workers’ compensation claims.
Friends: Reformers who back up their distaste for fraud with resources.
Enemies: Lawmakers who might take a further ax to state spending in coming budget negotiations. A hiring freeze for support personnel begun under Gov. Gray Davis, which is still in effect.
Popular fiction: Fraud abounds in the system. While the level of fraud can’t be judged by the number of cases investigated, that number is far smaller than some imply. In 1999, the most recent year for which statistics are available, 1.6 million workers’ compensation claims were filed. Investigators are probing only 989 of those cases.
What’s at stake: Not much. Despite reformer rhetoric that plays on the notion of rampant fraud, the Schwarzenegger-backed ballot initiative doesn’t call for an increase in the number of state investigators to tame it. Talk swirling around the expected compromise reform bill hasn’t centered on fraud containment, either.
After dealing with injured workers for over 25 yrs in one simple words MILLIONS of seriously injured workers are denied. I have my proof beyond what the insurance industry tells folks. Many fo these millions ended up on SS & Medicare. The white house & human rights advocates/activists know this too. So should you!
Dina Dina Dina…….
PLEASE READ FROM PATRICE WHO WROTE A BOOK LONG AFTER MANY OF US WERE WITNESSING THE SAME THING. ANYONE WHO IS WILLING TO HAVE AN HONEST DISCUSSION-DEBATE AND A MUCH NEEDED ONE, ABOUT THE COTTAGE INDUSTRY FOR INJURING WORKERS, THERE ARE INS FOLKS-COHORTS WHO MAKE MANY BILLIONS DENYING CLAIMS JUST IN THE STATE OF CA. WCIRB SHOWED THE 2006 WHEEL OF FORTUNE FOR THOSE WHO PROFITED WHILE SO MANY LOST THEIR HEALTH, THEIR LIVE & THEIR FAMILIES ALONG WITH JUST LOSING EVERYTHING. THIS IS NO JOKE, THIS IS A COTTAGE INDUSTRY!
I’d like to see when an insurance company or a large employer like kaiser or Lowe’s get to go to jail for all of the criminal acts & destruction of human beings. I guess you just have to be there…..IT IS A ONESIDED ISSUE & THE INSURANCE COMPANIES ALWAYS WIN & INJURED WORKERS LOSE.
WORKERS’ COMPENSATION CRISIS / FRAUD INVESTIGATOR / Expert sees fraud by bosses, not workers, as a new twist
March 29, 2004|John M. Hubbell
Note:
“In 1999, the most recent year for which statistics are available, 1.6 million workers’ compensation claims were filed. Investigators are probing only 989 of those cases.”
That works out to 6/100s of 1% of all claims were being investigated, hardly a crime wave by injured workers.
And why was 1999 the last year of the most recent data?
NYS changed the wc laws in 2007 as they now require the injured worker to work within the realm of their disability. NYS WC system is not friendly at all or to the disabled employee. What NYS needs to do is become as friendly as the Social Security Administration and ENCOURAGE working, trial work periods, etc. How many of these individuals who as a result of their wc injury were forced to file social security. NY WC doesn’t even consider that which they should. NYS needs to send notification to all injured workers regarding the laws that changed, the requirements that are expected of them, which they do not. If the case has been considered permanent partial and closed, you don’t get this information from the atty that handled the case at that time — so how does one get this communication. The Workers Comp Advocate needs to be doing this. They are USE LESS and need to be doing a better job. Once disabled employees get this information, you’ll see the allegations drop by a margin.
The WC laws are useless period, no matter how much info is out there, the whole WC system is nothing but a rigged game. and the insurance industry admits to “gamin it”. It is all about insurance companies making money off of sick or injured or dead people, and then dead man policies for employers. [period]
Any body that believes the insurance industry ain’t crooked or criminal is just naive as a 2 year old. After being exposed to the employer’s insurance and evolved into all employers for 26 years, the idea is that they make more money injuring workers and when they (workers without any medical help) die, it’s ll just a golden bonanza when the dead man policies kick in!. As they said in the old days of Chicago, ‘IT’S A BEEZNESS” giving us all who expect medical coverage fairness, justice, OR retraining for starters, is just giving us the BEEZNESS! WC is perhaps this country’s most inhumane system with the employers being the most inhumane while making obscene profits injuring us and denying all of our rights. Violating EVERY right for Americans.
as a employee with new york state currently out on workers comp ive seen fraud from all angles especially from insurance companys and employers.any where from being retaliating against officers out on comp bby making false claims to oig to nysif docs falsifying medical reports.its a horrible system that needs to be re-ramped.I feel for anyone who was injured in result of a job injury god bless you and good luck but all the nonsense im going through i rather go to work with two legs missing.corrupt and fraud with ins companies and employers is disgusting and i cant wait to leaven ny
Amazing. New York State Workers Compensation is notoriously corrupt, and defrauds injured workers of money they need to eat everyday, with no legal recourse, and is currently being investigated right up to the governor’s office, but has time to prosecute the little guy who takes a side job because Workers Comp isn’t paying lost wages so he can eat, and therefore it’s either a side job or welfare.
This is not a victory for New Yorkers. This is government covering up for government.
Why does the State Insurance Fund investigate people who are not on Workers Comp? Aren’t they obligated to pay an injured workers medical bills ruled so by a judge?
Another backlash from fraudlent claims is that often money has been paid out and reported to NCCI thus impacting a policy holders Experience Mod rating. I have seen a mod get amended when there was some recovery through subrogation, but in a case of fraud if money is not paid back and the person committing the fraud goes to jail I feel that there should be a way to have that experience removed from the mod calculation.
Jan,
Fraud is not always committed by the claimant, however the impact still goes to the holders, the system and the state. I’m involved in a WCB case where the attorney’s and the carrier have committed fraud and a total of 14 felonies are being filed against them. Seven have already been filed and seven more are expected by the end of next week. Imagine, you as the judge or opposing counsel in a case and the attorney for the carrier has evidence removed from the files without permission from the Board or opposing counsel and when a decision is made not in their favor, they cry foul!
I would like to see some jail time.
Why? What did you do?
I wish there were a way to have these non violent offenders serve “jail” time by continuing to work, supervised, but at the end of each work day they go back to the pokey. Their pay would be used to pay the cost of their incarceration and anything left over would go to the victims of their crimes.
That would work in some small way, however, their pay would not offset the cost of paying for their incarceration.
In the New York State workers’ compensations system, when an attorney or carrier or their representative commits fraud, it falls under a §114.2. This fraud is a class E felony and under the penal code §70 for a first time offender, non-violent, non-drug related offense, it carries a minimum of 1-3 years.
This white-collar offense, I think should have no jail time but rather carry a more lucrative un-incentive approach to the problem.
In a case I’m involved in, the attorney for the insurance carrier has committed fraud upon the court and opposing counsel. The NYS WCB Fraud Inspector General’s office has filed several felonies against them and the Insurance carrier in this case. It’s now in the hands of the DA. I have asked for vicarious liability against the firm where this attorney works due to the company wide allegations of misconduct and deceit upon the court.
My suggestion if this attorney is found guilty… which is a no brainer, is as follows.
The attorney’s punishment should be;
1) She should have her licenses suspended for 6-months. The firm she was working for, must pay her a weekly salary @ 50% her normal salary. This is so no burden is placed on the state.
2) She should be ordered to 100 hours community service working in a shelter or food-kitchen. This is to let her see what her misconduct and fraud has caused the injured worker in this case.
3) She should be required to retake the ABA ethics class and retake the Bar.
4) Upon passing the Bar with a 80% average or better, her licenses should be reinstated on a restricted bases for a period on Two-years.
5) During this time, she must return to her employer and her salary raised to 75% what it was at the time of the incident and she must donate 10% gross to a fund designated by the Bar for the areas homeless where the injured worker lives or where the injury occurred.
6) Upon completion of this two-year restriction, she is under the watch of the Bar for an additional 2-1/2 years. At which time her salary is now raised to 100% and her donation is raised to 20% gross, during this time.
7) At the end of this final 2-1/2 years (5-years total) The attorney should be reevaluated and her restrictions lifted and her recorded sealed for an additional period of 5-years. At the end of this period, should no further actions have commenced, her record should be expunged.
8) The Law Firm during this time, should be ordered to pay a punitive-non-judicial damage award in the amount of $100,000.00 per year for 5-years. This money should also go to the areas homeless where the worker lives or where the injury occurred.
9) In addition, the Law Firm must continue to pay the attorney’s benefits of medical coverage and other such benefits. The Law Firm is not obligated to provide special considerations such as bonuses until such time that the attorney is fully reinstated.
10) The Law Firm is prohibited in laying off or firing the attorney without cause during the attorney’s probationary period.
11) The damages paid by the Law Firm should be secured by the partners, preventing them of leave of liability.
12) In the event of additional charges filed under §114.2 during the five-year probationary period, this assessment should be raised for an additional five-year period.
13) In the event the Insurance Carrier is found guilty in the collusion or conspiracy of the fraud, they too must contribute a matching punitive-non-judicial damage award in the amount of $100,000.00 per year for 5-years in the same manner as the law Firm.
That’s what I think!
Sal
We could only wish. Injured workers commit fraud less than 1% of the time per federal data, but the insurance company corruption for Workers Compensation is rampant.
I would be willing to bet NONE of these people are UNION MEMBERS.
It has been my experiance that the most egregious fraudulent claims seem to be perpetrated by Union members – encourged by the Unions themselves.I would be shocked if any of these people were in Unions.
Griff
18 people? Some of the well known WC & PIP mills in Queens treat that many phoney claimants in an afternoon. This has been going on for decades. NYS will not touch them, except when they have to, because they are protected by both parties in the NYS legislature.
Why aren’t you up in arms regarding employer fraud? I would imagine that it effects the premiums even more.
The bottom line is that we should be appalled by all insurance fraud whether its the worker, employer, doctor orlawyer
The entire system is relying of the doctors to be honest . . . But they are financially motivated to make the claim bigger than they would have under any other situation – The injured workers are financially motivated to be more injured than they really are and The claimant’s Attys are all financially motivated to make the most out of every claim . . .
The WC system was established so that if someone got injured on the job – they could have treatment without having to sue – But thanks to lawyers always expanding the laws . . . Injured workers make more in a WC Claim than if they did sue!
Now a days; employers offer health insurance (as opposed to when the WC Laws got started) – There is no need for many things to even be considered work related!
Until the system is corrected – the US will continue to lose jobs in this country because we are “Competing” against countries that do not reward liars . . .
You must be smoking something. Injured workers can barely get enough money to eat and fight for years for benefits. The facts are that worker fraud is less than 1% nationally. The fraud is by the insurance companies who stall a $2.00 prescription for 10 months, double the premiums of the employer, and deny benefits to the injured worker, who winds up on welfare. The woman attorney on my case spends more for her Laboutins than I’ve gotten in a year.
Stop spouting rhetoric and get the facts.
Fine put all the crooks in jail; including those insurance executives like Fremont Compensation’s former executives that wrote $2.163 Billion dollars in accepted but unfunded Workers’ Compensation polices, and bribed State legislators, and Insurance Commissioners.
.
.
Please Note on: Page (8 of 22) Net Assets (Deficiency) …….. $(2,163,667,131.00)
.
http://www.caclo.org/perl/index.pl?document_id=bdaba3c9f9bf349333e6af0cc2a3386a
.
.
What about arresting some of these crooked insurance company executives who write insurance, but don’t cover honest Workers’ Compensation claims and then leave the state employers, employees and taxpayers “holding the bag” on the costs of honest claims.
.
$60 Million of Fremont’s Unpaid claims were those “Holding the bag” in the State of Alaska alone.
.
http://www.legis.state.ak.us/basis/get_jrn_Page.asp?session=23&bill=HB403&jrn=2415&hse=H
.
But who exactly is commiting the most fraud the injured workers or the insurers?
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Public Fraud Unit Favors Those Who Privately Fund It
SUNDAY REPORT D.A.’s workers’ comp section is paid for with money from employers that is doled out by insurers. Prosecutors tend to ignore both but go after workers. Courts see no problem.
August 06, 2000|TED ROHRLICH and EVELYN LARRUBIA |LA TIMES STAFF WRITERS
http://articles.latimes.com/2000/aug/06/news/mn-65499
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In that regard, California Applicants’ Attorneys Association (CAAA) refers to statistics indicating that in 1998, there were 358 fraud arrests, three-quarters of which were injured workers, and that amounted to “less than one-tenth of 1% of claims.”
http://www.dir.ca.gov/chswc/finalfraudreport0801.html
[actually 3/100s of 1% of all Calf. WC claims resulted in a conviction up to 1999]
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Is it the “fear factor” or just plain intimadation and insurance company corruption that works?
http://www.hrmorning.com/fighting-comp-fraud-fear-factor-works/
Fighting comp fraud: ‘Fear factor’ works
May 18, 2009 by Jim Giuliano
Workers-comp fraud costs employers $30 billion a year, according to insurance-industry estimates. So someone is cheating. Your best approach to the problem: Stop it before it starts.
Most of your company’s employees probably are honest people who wouldn’t fake an injury to collect workers compensation. Keep in mind, however, that it just takes one cheat to cause your comp bills to go up and – not incidentally – hurt the morale and productivity of good people.
The best way to stop the problem? Call it the “fear factor.” Warnings, when they come from the right source, really do help, according to the National Insurance Crime Bureau.
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http://laws.findlaw.com/9th/9410095.html
B. Racketeering Act 5-Workers’ Compensation
During the course of tape-recorded conversations, Jackson offered Robbins a $250,000 bribe. (Unknown to Jackson, Robbins had already been caught and had agreed to wear a wire in consideration for a reduced sentence.) Jackson promised this substantial reward if Robbins could bring under the jurisdiction of Robbins’ friendly insurance committee an upcoming workers’ compensation measure that would abolish the minimum rate law. Over a period of months, Jackson and Robbins discussed the outlines of the deal.
Jackson promised to raise the money from the small insurance companies he represented, and who would be wiped out if the workers’ compensation minimum rate law were abolished. Jackson solicited donations from several insurance executives, telling them that the money would be used to establish a coalition of similar companies backed by a political action committee.
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FEAR NOT WHEN REPORTING INSURANCE FRAUD
Reporting insurance fraud – even if done in bad faith – is protected, according to Fremont Compensation Ins. Co. v. Superior Court (Gopinath) 44 Cal.App.4th 867 (1996). The protection of California Civil Code §47, which provides absolute immunity for a report to the police, has been found to extend to insurance companies.
Insurance Code §1877.5 affords insurers only qualified immunity in reporting insurance fraud to the District Attorney or Department of Insurance, and only applies to reports made in good faith. This section limits immunity to reports made without malice and exempts insurers from “any civil liability in a cause of action of any kind where the insurer … acts in good faith, without malice, and reasonably believes that the action taken was warranted by the then-known facts”.
However, insurers are no longer limited to qualified immunity, and no longer to reports made only in good faith. Absolute immunity fosters “utmost freedom of communication between citizens and public authorities whose responsibility is to investigate and remedy wrongdoing”, which when balanced, outweighs the “occasional harm that might befall a defamed individual”. (See Imig v. Ferrar (1977) 70 Cal.App.3d 48.) However, any defamed individual retains the remedy of malicious prosecution against the prosecuting government agency.
Freedom of communication between victims of crime and law enforcement agencies is particularly important in the insurance industry because costs of crime are borne by all consumers, employees, and businesses in the form of higher rates. “Insurers and their policyholders ultimately pay the cost of fraudulent insurance claims”, as noted in Insurance Code §1875.10(b).
This case, then, extends absolute immunity to claims made even in bad faith. It concluded that Civil Code §47 gives everybody, including insurers, the right to report crimes to the police, the local prosecutor, or the appropriate regulatory agency, even if the report is made in bad faith.
Re: Rampino’s Rampage 11-Mar-10 10:56 am Was Rampino Little and McIntyre opposed to deregulation and “free-market” competition, Abe?
Sure seems that way!
“What everybody seems to lose sight of here is the concept that there are some broader issues associated with this industry, where it’s been and what it’s been through.
“When you eliminate the minimum rate law in the State of California that’s been in place for 75 or 80 years and put into place with the wisdom of a lot of people who wanted to make sure the insured workers were protected and that the companies were there to pay the claims and . all of sudden you take that regulatory control away, that’s a fundamental structural change to the industry. It’s tough to get your arms around managing a business for profitability when a whole world has changed on you.”
-by Lou Rampino
and note:
In Clay Jackson’s attempted $250,000 bribe of California Senator Alan Robbins who was the Chairman of the Senate Insurance Committee
B. Racketeering Act 5 – Workers’ Compensation
“During the course of tape-recorded conversations, Jackson offered Robbins a $250,000 bribe. (Unknown to Jackson, Robbins had already been caught and had agreed to wear a wire in consideration for a reduced sentence.) Jackson promised this substantial reward if Robbins could bring under the jurisdiction of Robbins’ friendly insurance committee an upcoming workers’ compensation measure that would abolish the minimum rate law. Over a period of months, Jackson and Robbins discussed the outlines of the deal. Jackson promised to raise the money from the small insurance companies he represented, and who would be wiped out if the workers’ compensation minimum rate law were abolished [deregulated].
Jackson solicited donations from several insurance executives [including Fremont’s James Little], telling them that the money would be used to establish a coalition of similar companies backed by a political action committee.”
from:
U.S. 9th Circuit Court of Appeals
USA v JACKSON
UNITED STATES OF AMERICA, No. 94-10095
Plaintiff-Appellee, D.C. No.
v. CR-93-00118-EJG
CLAYTON R. JACKSON, OPINION
Defendant-Appellant.
http://laws.findlaw.com/9th/9410095.html
Fraud by claimants is less than 3% in the US and less than 1% in NY. However the media always report the “guestimates” promoted by crooked insurers as claimant fraud being the largest. When NY started going after employers who were lying in Workers’ Compensation, they found the most costly fraud was being done by employers. My bet would be if NY went after fraud by the insurers especially by the “Responsibility” insurer they would find rampant fraud. I’ve seen numerous insurers come up with fake medical reports that they wrote themselves, claim’s examiners harassing employee’s physicians into not treating them and lies by insurers claiming they never got medical reports so they can delay the claim for decades hoping the employee gives up and dies. We need badfaith regulation in NY and the abolishment of “exclusive remedy” in a corrupt WC Board. I feel the whole system should be
amended to allow the employees an option of being able to sue their employers. Only the ignorant or true liars can say you get more on WC than you would in a straight lawsuit. Insurers have used the media to brainwash the ignorant with lies of high payouts and high settlements. Most of the cost in WC is for high CEO salaries and high litigation fees to fight and delay claims for years. The “responsibility” people have spent over 2 million dollars fighting one serious injury claim for 23 years when it would have only cost them 1/2 a million to step in immediately and treated the injured worker and for them back to work. However insurer’s own lawyers are raking in the dough litigating. As far as claimant lawyers? Most of them are useless and defend the insurers better than they defend the claimants. As far as union employees? I too have seen the vast majority of true fraud being committed by union people. Lucky for employers, unions only represent less than 6% of the nation’s work force. Unions in NY recently sold out the state’s work force by agreeing to cut benefits to all workers except union workers. They then got the maximum benefit levels indexed which only help union higher ups.
The stupid and corrupt insurers agreed to it like the fools they are. Employers really should be demanding an investigation into what the insurers are doing. I’m even sure many injured worker groups would actually help the employers expose the fraud by insurers and where their premiums are going.
MJ,
I would love to talk to you about your comments and Fraud by the carriers etc.
Regards,
Sal
WHEN does an agency or a commission ever go after insurance companies & any of its folks who lie to criminally cheat people out of their workers comp claims. The answer is NEVER! It’s a perverted systemic injustice starting with the denial of claims to our soldiers via the U.S Govt/military. When the govt can do it so can other employers both private & public. That is an unmitigated fact. The insurers will do anything criminally to deny a claim & leave workers destitute, ill or dead. Then shift the cost to federal, state & local programs like SS & Medicare. Tell me why? Because its monetarily profitable for Wall st.
Dina Dina Dina . . . While I do understand where you are coming from and I agree with you that there may be a small percent of legitimately injured workers who are denied a claim – I MUST STATE THAT YOU ARE DESCRIBING A VERY SMALL PERCENT OF THE WC CLAIMS!!! THE VAST MAJORITY OF CLAIMS ARE NOT ONLY ACCEPTED MANY CLAIMANTS ARE COLLECTING FOR ROUTINE AGING . . . WHOSE BACK ISN’T WORSE THAN WHEN WE WERE 18??? THE SYSTEM IS THROWING THIS COUNTRY INTO BANKRUPTCY – WILL BE HAPPIER WHEN WE ALL LIVE IN TENTS AT THE WALL STREET PARK???
But why are there no investigations and prosecutions of corrupt insurance companies and corrupt Insurance Commissioners?
“In 1999, the most recent year for which statistics are available, 1.6 million workers’ compensation claims were filed. Investigators are probing only 989 of those cases.”
That means .0006 or only 6/100s of 1% of all workers’ compensation claims are being investigated!
And why is the most recient data for 1999?
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http://articles.sfgate.com/2004-03-29/news/17416204_1_insurance-fraud-fraud-units-premium-fraud
WORKERS’ COMPENSATION CRISIS / FRAUD INVESTIGATOR / Expert sees fraud by bosses, not workers, as a new twist
March 29, 2004|John M. Hubbell
Steven Begley works in a 22-person office in Benicia, where he investigates insurance fraud for the Department of Insurance. Premium scams by employers are a big problem, he says. Chronicle photo by Michael Maloney
Credit: Michael MaloneyAsk Steven Begley to tell of the dumbfounding scams he’s exposed in 17 years as an insurance fraud investigator, and he’ll start with the “worker” he nabbed going from job to job using slightly different names and Social Security numbers, filing fraudulent injury claims along the way.
“He tried to do it four times — four times that I caught him on,” Begley said.
But ask the former Solano County deputy sheriff what the hot rip-off in the insurance racket is these days and he’ll provide a real shocker: premium fraud.
Not cases of employees gaming the system — but employers.
“I did one in San Francisco where the (employer) admitted that, ‘Not only do I not have workers’ comp insurance, I do withholdings from my employees — and I’m keeping them,’ ” Begley said from his 22-person Benicia office, where he supervises a team of seven. “His employees thought they were covered.”
Last month, Begley’s team had 85 open cases of potential workers’ compensation fraud, along with 16 of alleged auto insurance fraud and four property-casualty cases. Cases that could be prosecuted are sent to district attorneys.
To be sure, he said, employee fraud makes up a fair amount of the caseload. But left out of the public debate this year seems to be the cheating ways of their bosses.
Their scams, he said, include “not reporting all the claims they should be claiming, or running a shell corporation: changing the officers of the company on papers to lie and say you’ve never had experience running a business before. Or misclassifying your employees.”
Reinforcements for his team don’t seem to be on the way. In a system derided for allegedly abundant fraud, expanding fraud units hasn’t been a hot topic.
“It’s not uncommon for me to say we can’t open a case because we don’t have resources,” Begley said. “It doesn’t happen a lot, but it’s not uncommon.”
Steven Begley, 49, Benicia
Title: Fraud investigations supervisor, Department of Insurance
Role: Supervises seven of 142 investigators statewide who probe workers’ compensation claims.
Friends: Reformers who back up their distaste for fraud with resources.
Enemies: Lawmakers who might take a further ax to state spending in coming budget negotiations. A hiring freeze for support personnel begun under Gov. Gray Davis, which is still in effect.
Popular fiction: Fraud abounds in the system. While the level of fraud can’t be judged by the number of cases investigated, that number is far smaller than some imply. In 1999, the most recent year for which statistics are available, 1.6 million workers’ compensation claims were filed. Investigators are probing only 989 of those cases.
What’s at stake: Not much. Despite reformer rhetoric that plays on the notion of rampant fraud, the Schwarzenegger-backed ballot initiative doesn’t call for an increase in the number of state investigators to tame it. Talk swirling around the expected compromise reform bill hasn’t centered on fraud containment, either.
After dealing with injured workers for over 25 yrs in one simple words MILLIONS of seriously injured workers are denied. I have my proof beyond what the insurance industry tells folks. Many fo these millions ended up on SS & Medicare. The white house & human rights advocates/activists know this too. So should you!
Dina Dina Dina…….
PLEASE READ FROM PATRICE WHO WROTE A BOOK LONG AFTER MANY OF US WERE WITNESSING THE SAME THING. ANYONE WHO IS WILLING TO HAVE AN HONEST DISCUSSION-DEBATE AND A MUCH NEEDED ONE, ABOUT THE COTTAGE INDUSTRY FOR INJURING WORKERS, THERE ARE INS FOLKS-COHORTS WHO MAKE MANY BILLIONS DENYING CLAIMS JUST IN THE STATE OF CA. WCIRB SHOWED THE 2006 WHEEL OF FORTUNE FOR THOSE WHO PROFITED WHILE SO MANY LOST THEIR HEALTH, THEIR LIVE & THEIR FAMILIES ALONG WITH JUST LOSING EVERYTHING. THIS IS NO JOKE, THIS IS A COTTAGE INDUSTRY!
I’d like to see when an insurance company or a large employer like kaiser or Lowe’s get to go to jail for all of the criminal acts & destruction of human beings. I guess you just have to be there…..IT IS A ONESIDED ISSUE & THE INSURANCE COMPANIES ALWAYS WIN & INJURED WORKERS LOSE.
But why are there no investigations and prosecutions of corrupt insurance companies and corrupt Insurance Commissioners?
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http://articles.sfgate.com/2004-03-29/news/17416204_1_insurance-fraud-fraud-units-premium-fraud
WORKERS’ COMPENSATION CRISIS / FRAUD INVESTIGATOR / Expert sees fraud by bosses, not workers, as a new twist
March 29, 2004|John M. Hubbell
Note:
“In 1999, the most recent year for which statistics are available, 1.6 million workers’ compensation claims were filed. Investigators are probing only 989 of those cases.”
That works out to 6/100s of 1% of all claims were being investigated, hardly a crime wave by injured workers.
And why was 1999 the last year of the most recent data?
.
NYS changed the wc laws in 2007 as they now require the injured worker to work within the realm of their disability. NYS WC system is not friendly at all or to the disabled employee. What NYS needs to do is become as friendly as the Social Security Administration and ENCOURAGE working, trial work periods, etc. How many of these individuals who as a result of their wc injury were forced to file social security. NY WC doesn’t even consider that which they should. NYS needs to send notification to all injured workers regarding the laws that changed, the requirements that are expected of them, which they do not. If the case has been considered permanent partial and closed, you don’t get this information from the atty that handled the case at that time — so how does one get this communication. The Workers Comp Advocate needs to be doing this. They are USE LESS and need to be doing a better job. Once disabled employees get this information, you’ll see the allegations drop by a margin.
The WC laws are useless period, no matter how much info is out there, the whole WC system is nothing but a rigged game. and the insurance industry admits to “gamin it”. It is all about insurance companies making money off of sick or injured or dead people, and then dead man policies for employers. [period]
Any body that believes the insurance industry ain’t crooked or criminal is just naive as a 2 year old. After being exposed to the employer’s insurance and evolved into all employers for 26 years, the idea is that they make more money injuring workers and when they (workers without any medical help) die, it’s ll just a golden bonanza when the dead man policies kick in!. As they said in the old days of Chicago, ‘IT’S A BEEZNESS” giving us all who expect medical coverage fairness, justice, OR retraining for starters, is just giving us the BEEZNESS! WC is perhaps this country’s most inhumane system with the employers being the most inhumane while making obscene profits injuring us and denying all of our rights. Violating EVERY right for Americans.
as a employee with new york state currently out on workers comp ive seen fraud from all angles especially from insurance companys and employers.any where from being retaliating against officers out on comp bby making false claims to oig to nysif docs falsifying medical reports.its a horrible system that needs to be re-ramped.I feel for anyone who was injured in result of a job injury god bless you and good luck but all the nonsense im going through i rather go to work with two legs missing.corrupt and fraud with ins companies and employers is disgusting and i cant wait to leaven ny
Amazing. New York State Workers Compensation is notoriously corrupt, and defrauds injured workers of money they need to eat everyday, with no legal recourse, and is currently being investigated right up to the governor’s office, but has time to prosecute the little guy who takes a side job because Workers Comp isn’t paying lost wages so he can eat, and therefore it’s either a side job or welfare.
This is not a victory for New Yorkers. This is government covering up for government.
Why does the State Insurance Fund investigate people who are not on Workers Comp? Aren’t they obligated to pay an injured workers medical bills ruled so by a judge?