Reporting Carrier/Employer Fraud

[rickandkryss]

I just wanted to say...Great Info 1171!

[1171]

prncess:
sounds like they did not deny the injury (which the video confirms) just that it was done on the job.
Fraud requires a lie.
If you can show that it was within your job description and they knew it at the time they denied the claim then you have one of the main rquirements of a fraud case. you can discuss it the DA or dept of insurance when you file your complaint. Each state is a little different in how it words it's fraud statutes.

[Babebahn]

1171..in my case, my supervisor "crossed out" what she wrote regarding my injury and then later "whited it out" on another report. When the corrections were brought up, she stated that the department manager told her to change what she wrote because the wording was not professional....meaning it was not what the Hospital HR people wanted her to say...she did not get a reprimand.

[1171]

Changing, proof-reading, correcting, updating, spell-checking, re-writing, etc. is not fraudulent behavior.
You would have to show that deception and/or a material change in the facts of the case was done with the intent to deny the claim.
proving fraud is not an easy standard against either a worker or employer.

[capricorn]

1171....How about when the IC 's attorney lies and tells a co-worker that they were named as a witness but in reality they weren't? Nowhere have I ever stated that there were any witnesses BUT the IC 's attorney took a depo from one of my co-workers and at the beginning told him I named him as a witness. My attorney went off and asked him to show him where in my depo I ever said that there were witnesses. He couldn't but the co-worker was still sworn in and asked alot of dumb questions. I just think it's appalling that the IC can use stall tactics that involve deceit and get away with it. If I pulled a stunt like that you can be sure I would have perjury or fraud charges on me in a heartbeat.


CAP

[1171]

Attorney behavior is governed by the state bar. Most states have the ethics code on-line as well as instructions on filing a complaint.
No, you wouldn't be prosecuted. you could depose any number of supervisors or managers and subpoena many boxes of records and, in general, tie-up the employer's operations for long while in court.
It's perfectly legal and done regularly (often refered to as "green mail" as in " paying me $$ will be cheaper then fighting")

[Bad Boy Bad Boy]

Yes, green mail is very correct. I had done that to my employer with the Labor Board and with the EEOC and was Awarded the Right to Sue letters.

[1171]

cap:
Don't confuse ethics with what's legal. If you do, the world will be a cold angry place for you.
What you see as "stall tactics" they may see as being thorough and detailed and very much adhering to the legal code.

[capricorn]

Gotcha 1171........ There are alot of legal issues that are unethical. Sometimes I just sit here and wonder what the Judge will think as he's reading that my claim was denied because the boss was pissed at me and then the IC attorney lying in this co-workers depo. You're right. I hear you loud and clear. Unethical vs. illegal. What a tangled web we weave when at first we learn to deceive. I sleep at night. I had no other way to do it but honestly. I guess that's why all of my depos and paperwork are the same. You can't change the truth. Thanks for all your help and advise. It's much appreciated.

CAP

[nancy1861@yahoo.com]

Who do I contact in Texas? My treating doctor refused to give me my medical records (I asked for last years) – said I could only get my test results from the issuing Drs/testing centers. He also gave me a work release that exceeds my medical capabilities! Restricted duty - “DOT sedentary”, lift less than 10lbs for no more than 2-3hrs per day (no way I could lift 10lbs 2-3hrs!) and I am in bed or my recliner most of the day. He said, quote “pain is no excuse not to work”. I worry that on my next visit he might change it to be less restricted.

I had a multi-roll-over auto accident and then a semi truck hit my upside-down car. God, my seatbelt and airbags saved my life.

Medical records I do have:
Imaging 12/30/03:
• Severe compression fracture of T12 vertebral, 60-75%loss.
• Significant posterior retropulsed fragment of the margin of the T12 vertebral body superiorly, producing central canal stenosis and compression of the spinal cord. See Image #6/14 off the fourth sequence 12/30/03 This compresses the cord at the conus
• Additional vertical component of the fracture on the right posterolateral margin, seen as high signal intensity change on the trans-sagittal T2
• Abnormality of the inferior endplate of L1, appears to be Schmorl’s node
Myelogram 2/19/04:
• Broad base disk bulge at the C4-C5 level, narrowing of the AP diameter of the canal. Similar narrowing at C5-C6
• Broad base disk bulge less at the C6-C7