Florida work group begins effort to corral ‘shell-company’ scheme

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Even though ultimately we strive here to provide equal access to all manners of workers’ comp issues, sometimes we just can’t help taking sides.

In other words, our basic premise is that injured workers need to be treated fairly.

That being said, we also realize that some workers try to game the system.

Shame on such workers, for they bring undue scrutiny and added costs to the system–which eventually mounts up societal costs not only in terms of the worker’s attempted scam but also allows critics to label the barrel rotten because of a few apples.

Another factor is the worker’s comp insurance carrier: They have their games, too.

As do medical providers–and sometimes even the workers’ comp officials, as has been so publicly revealed in Illinois.

Medicare paid $550,000 for worker stricken with cancer, but workers’ comp should have paid

An Ohio case shows just how far some people have to go to get justice. An Aug. 17 story at Cincinnati.com describes a couple’s lawsuit against three defendants over workplace-induced cancer, several surgeries and workers’ comp benefits to repay Medicare–which shelled out over half a million dollars for James Cliff’s treatment.

Apparently Cliff’s wife Delores speaks for him because he no longer has a larynx.

“He has no voice box,” she was quoted in the story. “They cut him from ear to ear.”

Employee at claims company altered ironworker’s documents

They filed the Monday suit in Hamilton County Common Pleas Court against her ironworker husband’s former employer, Fenton Rigging & Contracting of Pleasant Ridge; Roselawn’s Matrix Claims Management, the company they say handled workers’ comp claims for Fenton; and Crystal Nguyen, also known as Crystal Sikes, who was convicted of altering Cliff’s workers’ comp documents.

A call to Fenton was returned by an attorney who declined comment. A call to Matrix wasn’t returned. Nguyen, who worked for Matrix, couldn’t be reached.

Delores Cliff said her husband was an ironworker for 37 years and worked for Fenton at several local sites where he was exposed to chemicals and other contaminants that resulted in him contracting throat cancer requiring several surgeries.

Case was won in June 2010

At first, Medicare paid for treatments and surgeries. Later Medicare “required the Cliffs to file a workers’ comp claim because he contracted cancer due to his job. Cincinnati attorney Harry McIlwain Jr. helped the Cliffs win their workers’ comp case in June 2010.”

The rigging company had hired Matrix Claims Management to administer its workers’ comp claims. Incredibly, the Matrix employee named as co-defendant attempted to forge documents after missing a deadline to appeal the workers’ comp ruling.

Nguyen, 29, initially was charged with forgery, tampering with records and telecommunications fraud. She cut and pasted part of a different person’s workers’ comp claim to Cliff’s claim to make it appear as if she’s appealed the decision on time, a spokesman for the Ohio Attorney General’s Office said Wednesday.

In March, Nguyen accepted a plea deal. She pleaded no contest to and was convicted of telecommunications fraud for faxing the altered documents. In exchange, the other two charges were dismissed. She was placed on probation for two years by Common Pleas Court Judge Beth Myers.

The Cliffs have fought since they won the workers’ comp case to get bill collectors seeking reimbursement for his medical bills to leave them alone.

Maybe punitive damages will allow couple to stay in home

Beyond the husband’s condition and the medical bills, says the story, the couple also care for a daughter with special needs as well as two grandchildren.  Plus, they fear losing their home.

The suit aims to force the co-defendants to reimburse Medicare and pay punitive damages.

State CFO leads effort to stop abuse of Florida system

Workers’ comp fraud is so bad in Florida that CFO Jeff Atwater is leading a task force to end the practice of using “shell companies” in a workers’ comp scheme that seems to be flourishing in the construction industry. The group includes law enforcement, state officials and trade groups.

According to an Aug. 30 piece at Insurance Journal, “officials held the first meeting of a working group to investigate the role of check cashing companies with an eye on developing legislative recommendations to be considered year.

“Atwater said the various check cashing schemes are becoming endemic around the state and hurting both employers and injured workers.”

An Aug. 26 account from The News Service of Florida explains:

Shell companies enable bypassing of legit policies

The schemes center on people who create shell companies that are used to buy minimal workers-compensation insurance policies. With the policies in hand, operators of the shell companies then hook up with construction sub-contractors who need workers-compensation insurance to get jobs — but don’t want to buy it.

The shell-company policies are used to get what are known as “certificates of insurance,” which are sent to general contractors as proof of coverage. The sub-contractors are purported to be employees of the shell companies, which allows the sub-contractors to get the jobs.

When construction jobs are finished, general contractors write checks to the shell companies. Those checks are taken to money-services businesses, with the sub-contractors getting paid in cash and the operators of the shell companies taking a cut for providing the insurance certificates.

Authorities said Thursday that operators of money-services businesses also are often part of the scheme, as the shell companies typically provide the certificates to numerous sub-contractors. The businesses get a cut for cashing large numbers of checks and going along with the fraud.

Authorities want to prevent premium hikes on legitimate operators as well as head off confusion over payments or treatment for injured workers.

We can help you find an attorney

Frequently enough, a worker’s compensation case may be so complex as to demand legal representation. However, sometimes what seems like a cut-and-dried situation to an injured worker may result in a smaller award than envisioned–or even a denial. Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

In the case of three workers fired from Ohio’s Workers’ Compensation Council, council Director Virginia McInerney has been nothing but consistent: consistently tight lipped.

When last we discussed the case (third item here), McInerney had simply denied all allegations of the workers who complained of wrongful discharge, religious discrimination and harassment, retaliation and age discrimination–and said she couldn’t discuss an ongoing case.

Employer-companies to pick up tab

On August 27, the “three former employees of the council–executive assistant Stephanie Irwin and staff attorneys Kim Finley and Shadya Yazback — signed a settlement that will net them a combined $55,102, according to documents filed with the Ohio Court of Claims,” says a report in The Plain Dealer.

The attorney for the trio gets another 15 grand, bringing the total settlement to about $70,000, which according to the Plain Dealer will eventually be borne by Ohio employers. “The money will be paid out of the council’s budget, which is funded by assessments on Ohio employers who pay workers’ compensation premiums, according to the Ohio Attorney General’s office. The council’s overall budget is $650,000 a year.”

Claims: ‘God to permeate the workplace’

McInerney fired the women in February; in March, they wrote letters to council members and, apparently, to legislators “charging that McInerney told her staff that she was sent by God to her job, that she wanted God to permeate the workplace and that Satan was to blame for obstacles the staff encountered in their jobs. She inquired about their religious beliefs, called them to pray aloud, cited Scripture in her reprimands and asked Irwin to listen to CDs of sermons and take notes on them, they said.”

As we posted in March, an AP story from March 3 quoted “a former staff attorney as writing in a letter that ‘It became increasingly clear that the Director was judging employees not on professional performance but on the quality of their faith, according to her beliefs.’ ”

No change in director’s ‘status’

McInerney retains her job and title as agency director–along with its $102,000 salary.  However, the agency’s chairman, state Sen. Steve Buehrer, released a less-than-ringing endorsement in his post-settlement assessments. From the Plain Dealer: ” ‘The move to settle in this case averts risk and avoids costly litigation.’ While Buehrer’s statement didn’t address McInerney’s future with the board, the lawmaker relayed through an aide that there is ‘no change in the status of her employment.’ ”

However, another legislator has taken aim at the entire council, which itself was created in reaction to a scandal that cost the state’s worker insurance fund $300 million in losses from questionable investments.

State rep wants to gut council

According to an Aug. 30 post at InsuranceNews.net, “State Rep. Dan Dodd, a member of the council, has questioned whether the council is even necessary. In an April blog entry on his website, Dodd [wrote], ‘In this economy, every dollar matters to employers. That is why the Workers’ Compensation Council needs to have its funding stripped before more money is wasted.’ ”

The Plain Dealer reports that “Dodd also sponsored a bill eliminating funding for the council that has cleared the Ohio House and is sitting in the Senate. Lawmakers are not expected back into regular session until after the November election.”

According the insurance trade site, “McInerney, who worked for the Ohio Legislative Service Commission before being hired as staff director, has taught seminars at Vineyard Church of Columbus and also wrote a book in 2003, “Singles Not Separate: How to Make the Church a Family.” Reportedly, she also has appeared on the 700 Club.

She hired a temp worker after firing executive assistant Stephanie Irwin and staff attorneys Kim Finley and Shadya Yazback and has said she is awaiting hiring instructions following the settlement. Laconic as ever about details of the firings, McInerney declined to comment on that aspect but said of the settlement’s resolution, “I have a 21-year track record of dedicated service and hard work for the general assembly. I stand on a solid record, not only of achievements but also with respect to my conduct.”

The awards are follows: $20,688.81 to staff attorney Finley; $22,051.50 to Yazback and $12,363 to staff assistant Irwin. Their attorney, John S. Marshall, will get $15,000.

Court approval needed; no wrongdoing acceded

After announcement of the settlement–which according to BusinessInsurance.com still requires court approval–Finley said that “obviously, we wouldn’t have brought anything forward that was untrue, but the matter has been resolved and we’re moving on with our careers,” according to the Plain Dealer.

In the agreement, the council characterized the settlement as a compromise, acknowledging no wrongdoing on behalf of the council or the director.

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Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Filing a claim