Workers comp cases reveal fraud, effects of unintended consequences
We think it’s always instructive to follow workers’ comp fraud, regardless of whether it’s providers, carriers or claimants trying to pull a fast one.
In our first case for this edition, the person who got busted did not pull a fast one.
She pulled a slow one.
79-year-old pleads guilty
From a recent winner of a Pulitzer prize, an Aug. 17 post of the Glens Falls Post-Star: “A 79-year-old Lake Luzerne woman who illegally collected $242,000 in worker’s compensation has pleaded guilty to a felony charge and been ordered to pay the money back.
“Anna R. Healey was sentenced to a three-year conditional discharge after her guilty plea to a misdemeanor charge of offering a false instrument for filing.”
Here’s the hook-line-sinker part, though–the authorities may be a tad late on ordering her to pay it back. Not only is she crowding 80 years-old but also the payments she apparently swindled date back to the late 1970s.
“The benefits were to be discontinued if she remarried, and investigators from the state Insurance Department sought a criminal investigation by the State Police after determining she had gotten married again.
“Healey illegally collected worker’s compensation payments for 30 years beginning in 1978.”
In other words, what are the chances that any given 79-year-old woman can come up with the dough to pay it back before she dies? True, from this one account we don’t know but what’s she’s now wealthy beyond measure.
But more likely the quick and dirty math takes over, which says she collected less than $700 a month during all that time. And most of us know where $700 a month goes in most householdds: utilities, food, and staples such as fuel and toilet paper.
Maybe it will turn out that she funded a trading account and became super-wealthy. If that’s the case, she should not only pay it back, but pay it back with penalties and interest–including charges against her estate.
Public oversight
But here’s the deal– the truly important thing involves public money. If one old lady got away with something, that’s one thing. Maybe she really needed it, but that’s a question for another topic.
The real question is this: Why did this go undiscovered for so long? And, given the parameters, how many more similar cases are ongoing?
Shouldn’t we demand more and better of our public officials?
Ok, here’s another one.
This guy got popped for taking comp money as if he couldn’t work, but according to the sources he could indeed work. The totals involved don’t even approach Healey proportions but do involve jail time and maybe some different questions about the system.
Double dipping
According to an Aug. 18 post at claimsjournal.com, former truck driver Martin DaLaRosa was “was sentenced to brief jail time and ordered to repay $1,647 in benefits to Texas Mutual.”
One thing we notice here is the source is Texas Mutual.
Now that doesn’t mean it’s wrong. As alluded to earlier, there really are people who scam insurance companies. We know this.
In DeLaRosa’s case, the Denton, Texas, man “reported a job-related injury while working as a truck driver for Texas Environmental Management of [nearby] Justin, Texas. He claimed he was unable to work as a result of the injury, and Texas Mutual began paying income benefits to him.”
Subsequently, however, the insurance company “uncovered evidence that DeLaRosa was working as a car salesman for a Denton car dealership while receiving income benefits.”
See, the problem is not that DeLaRosa could no longer drive trucks. State law requires claimants to report when they resume employment, period. Otherwise claimants are said to be “double-dipping because the claimant collects benefits for being too injured to work when he or she is, in fact, gainfully employed.”
Insurance carriers like to point out that double-dipping costs all employers who carry workmen’s comp via across-the-board premium hikes. (Texas is the only state that doesn’t require employers to carry workmen’s comp insurance.)
The case underscores the need for competent legal counsel–not only to help claimants receive the benefits they deserve but also to make sure claimants do not run afoul of the law once benefits have been awarded.
Volunteer firefighters back in the news
The final case we’ll look at today is interesting for a different reason. Justin Fauer was a volunteer firefighter who died while trying to save his boss in a farming accident. As we’ve noted in a previous installment, volunteer firefighters can find themselves–and the communities they serve–mired in complex situations concerning workers comp coverage.
But Fauer’s case is also interesting because the parties at odds do not include either Fauer’s employer or his survivors but rather two insurance companies.
Fauer and his boss were working at a manure pit, according to an AP account in the Aug. 15 Chicago Tribune, at Johnson Valley Beef in 2005.
“Fauer’s boss, Dwight Johnson, climbed into a manure pit at Johnson Valley Beef to retrieve a chain that had fallen into the pit and was overcome by methane fumes, court records show.
“Fauer, a volunteer firefighter with Andover Volunteer Fire Department, ran to the house to tell Johnson’s wife to call 911 and then returned to the pit where he climbed in and was also overcome.
“A deputy workers compensation commissioner ruled that Fauer responded to the emergency as both a farm hand and a volunteer firefighter because some of the injuries that led to his death occurred after he would have been notified in his capacity as a firefighter.”
Grinnell versus Travelers
The carrier for the farm, Grinnell Mutual Reinsurance Company, paid on the Fauer claim but subsequently sought to have Travelers pay half, hence the importance of the commissioner’s ruling, which left Travelers–the workers comp carrier for the volunteer fire department–responsible for paying one-half the amount to Grinnell.
Then came the turnabout:
“Traveler’s appealed but the commissioner ruled the timing of the notice to Fauer’s pager ‘was not critical to the determination of coverage … because Justin has been summoned to duty as a volunteer firefighter by the circumstances themselves.’
“The commissioner determined that failure to allow volunteer firefighters to call themselves to duty would have the ‘absurd result of deterring them from immediately rendering assistance upon encountering an emergency.’ ”
Traveler’s sought a review by the court and a district court rejected the commissioner’s ruling. “It concluded a volunteer firefighter cannot be summoned to duty by circumstances, but can only be summoned by the fire department or some other official channel.”
An Aug. 19 piece in a Southwest Iowa news outlet picks up it from there:
A chilling effect on volunteer response?
“So, where does that leave the countless volunteer firefighters spread across southwest Iowa?
“ ‘It’s an interesting ruling,’ said Council Bluffs Fire Chief Alan Byers, himself a former volunteer firefighter.
“ ‘The expectation for firefighters, if you’re paid or a volunteer, is that if you come upon an accident or fire, you’ll help,’ Byers said. ‘What if you’re driving down the street and see smoke from a house? You call 911 and try to make a difference and get hurt or worse, die, there’s no workers compensation there. It’ll make firefighters think differently in those instances.
“ ‘If (volunteers) get hurt or worse and can’t get back to their day job, workers comp is all they have.’
“Byers said he’s seen the ruling generate discussion across the state on message boards, through e-mail and in discussions.
“ ‘I think a lot of people were saddened by the decision,’ he said.
“Both Byers and Jeff Theulen, the Pottawattamie County Emergency Management Coordinator, Treynor assistant fire chief and a 30-year volunteer firefighter, speculated that the state Legislature would examine the issue.”
It’s very sobering to realize how the actions of one or two individuals can effect change that potentially affects thousands of other people.
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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:
