Ten popped for workers’ comp fraud in Ohio
Encompassing slightly more than 1,400 square miles, Herkimer County is in central New York state in the foothills of the Adirondacks.
It’s also a hotbed of recent workers’ comp litigation.
Sanitation worker pleads guilty on double-dipping
According to a May 6 account in the Utica Observer-Dispatch, sanitation worker Dennis J. Clark Sr., 52, of Paris, NY, pleaded guilty in Herkimer County Court to insurance fraud and was ordered to repay $42,600. He also was sentenced to five years’ probation.
According to the Observer-Dispatch, Clark “began to receive the benefits in 2001 after he was hurt while working as a sanitation engineer for a local garbage collection company, officials said. But he later worked for another garbage collection company while continuing to receive the benefits between 2005 and 2009.”
Even though the case demonstrates the risks, including potential jail time, of trying to game the system via workers’ comp fraud, it’s minor in dollar amounts compared a recent lawsuit between Herkimer County and three cities within the county. The case was heard by a jury in a neighboring county.
Three municipalities ordered to pay nearly $4 million to county
According to a May 16 account at a Utica station, “Three Herkimer County municipalities have been ordered by an Oneida County jury to pay the county over $4 million in back workers’ compensation benefits. The ruling comes after a six year lawsuit between the county and the municipalities.
“In 2005 Herkimer County municipalities withdrew from the Herkimer County Workers’ Compensation Self-Insurance Plan because of escalating costs. The plan was formed in 1956.”
However, 170 cases remained outstanding, which fell to the county. So the county formulated an “Abandonment Plan” that essentially gave municipalities that had withdrawn the choice to pay a withdrawal fee or make up their past portions on an annualized basis.
Subsequently, the Villages of Herkimer and Ilion and the Town of Frankfort sued Herkimer County over the Abandonment Plan, citing multiple complaints of invalidity. The county counter-sued and heard on May 11 the jury’s verdict, which directs the Village of Herkimer to pay $1,617,528, the Town of Frankfort to pay $1,369,137 and the Village of Ilion to pay $1,100,546.
BWC probe results in 10 pleas or convictions in Cincinnati area
According to a May 16 piece in the (Greater Cincinnati) Business Courier, “A total of 10 individuals, including three from the Greater Cincinnati area, were convicted or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during April.”
The convictions stemmed from investigations conducted by the Ohio Bureau of Workers’ Compensation (BWC) Special Investigations Department (SID).
In a BWC release, Administrator/CEO Stephen Buehrer said, “BWC continues to mount an aggressive attack on fraud in order to protect Ohio’s workers’ comp system and keep employers’ premiums down. While there unfortunately never seems to be a shortage of cases to investigate, our agents remain persistent in their efforts to track down fraud and put an end to it.”
The BWC release also lists highlights of the fates of the miscreants dealt with in April; following is a sample of their sampling:
Failure to obtain/maintain: 4th-degree felonies
Joseph D. Reed (Castalia, Sandusky County) pleaded guilty to two counts of failure to obtain/maintain workers’ compensation coverage, both fourth degree felonies. A claim was filed against the policy of Reed’s company, Reed’s Supply, after he failed to submit payroll reports but continued to operate with lapsed coverage. During the investigation, payroll reports were obtained and used to calculate premiums and penalties owed in the amount of $33,261.94. On April 26, Reed was sentenced to five years of community control and ordered pay the costs of prosecution, complete 50 hours of community service and make restitution through a payment plan with BWC.
Attempted forgery of certificate
James Slones (Millersport, Fairfield County) pleaded guilty to one count of attempted forgery for falsifying his BWC certificate of coverage in order to make it appear to a potential client that he had the workers’ compensation insurance coverage required to perform remodeling work on their home. BWC began an investigation of Slones, owner of Reed’s Supply, after receiving a tip that he altered his BWC certificate. A client of Slone’s was required to submit proof to a lender that the selected contractor (Slones) had valid BWC coverage to complete home remodeling work. SID discovered Slones did alter a BWC certificate belonging to another business. That business owner confirmed he previously provided a copy of his BWC certificate to Slones, who changed the business name and provided it to his client. The lender would not have approved the loan for the remodeling job if it was discovered Slones did not have valid BWC coverage. A judge sentenced Slones April 21 to 45 days of jail suspended and ordered him to pay court costs.
Operating with lapsed coverage: 5th-degree felony
Charles Thoerner (Cincinnati, Hamilton County) pleaded guilty to one count of attempted workers’ compensation fraud, a felony of the fifth degree, for operating with lapsed coverage. Thoerner, owner of Montgomery Flooring, allowed his policy to lapse and during that time accumulated nearly $20,000 in claims resulting from workplace injuries. SID met with Thoerner at his business and advised him that the policy was lapsed. He subsequently failed to submit the missing payroll reports and was served with a subpoena for the information. In October 2009, Thoerner submitted the payroll records but failed to remit payment or request a payment plan. Sentencing is scheduled for May 25, 2011.
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: