Illinois’ workers’ comp system finds new way to make news: deny a cheap headset

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Longtime California residents may be wondering “What the heck happened to our state?”

Who could blame them, given one public scandal after another, for years on end?

Funds voted toward California fraud probes

A recent piece in the North County Times addresses worker’s comp fraud:

Funding to fight workers’ compensation fraud slightly increased this year despite a tough state budget climate and a limp economy.

On Tuesday, State Insurance Commissioner Dave Jones recommended a grant of $4,861,584 to investigate and prosecute workers’ compensation fraud for San Diego County’s district attorney office. That’s about $36,000 more than what the county received last year, according to Dave Lattuca, the chief of the insurance fraud division for the San Diego County District Attorney’s Office.

Riverside County will receive a grant of $1,463,732.

This year’s grant to San Diego County is the second-highest funding level recommended to a district attorney’s office in the fiscal year that began July 1, according to Jones’ office.

The state urged $5.7 million for Los Angeles County to fight workers’ compensation fraud —- the most of California’s 36 counties. Riverside County ranked No. 6 with its award.

In total, the state insurance commissioner announced $32 million in grants to fight fraud throughout California —- slightly higher than last fiscal year’s total of $31 million, according to Dave Althausen, a spokesman for Jones.

Revised contract: a ‘brawl’ between providers and carriers?

A July 11 report from Insurance Journal calls into question whether injured workers are the focus that they should be:

A controversy in the California workers’ compensation market over a revised provider contract threatens to erupt into an all-out legal brawl as doctors for injured workers and applicants’ attorneys take aim at the state’s largest carrier.

The nonprofit State Compensation Insurance Fund, California’s carrier of last resort, has drawn intense criticism over its newly implemented medical provider network (MPN) contract.

State Fund, as the carrier is known, has stood by the recent changes, saying patients will benefit from the contract revisions, all of which it says were made following state law.

However, the California Society of Industrial Medicine and Surgery (CSIMS) and the California Applicants’ Attorneys Association (CAAA) decry the contract as fraught with legal deficiencies and ethical issues that pose harm to employees at workplaces operated by State Fund’s roughly 180,000 policyholders.

CSIMS, which represents doctors who treat workers’ compensation patients, described the State Fund MPN contract as a “heavy-handed” attempt at contract medicine.

In expressing the organization’s “grave concerns,” CSIMS Executive Vice President Carlyle Brakensiek said the contract compels doctors to restrict injured workers’ right to treatment.

Illinois’ system back in the news

Regular readers know we’ve been covering the scandal-ridden Illinois workers’  comp system; among our more recent updates was this post about the Menard prison facility.

More recently, the Belleville News-Democrat has done it again, that is, scooped every other news organization, this time about a worker who was denied a simple set of cheap headphones. Gotta tell you, if I were the local, nearby AP Bureau Chief, I’d assign a reporter to this Illinois workers’ comp agency. The BND.com folks are likely to win beaucoup awards for this ongoing coverage.

OK, back to news from BND.com: “Prison clerk’s lack of headset costly to taxpayers — $128,424 in medical bills so far”:

Prison finance clerk Angela Grott complained to her supervisors that file drawers at her work station jammed, the computer keyboard was set too high and her chair was hard to move, according to state workers’ compensation records.

While Grott stated these factors contributed to pain in her neck and shoulder area, she testified during a Dec. 14 workers’ compensation hearing that it was primarily the lack of a headset for the telephone at her desk at the Menard Correctional Center that caused severe pain. She said this pain worsened because, not having a headset, she was forced to hold the telephone receiver in the crook of her neck for hours while typing on a keyboard.

Grott’s workers’ comp claim so far has resulted in a $128,424 medical bill that must be paid by public money because Illinois is self-insured.

While headsets were readily available close to the prison — one currently sells for $9.96 at the Chester Walmart — Grott testified at the hearing that her supervisors repeatedly rejected her requests to provide one or to ergonomically alter her work station.

Reached at her job at the prison, Grott said, “I have no comment.”

A spokeswoman for the Illinois Department of Corrections said officials are waiting for headsets to arrive. They will then be given to any employee who wants one.

As you might surmise from the preceding, workers’ comp cases can get very involved in government problems that have nothing to do with obtaining prompt, thorough treatment for an injured worker.

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

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:

Workers compensation basics

Injury on the job

First of two parts on fraud in workers’ comp cases

Fraud arises in all human endeavors, in all shapes and sizes, every flavor and scent.

Accordingly, it’s no surprise that workers’ compensation fraud runs the gamut from simple to elaborate, from ordinary to exotic. For example, a Jan. 18 brief from New York state describes a “Port Jervis woman [who] was arrested by Monticello Police for submitting a workers’ compensation claim with allegedly false information about her mileage and prescription costs in order to collect $2,057 in money to which she was not entitled.

“Danielle Devore, 33, was charged with felony insurance fraud in the fourth degree, falsifying business records in the first degree and grand larceny in the fourth degree.”

Another fairly simple case: snow plow buried him

A Jan. 25 piece describes a Connecticut case in which “Richard Bates, 55, pleaded guilty in New Hartford Town Court to a misdemeanor charge of second-degree offering a false instrument for filing and was fined $1,000, prosecutors said.” He also paid about $6,500 in restitution. Apparently, he got caught working at a snow plow business after telling authorities he couldn’t work due to injuries received at a different job.

Dont’ mess with the feds

Another case, detailed in this Jan. 27 article, is a about a guy who got nabbed also doing snow removal work, plus lawn care. However, the employer with the alleged bogus workers’ comp claim was the U.S. Postal Service: “Former U.S. postal employee Norman J. Motko, Jr., 61, of Cleveland, was sentenced to five months in prison and must pay $116,980.34 in restitution after pleading guilty to worker’s compensation fraud, according to U.S. Attorney Steven M. Dettelbach.

“U.S. District Judge Lesley Wells also sentenced Motko to three years of supervised release following his prison term.”

Motko got popped for taking benefits from Dec. 2004 until Feb. 2008. The case was investigated by the Inspector General’s office of not only the USPS but also the Labor Department. Not to say state authorities are lax, but those who would game the system should recognize that a federal investigation is going to be played hardball:

“The U.S. Postal Service pays over $1 billion annually in workers’ compensation costs,” said Eastern Area Special Agent in Charge Elizabeth A. Farcht, U.S. Postal Service Office of Inspector General.

“The majority of postal employees who collect federal workers’ compensation benefits have legitimate claims due to on-the-job injuries and are truly unable to perform any work. A small percentage, however, abuse the system and cost the Postal Service millions of dollars in fraudulent claims.”

“This conviction and sentencing should put those who choose to defraud the system on notice that Special Agents with the USPS Office of Inspector General will aggressively investigate these cases, and present them to the U.S. Attorney’s Office for criminal prosecution when appropriate.”

When the going gets weird

Stepping up the ladder in terms of complexity, this next case still involves an injured worker, but now we’re really in the shadow realm. We cover plenty of cases involving law enforcement officers and firefighters, but this story smacks of espionage and the dark corners of police investigating police.

From the Southeast Texas Record, this Jan. 18 article starts off thusly: “A former Brazoria County sheriff’s deputy claims that he was terminated in retaliation for filing a workers compensation claim after being injured on the job, recent court documents say.

“In a lawsuit filed Jan. 10 in the Galveston Division of the Southern District of Texas, Mark Wiggins accuses the Brazoria County Sheriff’s Department of  ‘using false accusations of misconduct to concoct a pre-text to terminate him.’

“The complainant insists that the law enforcement agency dispatched him to a public intoxication call two years ago as a way to get him fired, the suit argues.”

In other words, Wiggins is saying that once he filed his workers’ comp claim, the sheriff’s department set him up.

According to a Jan. 11 post at the Houston edition of Examiner.com, Wiggins first filed an injury report in 2008 after what he described as being attacked by a bull–certainly a possibility for almost any deputy in Texas. For that matter, it’s not outrageous to posit a situation in which even a metro police officer might engage a livestock encounter, given the blend of city/rural landscapes; high-profile, pro-circuit rodeos; big-time fairs; and small-town annual celebrations.

The Texas reality

Regardless, the daily reality is that officers of a sheriff’s department are more likely to deal with rural, or out-of-town, predicaments than are city police. Basically, police deal with problems inside the city limits, and sheriff’s departments deal with the rest of the county.

Now, back to the Southeast Texas Record, about the second claim:

The most recent injury occurred on Aug. 8, 2009, when Wiggins attempted to make an arrest after a disturbance call. He reported the injury to the sheriff’s department the next day in an effort to receive medical treatment by way of workers compensation insurance.

After filing the necessary documentation, a dispatcher called Wiggins to assist the West Columbia Police Department with an allegedly intoxicated person on the San Bernard Bridge.

“Unknown to the plaintiff at the time, this call was an invitation to a trap set by the Brazoria County Sheriff’s Department so that it could have a pre-text for firing the plaintiff,” the original petition says.

It further explains that Wiggins “performed his duty properly by concluding he should arrest the person for public intoxication as opposed to driving while intoxicated because he personally did not see the suspect driving the car.”

The arrest reportedly angered Chief Deputy Jeff Adkins, who demanded Wiggins “resign or he would never work in law enforcement again,” the suit says. In response, the complainant declined to resign under the threat.

Anyone with questions about the complexities about workers’ comp cases should read each of these linked stories, as a way to gauge to all the legal questions that can arise.

In the next installment, we’ll pursue more cases, cases that move from injured workers’ claims into alleged wrongdoing by medical providers and insurance carriers.

Stay tuned.

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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

Filing a claim

We cover workers’ comp fraud from all angles. Sometimes the point is to help workers be alert to scams that employers may try to pull on injured workers. Sometimes the point is to remind everybody that workers’ comp law can be minefield for people who don’t have a competent, experienced attorney. Sometimes the point is that workers who scam the system can get in big trouble, too.

Earlier this month, the San Francisco Chronicle ran a short piece about a big scam.

‘One of the largest cases in California history’

“A Laguna Hills roofing contractor has been sentenced to 10 years in state prison,” says the Chronicle, “in what prosecutors are calling one of the largest workers compensation insurance fraud cases in California history.”

According to the Los Angeles Wave, “Michael Vincent Petronella was also ordered to pay $500,000 in restitution and a $500,000 fine, amounts that prosecutors said were far too low, given that he had committed a fraud that they said netted between $11 million and $35 million.

“A jury found Petronella guilty Feb. 11 of 33 felony counts of insurance fraud with a sentencing enhancement for aggravated white-collar crime of more than $500,000.”

Under-reporting payroll

The Chronicle account says prosecutors described a scam that Petronella and his wife, Devon Lynn Kile, began in 2000 by taking out workers’ comp insurance “for their multiple companies” and subsequently turning in 42 fraudulent claims for workers who were not insured, meanwhile failing to report $29 million worth of payroll in an attempt to avoid paying premiums. “The scheme,” says the Chronicle, “resulted in the state incurring more than $253,000 in uncovered injured worker claims and insurance premium losses in the millions.”

According to the account in the Wave, the scheme was so complicated that “Orange County Superior Court Judge Richard King held hearings all . . . week to determine what restitution Petronella would have to pay his victims and what punishment he deserved.”

A ‘defiant’ defendant

The demeanor of his co-defendant wife is not mentioned in either piece, but according to the Wave Petronella was not only not remorseful but also bitterly challenging.

A defiant Petronella, at times raising his voice, angrily blamed State Compensation Insurance Fund officials for his dilemma. He claimed he was a “safety nut,” and received awards for job safety from regulators and that the insurance fund officials had the responsibility to bring the discrepancies to his attention.

“We had a safe working environment and they didn’t reward us for it,” Petronella said. “They punish you for getting around the insurance laws they try to ram down your throat… You’re in a hostage situation. It’s either their way or the highway. They won’t spend 15 minutes to help you understand their business.”

Petronella’s attorney said the man did not report to proper number of employees in an effort to make up for what he considered “inflated insurance premiums.” However, doing so caught up with the couple because the number of claimed injuries attracted attention based on reporting too-few employees.

The wife is due to be sentenced soon but is expected to angle for a plea deal, presumably for having a smaller role in the scheme, which came to light in 2006 when a worker fell from a roof. He was listed as an employee of one of Petronella’s businesses–but was not covered by workers’ comp. The couple were arrested in 2009.

Home repairman faces four years

A less flamboyant case reminds us that even “run-of-the-mill” workers’ comp fraud can result in serious jail time.

A Nov. 5 press release from the New York State Insurance Department says, “A Sullivan County man accused of running a home repair and painting business while collecting workers’ compensation benefits was arrested Wednesday, the New York State Insurance Department reported.

“State police arrested Homer Spangler, 54, of Kenoza Lake, following an investigation by the Insurance Department’s Frauds Bureau.”

So, yes, the authorities really do have investigators who go out and check up on this stuff.

A re-post at workcompwire.com says, “Spangler is accused of fraudulently accepting $7,470 in benefits after submitting documents to the New York State Insurance Fund falsely stating that he was physically unable to work.

Caught by routine check up

“An investigation was begun after Spangler was discovered running his own business last October during a routine check by the Insurance Fund. He started collecting permanent partial disability benefits after suffering a job-related injury in 1988 while working for a glass company.”

After arraignment, Spangler was released on his own recognizance–but he faces up to four years in prison for the two felony charges, “workers’ compensation fraud and offering a false instrument for filing.”

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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

Filing a claim

A former Department of Correction officer in Massachusetts has been arraigned on a charge of fraudulently collecting workers’ comp benefits, while a motorcycle police officer in Montgomery, AL, is being denied workers’ comp benefits because when he was injured in a funeral procession he wasn’t on the city clock.

Originally injured in 2008

According to an Oct. 27 article at SouthCoastToday.com, John Cloutier, 45, of East Freetown was hurt on the job in Freetown in 2008 and began collecting benefits and continued to do so until March 2010.

“During this time, Cloutier allegedly repeatedly told medical providers that he could neither stand for long periods of time nor do any strenuous activities that could potentially aggravate his injury.”

But the attorney general’s office got a tip that competed in two half-marathons and one full marathon in 2009.

‘Never disclosed marathons’

“Authorities allege Cloutier never disclosed to correction officials or any of his doctors that he trained or ran in any of these races or engaged in any kind of strenuous exercise.

Calaculations: ‘more than $56,000′

“Investigators subsequently calculated that Cloutier fraudulently collected more than $56,000 from the state after January 2009.

“The matter was then referred to the Attorney General’s Office for prosecution.”

Cloutier pleaded not guilty at the Oct. 26 arraignment  and was released on his own recognizance, awaiting a pre-trial conference in December.

Motorcycle officer hurt on escort job then ambulance turned over

In Alabama, says the Montgomery Advertiser, Cpl. David Brown “was critically injured when his motorcycle was hit by a car while he was escorting a funeral procession Sept. 11. Afterward, the ambulance carrying him turned over on the way to the hospital.”

Brown has, however, received some benefits, including medical disability.

Lawsuit details injuries

His family has filed a lawsuit seeking workers’ comp benefits. “The lawsuit states Brown has suffered permanent disability, including ‘a broken jaw, cracked pallet, shaken baby syndrome, bleeding on the brain and multiple infections in his amputated limbs.’ Since the accidents, he has undergone numerous operations, including the amputation of his right leg above the knee and his left arm above the elbow.”

Mayor Todd Strange said Brown last week received medical disability retirement “and will receive retirement benefits for the rest of his life.” He said Brown has received paid leave time and other benefits.

‘Knowledge of the city’

According to the Advertiser, “The lawsuit states that Brown’s duties that day were done ‘with permission, knowledge and approval of the City of Montgomery Police Department and were performed for the benefit of the department and citizens of Montgomery.’

“Brown’s brother, Todd Brown, said Tuesday that the family wants the city to declare the police officer on-duty that day.”

The mayor said he wishes he could help more but because Brown was off duty and performing under contract with the funeral home, there’s nothing he can do.

” ‘I’d love to be able to say “yes” (to the claim), but I don’t have that prerogative,’ [the mayor] said.

Using city equipment

Strange concedes Brown was using city equipment on the escort job but maintains that doesn’t help Brown’s case for city-based workers’ comp.

“Brown was using city equipment when the accident occurred, but Strange said that would not have an impact on the family’s claim. He said police officers take their equipment home with them in Montgomery, and state law allows for the use of police equipment while officers are working private, off-duty jobs.”

An official with the Alabama Department of Industrial Relations said “the circuit judge has the exclusive discretion on whether to grant the workers’ compensation.”

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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

Filing a claim

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:

Workers compensation basics

Injury on the job

Filing a claim