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Los Angeles Employer Workers' Compensation Law Blog

Employee fraud: California man faces charges of insurance fraud

Some California workers who have financial struggles attempt to use the state's worker's compensation system to boost their incomes. Employees sometimes fake injuries or exaggerate the severity of workplace injuries. In other cases, claims may be filed for injuries that are not work-related. Such employee fraud can be costly to employers because it will cause higher insurance premiums. This can have a severe impact on the profits of the company.

A 23-year-old man from Hemet was arrested in November after an investigation that followed a worker's compensation claim that he filed in Oct. 2012. Upon suspicion of employee fraud, the San Bernardino County District Attorney's Workers' Compensation Insurance Fraud Unit launched an investigation. The man was arraigned on a recent Thursday on felony charges of insurance fraud.

Employer defense: Worker's claim of PTSD rejected for benefits

Unfortunately, there are often reports of cases in which employees in California and elsewhere take advantage of the system by filing fraudulent claims. Sometimes the validity of the claims are difficult to challenge, and experienced employer defense may be required to protect the business owner from unnecessary increases in insurance premiums. A case that went all the way to the special workers' comp branch of the Supreme Court in another state demonstrates just one of the tactics of some workers filing fraudulent claims.

The worker who filed the claim was a nurse manager in the employ of a mental health management concern. In 2012, his employer required him to attend a conference that would help him in his task of determining patients' suitability for admission to the psychiatric unit. The worker claims that the session leader at the conference told the attendees to picture themselves in the positions of patients when asking them about any history of physical, emotional or sexual abuse.

This dancing hamster is guilty of employee fraud

Workers' compensation is an important protection for workers who are injured while on the job. These benefits can help families avoid devastating financial consequences that can follow a serious work-related injury, and can give workers the ability to focus on getting better and getting back to work, which is a goal shared by both employees and employers. However, there are many cases in which California workers take steps to defraud both their employer and the system. Employee fraud is a serious issue, and one that drives up costs for everyone, including the rest of the company's workforce.

An example is found in a recent case involving a professional dancer. The 29-year-old California man works on commercials and as a back-up dancer for live performances. In 2010, he was working on a project with John Cossette Productions, Inc. when a piece of ceiling fell and struck him during a sound check. As a result, he began collecting disability and workers' compensation benefits, which continued for a period of one year.

Employee fraud: Trucker works while banking disability benefits

Some business owners in California have experienced situations in which they suffered the financial consequences of fraudulent workers' compensation claims. Employee fraud is prevalent, and, to protect themselves, employers need to know what to look out for when injury claims are assessed. A man in another state was recently sentenced in a common pleas court for defrauding the insurance system.

Court documents indicated that the man received workers' compensation benefits after he suffered an injury that allegedly caused him to be permanently disabled. However, investigators determined that the man was driving trucks for a logistics company under a business name as an independent contract driver. All the while he was apparently also receiving monthly workers' compensation benefits for permanent total disability.

Workers' compensation fraud issues that can lead to litigation

When it comes to workers' compensation, California company owners will likely face legal issues at some time. Not only do they have to work through the insurance-related legal requirements for businesses, but they may also have to deal will fraudulent workers' injury claims from time to time. The insurance system in another state reported that convictions were obtained for nine individuals who committed workers' compensation fraud.

Some of those convicted included several business owners whose workers' compensation insurance policies had lapsed -- one as long ago as 1994. Others had failed to obtain insurance to cover employee injuries, falsely classifying their workers as contractors or subcontractors to avoid paying insurance premiums. Although workers in such circumstances might be awarded benefits, the compensation system will seek to recover those funds from the employer.

Fatal work accident with lathe may require employer defense

Every work environment comes with its own risk of injury regardless of the industry. Even those simply doing office work in California may end up hurting themselves in one way or another. However, workplaces that require employees to use heavy machinery generally have a higher chance of a serious workplace accident occurring that could result in an injured worker claim. Launching an employer defense may be required in certain instances.

This may be exactly what is required after a recent workplace accident at Viking Blast & Wash Systems. The incident occurred when a 24-year-old worker was using a lathe one morning in early January. Somehow, the part of the lathe the man was working on ended up becoming bent. This caused the lathe to strike the man in the head, killing the man instantly.

How can employers identify potential employee fraud?

As long as workers' compensation insurance covers employees, there will be those who take advantage of the system. It is often suggested that California employers be aware of potential employee fraud and abuse of privileges, and learn how to handle such problems if they arise. The failure to understand the methods used to defraud the workers' compensation system can result in unnecessary increases in insurance premiums and a negative impact on company profits.

A recent case in another state is a good example of how employee fraud can be committed. A 54-year-old former police officer reported a knee injury in March 2011, claiming to have suffered the injury while on duty. Although his injury was confirmed by a doctor and reported to his employers in the appropriate manner, investigators allege that the injury did not occur in the line of duty. The officer retired from the police service in 2012 but continued to receive benefits payments for his injury.

Plastics company faced with employer defense challenge

Prevention is the key to maintaining a safe workplace and avoiding injuries to workers and employees. This is why there are rules that regulate the safety standards of every industry in California. However, sometimes an employer ends up not meeting these standards for one reason or another. This can result in serious legal problems that could require an employer defense strategy to deal with citations issued by work safety authorities.

This is what Fukuvi USA Inc. is now facing after a recent workplace accident that occurred in early October. Following the incident, the Occupational Health and Safety Administration (OSHA) investigated the accident at the plastic extrusion company. The investigators claim to have discovered ongoing safety violations at Fukuvi.

Workers' compensation: Conviction follows lack of insurance

Business owners in California are required to provide workers' compensation coverage for all their employees. To avoid criminal prosecution, most company owners comply with this law. Business executives may want to ensure their policies don't lapse because the financial consequences of the lack of insurance may be severe.

An employer in another state recently convicted of a misdemeanor and received a suspended sentence. In addition, he was ordered to pay almost $4,000 in restitution and fines of $400 for neglecting to renew his workers' compensation insurance after it lapsed. It was reported that the business owner paid wages to employees but claimed that they were all subcontractors. The Bureau of Workers' Compensation apparently worked with the company owner and allowed him to pay past due insurance premiums. However, he apparently continued to declare the workers as subcontractors.

Concrete pump malfunction can cause injured worker claim

Most of the time, those working in construction are generally safe from injury or harm. Nevertheless, compared to many other occupations in other industries, construction workers tend to have a higher chance of being injured in a workplace accident in California. This can easily result in an injured worker claim which could require an employer defense strategy.

One employer may be facing this problem after a recent industrial accident at a construction site at a local school. Apparently, somehow a concrete pump ended up blowing up in a construction worker's face. The pump was being utilized near the back exit of the school property where the soccer and tennis complexes are located. The workers were using the equipment to pump concrete into the tennis complex.

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