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Los Angeles Employer Workers' Compensation Law Blog

Can you detect workers’ compensation fraud before it is too late?

Workers’ compensation is an excellent resource for your employees to use if they are injured on the job. It is also valuable to you as the employer because you can protect your company and its reputation if an accident occurs. However, sometimes your employees may be tempted to take advantage of workers’ compensation benefits. Your vigilance can help you recognize fraudulent behavior before it is too late.

The HR Daily Advisor suggests some helpful precautions you can take to reduce workers compensation fraud from occurring in your establishment. Here are some of the things you can do:

  • Properly train management: Your entire human resources department and all other management who may deal with claims, should be thoroughly trained on recognizing fraud. They should all understand the protocols to follow before awarding compensation of any kind.
  • Designate a medical provider: Create a strong relationship with your pre-determined medical provider. Establish regulations that will guarantee that all injured employees have to see them for medical care.
  • Investigate all claims: Even if one of your employees seems to be telling a legitimate story with noticeable evidence to back it up, always conduct an investigation of your own. Determine that timelines match up, dates are correct and any witnesses have been interviewed.
  • Establish a clear policy: Make sure that each of your employees understand how the workers’ compensation policy functions. Encourage them to be forthright about any concerns and to immediately report any injuries. Implement programs aimed at helping your employees to recover and resume their responsibilities as soon as possible.

How does an investigator uncover fraudulent workers’ comp claims?

When an employee reports an on-the-job injury in California, you may assume that your workers’ compensation insurance will cover the costs of the medical bills and a portion of the lost wages. However, according to Property Casualty 360, false claims raise the cost of policies, so any red flags may warrant an investigation.

An examiner may recommend further investigation of a claim if there is record that the employee has pre-existing health problems, family or money issues, or is in a rush to settle the claim. Other indications that there may be fraud include injuries that occur in a situation that your employee should not have been in or injuries that are much higher than the accident conditions would signify. A lack of witnesses or refusal to provide evidence of the loss may also generate suspicion of the need for further examination.

Goodwill facing multiple safety violations

California employers large and small can come under fire from current employees, former employees and others for alleged safety violations at any time. In some cases, these allegations may even be escalated to and involve the Occupational Safety and Health Administration. When this happens, it is important for companies to remember that they have the right to defend themselves against what may not always be accurate accusations that could threaten the trust of their brand reputations.

The well-known and trusted company Goodwill is one example of a business that is facing this level of scrutiny today in part due to allegations made by a man who used to work for them in one of the northern California facilities. The allegations came after an accident at the location in which another employee died. Few details of that incident are known other than the man was reportedly crushed.

Types of employee fraud in workers' compensation cases

As an employer that is required to either carry workers' compensation insurance in California or to be essentially self-insured, you have the right to know and trust that any claims that are made are legitimate. Unfortunately this is not always the case as employee fraud when it comes to workers' compensation is all too common. According to the California Department of Insurance, it is believed that this type of fraud may cost upwards of $3 billion annually in California alone.

Because employees are not required to prove that an employer was actually at fault for an injury in order to make a claim for workers' compensation benefits, the temptation to try and cheat or beat the system can be great. Many people may actually believe it is easy to do this. It may entail exaggerating just how bad a particular injury really is or it may even entail a person making up an injury that never really happened altogether. Even medical professionals like doctors, chiropracters and physical therapists may take part in defrauding the workers' compensation system through unethical billing or other practices.

Man arrested for receiving workers comp benefits while working

Oftentimes, the prevailing attitude amongst many workers in Los Angeles is that they are entitled to workplace benefits. Given the effort they put into their careers, they may feel justified in occasionally embellishing the details of an injury in order to obtain more time off of work or collect a little more in workers’ compensation benefits. The danger in this line of thinking is that it may persuade some to attempt to “game the system,” continuing to collect benefits while not having to return to work.

 People engaged in such activity may be forced to learn the hard way that such action can result in serious consequences. A New York man is currently learning that lesson after having been arrested for workers’ compensation fraud. He currently faces criminal charges which include insurance fraud and grand larceny. His predicament stems from having lied on work activity questionnaires in 2012 in which he said he was not currently involved in any type of work. He had supposedly not been working while collecting worker’s compensation benefits due to wrist injury he suffered while working as a law enforcement officer in 1998. It was later discovered that at the time he completed the questionnaires, he was actually employed at a local race track while still receiving his benefits.

Understanding your rights under the Paid Sick Leave Law

It is well known that a healthy workforce is a productive workforce, which is why you may have no issue with sick employees choosing to not come in to work in Los Angeles. Yet the issue of paying employees while they are out on sick leave can often be a tricky one. An amendment to the Healthy Workplace Healthy Family Act of 2014 made it mandatory for employers in California like yourself to offer paid time off to sick employees (or those caring for sick family members). Yet based off feedback we here at Sacks and Zolonz, LLP have received from clients, there is still much confusion surrounding this new “Paid Sick Leave Law”.

According to the Department of Industrial Relations for the state of California, the paid sick leave law requires that all employees be given one hour of paid leave for every 30 hours worked. This includes part-time and temporary or seasonal employees. That means that an employee can potentially accrue over nine days of paid sick leave each calendar year if he or she works a traditional 40-hour work week.

The risks of not carrying workers’ compensation insurance

As an employer in California, you are required by law to have workers’ compensation insurance to protect yourself and your employees. If an employee does get injured and it is discovered you do not have insurance coverage, you could face serious penalties. At Sacks & Zolonz, LLP, we understand the complications that can arise in such a situation. So you can avoid penalties and other issues, you must understand the law and what it requires of you.

Workers’ compensation requirements for employers vary from state to state. California is rather strict, according to the State of California Department of Industrial Relations, requiring all business owners who have at least one employee to carry insurance coverage. If you do not have insurance and an employee get hurts, you will be required to pay all related expenses. Your employee may also sue you. If you fail to pay, the employee may seek compensation through the state-ran Uninsured Employers’ Benefit Trust Fund. The state may pursue your assets and collect compensation from you to fund the UEBTF benefits your employee collects.

Common OSHA violations highlight importance of workplace safety

In Los Angeles, employers must make sure that their workplaces diligently adhere to all applicable safety standards. Failure to do so can not only result in lost revenue thanks to injured employees, but it can also bring about serious legal reprisal. Here at Sacks & Zolonz, LLP , we’ve seen the harm that can befall an employer who forgoes proper safety measures. That’s why we counsel our clients on how they can prevent violations and ensure proper safety measures are upheld at all times.

The National Safety Council highlights some of the more common violations taking place in recent years as cited by the Occupational Safety and Health Administration (OSHA). For instance, scaffolding came in third among the top ten violations. Scaffolding design is crucial in worker safety, and OSHA found issues with design and application of scaffolding on work sites. Chemical hazard communication is the second most common violation, which concerns the proper handling and storage of dangerous chemicals during the course of work.

How traumatic brain injuries occur

Traumatic brain injuries are a somewhat common occurrence in workplaces across California and throughout the United States. These injuries occur in a wide-range of industries, from offices and schools, to construction sites and warehouses. In fact, the Centers for Disease Control and Prevention report that traumatic brain injuries are contributing factors in at least 30 percent of all injury deaths. Brain damage is one of the most common workplace injuries, causing serious dysfunction, loss of production and long-term disabilities.

Brain injuries can occur when a falling object strikes workers on the head or when employees slip, fall and hit their heads. Any significant blow to the head can cause the soft brain tissue to hit the hard skull bone. This forceful impact can result in brain bleeding, bruising and inflammation of the tissue. In some cases, signs that a brain injury has occurred may appear immediately after the accident. In other situations, however, people may not know that they have a brain injury until days or weeks after the incident. Whatever the case, immediate medical attention is needed to maximize the outcome of the case.

What is America’s most common workplace injury?

If you work in California’ entertainment, mining, automotive or construction industries, among a multitude of others, you run the risk of suffering what the California Health Care Foundation calls the most common work-related injury in the nation: hearing loss. Costing the nation an estimated $242 million every year in workers’ compensation costs, hearing loss is a highly pervasive problem, but critics have differing opinions about what to do to address the growing issue moving forward.

Some believe additional measures must be taken to enhance your safety and that of your coworkers while at work. The U.S. Department of Labor, for example, is seeking ideas for new technological innovations that would minimize noise exposure for you and your colleagues in the workplace. Others argue that the problem is not so much a lack of protective gear and technology in the marketplace, but rather, that companies and employees do not always rely on them and take necessary measures to stay protected on the job.

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