When you look to categorize employers in Workers' Compensation most fall into one of two categories: insured and self -insured. They are the "good" employers since they took the steps to take care of their injured workers. Yet there is another category consisting of the despised and reviled employers who have no coverage of any kind in place: uninsured employers. The common perception is that they are this way (uninsured) out of an intention to save a buck. In our California legal system these uninsured employers are formally referred to as "illegally uninsured" and they are statutory criminals. They are suspect in their testimony (as recounted by some in our judiciary) because, after all, they are trying to protect themselves from their own misfeasance by not procuring the mandatory insurance coverage. Their employees do not have the constrictions or benefits of a medical provider network, and utilization review does not exist for them. Injured workers are free to seek whomsoever they wish to treat them and there are no formal checks on the amount or nature of the treatment, contrary to the way it exists with insured employers and utilization review of treatment.
Authorities charged three California workers with insurance fraud for claiming that workplace injuries were preventing them from returning to work. This includes a roofer, housekeeper and lab worker. While all three claimed debilitating injuries, there are allegations that all three engaged in physical activity going beyond their restrictions. At the same time, all three claimed thousands of dollars in benefits from insurers.
California readers may be aware of the lawsuit facing former NFL player Brad Culpepper. The football veteran spent nine years playing in the NFL, but he claimed that injuries he sustained in his capacity as a football player left him partially disabled. He is currently being sued for workers' compensation fraud, and he recently spoke to the media concerning accusations that he bilked an insurance company out of $175,000.
Workers' compensation fraud is a crime in California and can have serious consequences for an employer who is the target of the fraud. A business owner may suffer unnecessary financial losses if a fraudulent claim goes unnoticed. One vigilant business avoided losses when it became suspicious of one man's claims. He has since been charged with workers' compensation fraud.
Workers' compensation fraud can cause damage to a business and place the owner in a difficult position, both financially and professionally. Some people may question what led their current or former employee to abuse available benefits for personal gain. The decision for an employee to commit workers' compensation fraud in California may stem from being disgruntled at the company or from someone trying to take advantage of a particular situation.
When an employee commits workers' compensation fraud, it can place a business in a financially difficult situation. A company may lose money over time through the potentially rising cost of insurance premiums that reflect excessive amounts of benefits paid out. A California business owner may choose to take legal action if he or she suspects that an employee took advantage through workers' compensation fraud.
When a large group of employees is accidentally exposed to a dangerous chemical, an employer defense may be established to help prevent detrimental financial damage. A total of three California schools were recently closed after asbestos fibers and dust were said to have been found inside some of the buildings. The decision came after a heated discussion and vote among the school board that addressed the potential closing of 11 schools that had been under construction during the summer months. The school district may consider an employer defense in the event that the faculty and other workers fall ill.
Working as a police officer or firefighter in Los Angeles can place a person at a higher risk for work related injury. The generous benefits provided when a person is placed on leave may contribute to an overwhelming number of potential workers' compensation fraud that may exist among public servants. An employer that suspects workers' compensation fraud may question the validity of an injury and begin an investigation.
An employer defense may have the potential to ease consequences in the event an employer is accused of dishonest practices. A recent report revealed the high number of businesses in California and across the nation that have intentionally labeled employees as independent contractors to intentionally avoid higher costs. Lawmakers in Washington have announced their plan to expose companies that mislabel the classification of their employees in an attempt to financially benefit. A business owner may prepare an employer defense if they suspect they may be investigated.
Workers' compensation defense may be necessary for some California companies that foresee a future risk of serious health related problems among multiple employees. The medical costs of multiple workers that suffer health damage from chemical exposure may be extensive for an employer, making a strong workers' compensation defense valuable. The National Institute for Occupational Health and Safety recently completed a study that found high levels of Benzene exposure in specific oil and gas industry positions.