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.
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.
The former owner of a California company that installs drywall was recently sentenced to 120 days behind bars followed by probation for three years. The sentence followed a conviction on payroll and workers' compensation fraud. He will also have to pay the defrauded insurance company more than $262,000 for underpaid premiums. Furthermore, over $160,000 of stolen wages was repaid to workers during the prosecution of the case.
Regardless of how well California employers manage their workers' compensation programs, sooner or later they will likely become involved in litigation over workers' injuries. Unanticipated claims from former employees or being named as one of many defendants in occupational injury exposure claims may require the employer to hire a professional to handle employer defense. The demands of running a profitable company can be taxing on a business owner, and having to deal with complicated workers' compensation claims may be better left to experienced professionals.
"Times are hard", especially if you are a small business person.
The unexpected death of a worker is understandably devastating for the worker's family and his or her community in California. One community in another state was recently faced with this situation following a workplace accident that occurred about a year ago. Dozens recently gathered to remember the victim who lost his life while on the job. However, the tragedy of the fatal workplace accident also affects the employer who may now require an employer defense.
Construction companies should always be looking to improve the safety of their work environments in order to avoid possible future legal problems resulting from workplace accidents in California. This is particularly important since construction workers are always working around heavy machinery and tall heights that could increase the chances of severe injury or even death when an incident occurs at a construction site. Employer defense may be required in the case of an injured worker claim or citations from work safety authorities.
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.