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Workers' Compensation Defense Archives

Workers’ compensation fraud and patient protection

Despite California’s strict penalties for workers’ compensation fraud, there are still plenty of attempts to beat the system in many industries, including medical services. This is evident in a recent legal case that is returning to court this month and that involves not only workers’ compensation but also serious threats to patients’ health.

What happens if my claim is denied?

As an employee in California, you are entitled to certain rights under the law if you are injured during the course of work. In some cases your workers’ compensation claim may be denied, but fortunately you can appeal the decision if you feel it was made in error. To this end, it’s important for you to be aware of the steps involved in appealing a denied claim in order to have the best chance of success.

Types of workers’ compensation fraud

Workers’ compensation fraud is a serious issue in California. According to the Collation Against Insurance Fraud, fraudulent claims cost everyone money, even consumers. This is because the costs of paying claims get passed down until eventually it is the consumer who is paying for them through higher prices everywhere they go.

Beyond negligence: serious and willful misconduct

As a California employer, having an employee sustain a minor, serious or fatal injury on the job may be at the top of your list of things you never want to happen. Sometimes, though, accidents do occur. In these cases, your workers’ compensation insurance should provide benefits for an employee’s medical costs and some of the lost wages, regardless of whether it was a working condition that caused the injury, or the employee’s own negligence or carelessness. However, at Sacks & Zolonz, LLP, we understand that there are times when dishonest employees make false claims in an attempt to hold the employer liable beyond what is covered by workers’ compensation.

How to combat worker’s compensation fraud

Workers’ compensation fraud costs everyone in California money. However, employers are usually the first victims of this crime. According to the Coalition Against Insurance Fraud, there is a small number of people who actually try to scam the workers’ compensation system, but even a small number of fraudulent claims can create a huge expense. The cost of fraud includes a loss of jobs and pay, more expensive premium costs, closure of businesses and higher prices for consumers.

What you need to know about workers’ compensation subrogation

Before modern workers’ compensation laws were implemented, employees who were injured on the job had to sue the business owners if they wanted to receive any support or compensation. While current California laws force employers to provide insurance for onsite accidents that result in injuries, changes have also been made to reduce the ability of others to enter into a lawsuit over the incident.

Fighting Back as a Small Business Against Workers' Comp Fraud

Most employers are required to carry workers' compensation insurance in order to support and protect their employees in case of injury or illness that occurs on the job. Some do this with an official policy or as part of their regular business insurance. Others set aside an account in order to self insure against whatever might happen. In most cases, employees don't file a claim unless they are actually hurt on the job, but there are exceptions. Some employees get hurt, but the injury isn't a result of what they do at work. Others might take a very minor injury and attempt to make it look as if it causes them more pain and suffering than it actually does in order to get a worker's compensation settlement, which is more than what they deserve. Like other forms of insurance, the more it is utilized, the more premiums rise. For a small business that operates on a tight budget, this can seriously impact their ability to expand. In many cases it can mean the difference between staying in operation or not.

Particularly in California, workers' comp claims are a threat

As the recent election proved and as others have proven in the past, states are entities with minds of their own. So when there is a seemingly national trend, there are still those states that stand out as different and notable in regards to certain matters. California tends to stand out for various reasons. 

Workers' compensation fraud is a cost to society

Today's society provides a sense that business can be the big bad wolf. But that is simply not true. Businesses keep an economy strong. They keep people employed and able to support their families. The strength of corporate America can symbolize an overall strength of the country. 

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