Safety and OSHA News

Why one employee got banned from workers’ comp — for life


Workers’ comp laws in some states do contain provisions to discourage employees from trying to cheat the system. Here’s one example:

A worker injured his back on the job while lifting boxes. He had substantial back surgery and received workers’ comp benefits because he wasn’t able to work.

The employee said due to pain in his leg from his back injury, he walked with a limp most of the time and that his activities were extremely limited. He said he could only “lift a little.”

However, video from the insurance company showed him bending, picking up and swinging his grandchildren, among other activities.

When he saw the insurance carrier’s doctor, he walked with a severe limp. However the doctor watched him walk out to the parking lot with only a slight limp.

The Workers’ Compensation Board in New York state ruled that, because of his exaggeration, benefits were cut off. But that’s not all.

The Board also, under law, has the discretion to disqualify someone from receiving any future workers’ comp benefits even if the person suffers a compensable injury in the future, and did so in this case.

The worker appealed to a state court which affirmed the comp board’s decision.

Do you think relating this story to employees during a safety meeting would discourage employees from trying to become comp cheats? Let us know in the Comments Box below.

Cite: Church v. Arrow Electric, 3rd App. Div. NY Supreme Crt., No. 503836, 1/7/10 (PDF).

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  1. George Colby says:

    Oooh…caught a malingerer!

  2. I don’t think that it would have an impact, if the person is already planning more then likely they will go through with it. I believe also that even in other areas example health and auto insurance should do the same disqualify a person for life for making false claims.

  3. Here in Michigan, that individual would have received worker’s comp benefits for the rest of their life even if there was video evidence of fraud or exaggeration. Michigan is a very liberal state.

  4. Daniel Doose says:

    I believe that it is a good thing that the workers’ comp board took the steps that it did.
    However I do not believe that relating the outcome of this case to other workers would have any affect on preventing someone from filing a bogus workers’ comp claim.

  5. It might discourage some from even thinking about it, but the people that would try to cheat the system like that, usually think they’ll never get caught. They already know they are not to supposed to lie and cheat the system, the threat of not ever being able to receive workers comp again seems trivial to the punishment you can already get if you are caught cheating the workers comp system.

  6. Yes, I do agree that a story like this will help to curb the amount of people who make false workers comp claims.
    It puts a little meat to the phrase “Don’t abuse the system”. Workers comp was started to help people who needed it, but like all good ideas put in place for the employee, someone will try to “work the system” to get extra time off.

  7. “Do you think relating this story to employees during a safety meeting would discourage employees from trying to become comp cheats?” – Only in New York – NEVER in California.

  8. I’m thrilled to see that an insurance company actually did an investigation. Most insurance companies don’t.

  9. No one commits a crime if they believe they will get caught. I believe this is true with workers’ compensation fraud and, lets face it, the chances of getting caught are slim and none.

  10. Cool Daddy says:

    New York – you deserve applause. Do I think this will curb WC abuse? By itself no. However if a hard stand is used consistently it will assist to quell the abuse of a good system. We have discussed over the last couple of months several cases that were totally absurd, where WC boards have made awful decisions, i.e., ee gets hit by soda machine, ee gets comp while working out. I believe that WC is necessary where the employer neglects to do h/her best to prevent injury to employee while h/she is doing their job. Over time, WC boards have broadened the boundaries by making decisions where it takes a stretch to connect it to the workplace, this has caused abuse of a good system as others use the examples to parlay their own situations into WC cases. Way to go NY, now hopefully, other states will use their example to improve the system

  11. J. Messina says:

    Great story! Could this individual simply move to another state and start over again? While this was a NY case, is this information shared via the index system, and if so, should he file in another state, could that state cite the fraud issue and apply same findings as NY? Would be nice.

  12. Come to TX they do nothing. We have a worker that “hurt” his arm second day on the job. “Hurt” so bad would not even let the Dr’s touch it. Told the Dr and I quote “I just want to be disabled so I can buy a little house and go fishing all day.” This is the Dr’s notes. Texas Mutual has vido of him riding a bike using just his bad arm. Waving to people with his bad arm. What and they done? What has the state done? NOTHING!!!!

  13. Only in NY hey? Well I do agree with Ed Piere, that this should happen across other industries, with regards to insurance fraud claims. I also agree that siteing this story during employee safety meetings may not be a good idel. It could be construe as scare tactics. Every body is not out to cheat the company, and I have seen my share of those who try to. I also have the same question with J. Messina. Would this baring be across all States?

  14. Maybe there is hope yet, the sad thing is the risk of loosing benefits will not deter anyone who is intending to defraud the system, it is already inappropriate and I believe illegal to file false claims. Unfortunately since WC is regulated at the state level if he moves to another state he will then have coverage there.

  15. Dennis Forsythe says:

    It irritates me to no end that people use Workmans Comp as a hustle. But then the road to hell is paved with…………

    It also continues to astound me the length some folk will go to to get over. From actually injuring themselves to falsefying documents.

    And then there is the benefits that the “Injured employee” is usually unaware of. Harm done to a carreer and the stigma(in the workplace) of having a Workmans Comp Case making promotions and advancement less attractive to both the Managers and the staff.

    Hustlers usually do not care but having a Comp. Case can prevent the employee from advancement. I have had Drs tell me to never leave where I work now because that could risk my future treatments.

    Bravo for the investigation and follow-up.

  16. I would gather from this story that there was no medical reason for the change in the limp, but I wonder how many here have called in sick and provided a fake cough and sniffle to convince the supervisor you were truly sick. You may have been sick, but you thought you didn’t “sound” sick enough so added the flourish for effect. Perhaps, that is what this fellow did. I certainly think that most people on Workers Comp have suffered an injury. Perhaps it is better some days than others and I would hate to think that one day, wincing through the pain, a person lifts his kids up and it disqualifies him and his kids from the program.

    I don’t think the story will prevent any workers comp abuse. I think the distrust by most that the Workers Comp doctor will miss the symptoms, or won’t believe the person when they say it was “worse yesterday and comes and goes,” so they add a little dramatic license will be the rule.

    Bannned for life is problematic too. Look at an 18 year old on his first job and tries to pull one over because he heard “everybody does it.” He gets banned for life?

  17. My question is lets say this guy quits there and you hire him not knowing he has been “banned” from workers comp. Then he has his is arm ripped off by a conveyor belt working for you. Are you as the employer going to be responsible for his medical bills because the insurance wont cover it? What type of exposure does that leave me in? Do I now how to start screening all new hires through my workers compensation insurance?

    I love the fact that they are cracking down on false claims as I occasionally have an employee that looks for ways to get the system but I want to make sure I’m still protected too.

  18. Couldn’t hurt – might help. There are all kinds of surveillance videos out there (that we have used) to demonstrate the situation described in the article.

  19. Great story…I agree needs to be shared and on NEWS…

    What I find also frustrating is how a company has to have Safety Programs, meetings once a month or more, and Injury Procedures for the employees all in place or get fined. Then an employee says he got hurt at work and does not follow ANY, (not just one of the procedures) the employee disregards all that the Company spends money on, and the employee can still collect from an injury that could have accrued over their weekend, not at work at all, plus collect wages and go disability.
    It’s the liars…Insurance.

  20. Does anyone know for sure if an employee who signs a full release settlement for a (minor and debatable) work comp injury should be eligable to collect unemployment a mere month after the settlement is completed? I am fighting / investigating that currently here in NW PA–another VERY employee friendly state. This just doesn’t seem right to me. I am being told that if the employee had a “necessitious and compelling reason” to sign the WC settlement agreement, then he may be eligable for unemployment compensation. Come to find out, after the settlement, this employee collected UC benefits for a few months, found a new job which he worked for about 4 months and then filed for UC benefits again, for which our company is still being charges a % of. I have filed a petition with the UC office and they are looking into it, but the fact that this ….person… has gotten away with this “scenario” for this long just shows me how much probably falls through the cracks in our country, creating so much wasted (stolen???) tax payer money…

  21. I think the story will make people who already have a conscience think twice. However, those who want to steal think they are smarter than the rest of us and will just dismiss this story as a stupid person who got caught. This story is like a lock on a gate; it will keep the honest but weak people out, but the true criminal won’t be deterred at all. The only real cure for this sort of crime would be for all state boards to heed Cool Daddy’s advise. If every one who cheats gets caught and disciplined, then and only then will the ‘smart guy’ be afraid to try a scam. Even so there will still be a few sociopaths that are beyond redemption, and will try anyway. They need to be put in jail through legal process one at a time.

  22. noaccident says:

    Using a good system (WC) for a bad cause (fraud), should carry a heavy punishment. Who pays into WC? you, me, and every other honest hard working AMERICAN. If some lazy turd thinks he can just skate on by, living off of taxpayers’ dollars, he should be put to hard labor in a salt mine.

  23. In Oregon, they need to tighten the belt on these types of people. I have had several guys at my company that “hurt” their backs about an hour into the Monday morning shift, after they have spent a rough weekend drinking and playing softball. One even competed in a Karate tournament over the weekend and then immediately hurt himself when he came to work. You know it’s just crap and there is nothing I can do about it. I do however watch them like a hawk and get them on performance and quality of work. I consider them to be no better than crooks.

  24. I had to think about using the story in some of our department meetings as a “safety” topic for a few minutes. In a hospital there are entry level worker up to technicians and licensed professionals all working side by side. I think our society will always have a few bad apples that have to be culled. It seems in my experience that the entry level workers “seem” to have a tendency to work the system more so than other. Maybe that’s they’re “street-smart” survival charactor coming out. I do know that that group of workers tend to “chatter” about how their work comp case is going with co-workers more than other workers. Even if they did not have ideas on how to milk the system, there is a good chance that a co-worker did. We also see a fair amount of our workers getting injured and find out that their spouse is also on work comp. We have one good tool in our State. If the worker refuses light duty work while injured, they lose lost time benefits. So if their plan was to stay home and watch T.V. and get paid, it doesn’t work here.

  25. Great responses, All! S. Black totally agree with you!! At least this story provides “some” hope that, in some instances, WC does its due diligence and essentially makes the right decision.

  26. Cool Daddy says:

    I believe it all comes down to the WC Board’s decisions. With each poor decision, it broadens the scope of the program, and sets precedence for each preceeding case. It is a balancing act. People will (both the employer and the employee), tend to push whatever side that most benefits them. It is up to the WC boards to determine, in a fair manner, the correct decision. In this case, the NY board got it right – the employee, based upon the facts listed in the article was abusing the system.

  27. I think sharing this story will deter someone who “might be contemplating” faking a claim, but it will also alert fakers that most Dr. offices and hospitals have cameras.
    The only sad thing is that if the guy in this story had even a little limp for real, then he probably was still in some pain. (If you ever had sciatic nerve pain……..WOW that hurts.) He already had “substantial surgery” which indicates it was in his spine, and that kind of surgery doesn’t always heal 100%. It can take months up to years to recover if ever.
    What the real clincher was his stupidity to pick up his grand kids and swing them around. Almost like he was looking to re-injure himself…….

  28. Marty88210 says:

    My work with inmates as a psychologist in the penitentiary system bears witness to: “I was smarter than that idiot that got caught!” Like our elders taught us: “Think positive.” Worker’s Comp thieves, and thieves they are, NEVER think about getting caught, else why do the crime?

  29. I agree with the boards decision, however I do not feel this instance would change the actions of an employee who would choose to follow this course. At the same time, I do think it would be an eye-opener for the general population of employees.

  30. To Eric – TX is a case by case basis and how good of an attorney either side has!
    I once knew an investigator for an insurance co. that provided Comp for a lot of oil related business. By nature the oil field is a dangerous place to work and lots of the people that work there know the ins & outs of taking advantage of the “system”.

    This past friend who was doing the investigations had a really cool camera setup (before the days of digital editing) he would use in the course of his investigations. He would often catch a lot of the folks he was investigating in some bar or honky-tonk living it up and doing some rather strenuous dancing out on the floor, he even got some X-Rated footage once when one of these guys went from the dance floor to the back seat of a car with the gal he was dancing with (this guy lost his comp benefits!). But even with irrefutable video evidence the company he worked for only got a little over 60% of those “comp” cases overturned. To me that’s pretty sad! I would have thought 99% or better.

  31. As with Michigan, if that occurred in Maryland or DC, even with hard evidence, that person would be set for life. It is so liberal in this State and District that it isn’t even worth trying to fight it. I have experienced blatant fraud in both MD and DC and yet they still have sided with the employee. Very hopeless cause for honest folks around here, because we are the ones that end up paying for it. I don’t think providing them with this story would affect those in my company who know how to “play” the system here. Sad part is, we know the ones who take advantage and there is nothing we can do!

  32. This would not deter the person looking to game the system. Sadly, many employees injure themselves over the weekend by moving furniture for a friend, playing full contact sports or just working on their home/car/boat. It’s not until they start work that the back catches, the nerves lock or the muscle spasams and they are injured. Of course then it’s all on the employer to prove the injury didn’t happen at work, an impossibility since most of us are not doctors and haven’t spent the weekend following the employee around! Glad to hear that at least one person got banned for good. Sad that in many cases the investigator and even video doesn’t nail the gamers.

  33. Chuck Woodings says:

    I think this was a very good decision and as stated in other comments we need more decisions like this one. My comment though is what about the doctors who abuse the system? The ones that see a WC claim as a way to pay their Mercedes payment or their vacation in Fiji. I’m talking about the Dr.’s that instead of saying go home and put some ice on it or rest for a day or two and then let’s look at it again. Then there are those that will put six stitches in when a bandaid would do just fine. I get so fed up with the abuse of the WC system by the doctors. I’d like to see some of them taken to court to prove that the patient actually required the treatment they were given.

  34. Maybe if they slapped some insurance fraud charges on there. As is, it’s a win for the guy with paid time off. Only would encourage because of no reprecussions.

  35. Sad State says:

    Chuck you do bring up an interesting point and probably true is some cases, however lets look at it from a Doctors perspective (I am not a Doctor). Using the stated examples, if they suggest icing an injury or not putting stiches in what is to prevent the patient from filing for malpractice, in this sue happy society we have created the Doctors are trying to cover themselves, malpractice insurance is expensive and like everything else if you file a claim or have one filed against you the costs just keep going up. It may not be right but it is reality in the current state of this nation.

  36. New Safety Girl says:

    We live in a “damned if you do and damned if you don’t” kind of society.
    Sad State brings up a good point about doctors having to make sure they are covered. Yes, a bandaid might do it, but if the patient doesn’t change the bandage and the wound gets infected, they can sue the doctor and say that if the doctor had just done the stitches, they wouldn’t have all of the pain and suffering of an infection. If you push someone out of the way of a moving vehicle and they end up breaking their wrist instead of being dead, you’ll probably end up with a lawsuit for assault and battery. There are just too many people trying to think up new ways to get rich while sitting on their butts.

    After reading some of the responses on here, I feel pretty lucky with the people that work here (even though they give me a hard time about paperwork). One of the guys was adjusting a drill press and his hand slipped off the handle. He ended up with 4 stitches above his eye where it was gashed open from hitting the edge of the press. He wouldn’t fill out paperwork and told me he would rather pay for the ER visit. He even refused to fill out the paperwork at the ER when he told them he did it at work. It sounds like I ended up with a really good group.

    If people are going to try to cheat WC or any other company, they are going to do it. Nomatter what kind of storys have been published. They just may be a bit more careful about doing things where other people or video equipment could see them.

    • P. Nicholson says:

      Those are the kind of people you don’t mind covering health insurance payments for when they are out on WC. That’s the situation I’m in now, out for 9 weeks after a torn rotator cuff surgery, and I have to pay for the health benefits they continued for me while I was out healing. Dr wanted me out longer. All set!

  37. A.Cornell says:

    Great discussion; A lot of different and pertinent views. Working for a Doctor who gets a lot of injury patients, I have trouble believing there are a LOT of doctors working the system on WC claims. It’s extra work for us and costs more in the long run. Frequently, after a surgery the patient “suddenly remembers” they were hit in the head prior to the symptoms occurring…. at work! I think, just like there are few people who file false claims or exaggerated claims, there are few drs. trying to trump up charges for a WC patient.

    I dont think telling staff the story will change things, but it’s a great story anyway. Most people LOVE to hear things about people getting caught!

  38. Ray Kuryla says:

    I think discussing something like this with department personnel during a safety meeting would be beneficial. I’m sure it would generate some discussion. In my opinion, the vast majority of people in the work force are honest and would not do something like this. However, this may deter the one who is the “exception” from trying something like that.

  39. Bob Fitzgerald says:

    We had a worker who suffered rotator cuff injury. Had repairs made and rehab. Left the company and year later went to WC doctor stating continued pain. WC reopened case. I found it and requested WC to investigate. The investigator watched worker, throwing bales of hay on thier ranch. Companies have to monitor WC and request investigations when they think the case is fraud. If you aren’t monitoring it WC will not question it. I review WC log monthly for activtiy.

  40. I am glad he got caught. So many peopel that are fully capible of working are approved all the time for disability benefits. The truly injured and sick have to hire attorneys and still get turned down. Goes to show you how messed up the system can be.
    Just another thing the honest people have to pay for because the dishonest people use the system and think everybody owes them.

  41. I do think making employees aware in safety meetings of cheating Workers Compensation could result in loss of future Workers Compensation in Delaware.
    My company’s insurance carrier does investigate our Workers Compensation Injuries for validity.

  42. Knowledge can be a blessing or a curse depending on the person using it. I’d hate to give a problem person any knowledge of what can be used to find them out.

    In regards to Docs using the system. I don’t think that happens very often because they get paid on a scale that is less than what they would get in the open market and most Docs are far too busy to do fradulent work just for a buck.

  43. tommy leary says:

    i think that is bull. i am an injured worker who is dyeing because of these law breaking insurance companies who pay the judges,attorneys,doctors and our so called politicians , i also walk with a limp and a cane sometimes. i could be limping a lot one second and the next second you would have to look real hard to notice me limping. when you are on time release meds like oxycoten 80mg,you are off balance and then back to hardily a limp all in a matter of seconds. so the judge and there subrosa video need to be locked up for fraud,racketeering and murder for what they do to the injured worker and his family! as far as i see it! they can stick it where the sun dont shine!

  44. Cool Daddy says:

    Although there is sympathy for the situation, it is beyond my imagination that an employer would not provide an opportunity (or require the report) for an incident (much less an injury) when it happened – not 90 days down the road. Blame the insurance company, blame the employer, but that opportunity to report was there, and most likely required. Accountablity to report it was on the employee – the employer cannot address what he does not know. There has got to be some statute of limitations, and common sense tells me that 90 days (3 months, 1/4 of a year) is far to long.

  45. What the video shows is subjective, If the true facts and clinical results were objective then there is no reason to ban him. Bottom line is let God judge him in the end. Insurance companies have a way of manipulating anything, People are so easy to judge sonbody else unless it happens to them. Where is compassion in humanity today? My Dad suffered with Back pain and surgeries for many years, Does that mean he can’t enjoy his grandchildren and pick them up and hold them? Does that mean he dosen’t have anymore pain. Walk a mile in his shoes before you speak unless your totally Stupid and Ignorant! If the man was lying, then let him be judged in the end by his maker.

  46. Insurance companies aren’t dumb, The insurance company takes on the risk from the employer for a set fee. If the employer promotes and practices good saftey in their business then they will get a good rate from the insurer based on their incidents. Good practice makes a good work safe enviorment. When an employer ignores these practices, then it is the employee that gets hurt. HE/SHE can easly be replaced, they are just a number! When the insurace company has to pay out to the employee, there profits aren’t as much. Weather or not the injury is real or not has nothing to do with you or I paying more. They tell us not so intelligent people that to justify their increases, any make us think its the fraud causing the problem when really all they want to do is make the CEO and Shareholders MORE MONEY. When they have to pay out for legitiment claims or fraud they tell you they lose money. They will always tell you they lose money. They are still making a huge profit. Thats what the CEO does, Is make the shareholders MONEY, and in Turn they Give the CEO a huge, Huge Bonus! Its not the so called Fraud driving up the increases, it’s the GREED so some CEO can have 5 multi, multi million homes. That’s what it’s about. So when you answer the stupid question like the one that started this, yes, the question that puts the little guy against the little guy, Its the GIANT laughung all the way to the BANK and back! Its not the little guys fault. Right or wrong. Its the Big Guy at the top scewing all of us little guys and laughing about it! WAKE UP!

  47. Tommy and the others

    I was injured on the job in 1993. At the time I only felt a pull in my mid back (I was grabbed by a Psychiatric Patient where I work) The injury showed up the next morning as frequently whiplash does. I ended up in 8 months of physical therapy. I has my first relaspe a year later. I have been hospitalized I got brain damage from sudden spasems that caused me to fall unexpectedly my short term memory is very damaaged. These falls occured usually when I was walking or standing then I would be on the floor. In one year I gave myself several concussions it took a long time to locate and understand what was happening mostly because I would have no memory of what happened.

    By the year 2000 I had been a patient at two Pain Management clinics at world class hospitals. They told me they could not help me. To date I have been under tha care of about 43 doctors and many many therapies. I walk better from a program at one hospital of 16-35 trigger point injuctions from the top of my right ear to the bottom of my spine supposedly that would help me and it did for I am able to walk without a pronounded limp, however that did nothing to cope with my continous pain nor did it stop the falling.

    I now have a Dr. who has been keeping me going inspite of some really bad predictions from other Drs (as I would be unable to work, I would be confined to a wheelchair etc) I also will be linping for a while then it would clear up. There are many occasions that I have a bad time from pain when sitting walking laying down those time the pain meds seem to not work. In order to have some kind of a life and to support my family I made it a major goal to keep working.

    By the year of 2007 mywhole family had died so now I am alone( my family died of the following my partner of 34 years a heart attack my mother also. Our boy was strangled my dad and father in-law of cancer, my mother-in-law from demtia and heart attacks my sisterin law of heart attacks and strokes my dad a non-smoker of lung and brain cancer.) My partner was disabled with COPED and lived on 6 liters of oxygen a day 24 hours a day. That was in-addition to 3 other fatel diseases and conditions many causd by the side effects of the 26 medications taken 4 times a day to stay alive.

    From the brain stuff I was forced into a demotion at work losing $16,000.00 a year from my salery inaddition I am unable to call-in if my back is really bad because if sick calls for the same reason accrue to a total of 365 day in total I can be terminated.

    The things I am sharing are needed to be shared to make the following comments clear.

    -I have been since the injury denied WC benefits several times and have had to get laywers to help me in court.

    -My meds for pain control are expensive WC has not given me any $ for that.

    -In spite of being in treatment since 1995 WC frequently closees my case and I have a major headace getting it reopened.

    -Periocally work has tried to get me to take another demotion even though I am declared permanently partially disabled and the problems gets more intense as I get older (I was 43 when it happened I am not 59 I also have been in the work force since I was 17 years old working while I was in school both high school and college) limiting my enjoyment in life.

    -While I am functional sexually the act causes me intense pain for several hours after completing the encounter and just as beig touched causes me intense pain.

    I find it at the very least annoying and upsetting that so many folk hustle the system just collecting the benefits when there is nothing to prevent them from working. Many people find themselves injured unable to work and constantly having to battle with WC just for treatment.

    All of us pay for WC and it is there should we need it, the abuses sicken me. I understand the man in the article reluctance to report the injury. Many times more than should a WC episode at work keeps you from any type of advancement. And the injured person is looked upon as less than human and because of the injury are subjected to demotions and terminations. Three years ago the upper administration tried to force me into a early retirement at that was the third time that was attempted. The first two times I was dealing with all this stuff and I was not aware of the drain damage, I knew something was wrong but not what I nearly panicked and went along with the program even though the $ I would collect was not enough to live on. When the brain damage was identified my Drs wanted me to have cognitive therapy the only programs I could attend were during work hours. At work I was informed I took to much time off for Drs and treatments so it was not approved and I was forced into dealing with that on my own establishing a therapy myself.

    Some back ground I was the Head of a large department as well as worked on facility wide safety issues and I was to identify newly indetified hazards. I would design programs and monitir the programs for tweaking effecicay and to incoperate new standards fro OSHA CHO CDC etc. I also was the Right To Know Officer and the Harzard Materials Coordinator two things I still have the resopnsibility of.

    Having the above happen to me makes me angry because many times my superiors make me feel like I am trying to take advantage of the system. And yet there are many who play the system as a game and rip it off. I know of several people that have similar experiances to mine. I fully understand why someone would be hesitatent to report an on the job injury because of the above. I choose to try to keep haveing a life of sorts but many are overloaded and feel they are not heard when they speak up(for the most part tehy are right) so they choose to hide their problems as the man in the article.

    Many times people are terminated because to On The Job Injuries or from becoming disabled and there are few resources that are awarded to these people but only after a long demeaning fight.

    I am sharing this because I have rarely seen any one talk of the issues concerning a person genuinly disabled and who is trying to hold things together. In my case I want to have as much a life as anyone else and there are many like me.

  48. Captain Safety says:

    Compassion for humanity? How do you figure that enters the fray? I empathize with anyone who is injured – regardless of how. Saying that, I have personal experience with pain, i.e., two hip replacements at age 45. Could it be job related? Yes, if I wanted it to be. A job is something more important, and I don’t have to worry about being video taped whatever I do. Theres a lot of stuff I can’t do with my 5 year old son, that I would like to, but having a job is more important in the broader scheme of supporting a family. I have seen WC fraud in my own family, same thing, always the back! So my uncle has back surgery, gets comp, next thing I know he’s out in the driveway doing mechanics work, hell, does having an injury mean he can’t enjoy his favorite hobby? Your damn right it does. He never uses his cane around the house, but you better bet he has it for every doctors visit – brings the limp along too. Can he work, you betcha, fixes every car up and down the creek. You ever leaned over an engine? Cramps the back pretty good. Can he work? I see him work everytime I get to his neck of the woods – completely redid his house, drywall and all. Let God judge him? God’s gonna judge him pretty severely, because, you see, he has a 30 year old son, the apple didn’t fall far from the tree…openly talks about how lucky he is not to have to work…his dad helps him navigate the system. Yes – that equals about 30 some years of abuse, bi-generational. I say Video Tape the hell out of them, if they are truly hurt, there is nothing to worry about. If they’re not – they get caught, throw the book at them…

  49. Marty, I don’t understand. The man’s own actions condemned him. He was proven to be exaggerating his injury, in my opinion, to take the company for all it’s worth. That is the same a defraud… There is also no need to wait for him to see “his Maker to be judged,” for he was judged by State Judge, and found Guilty. Sorry for your father. He was probable an honest man, but this guy was not.

  50. Well I guess we can all agree to disagree! CEO’s And shareholders love to pay us a small salary and pit us against each other. So they hire an investigator who they pay peanuts to go rat the guy out who may have a ligitimate injury and screw him out of what is entitled too for working x amount of years with a company based on a tibit of what he is doing in his life. Yes people lie and cheat. Has them if they have a bad back when they go to the doctor they say yes, that is subjective. Doctor does xrays and cat scans and shows his back is broken, thats objective. Guy goes home form doctor with pain picks up his 10lb grandchild, does that mean he is not injured or is not in pain? So the 15 seconds the insurer is video taping him doing that makes the injury and pain go away? Wrong! People tolerate pain differenty. Who makes out in the end? Insurace company. Where do profits go? shareholders, Greed. I choose to side with the little man vs. the greedy man! If he is exaggeratng the injury then I need to see the evidence and not pictures.

  51. WOW Marty! You seem almost cynical, as though the fellow in our story was not caught trying to defraud his company. Believe me, it happens everyday. And it is not always for the profit of the “Big” CEO’s. I work for a unionized company, and believe me, the union has more to do with who get fired than the CEO. There are cheates in every company. We are greatful when the courts, Dr’s, CEO’s, and yes, even unions see them, and they get fired! Those with legitimate injuries are protected, and should get the care they need (including W/C, or Disability). But those who cheat should be invetigated AND FIRED, and like in our story, be prohibited for live from collecting W/C benifits.

  52. Joe,
    If this is the truely case then I am with you all the way. I am a 30 year Union millwright and I have seen first hand people get hurt on the job ligit only to be followed by insurers and get the shaft.

  53. As for the Workers Comp…It’s an Insurance and like all Insurance…It’s not there for the People~
    It’s a business to make money. It does not protect anyone. I can look back just at the past 3 years, the WC cases at the Company I work at, the ones that cost the most where employees looking
    to make a fast buck. The sad part is the money they made ended up going to the lawyers, and the doctors, the employees that thought they were getting so much money where employees that could have earned a lot more, if they had only worked. Not too many people out there like “D F SAYS” these are people that need to be helped, and that added help does not come from the Insurance, it comes from with in the Company that you choose to work at.

  54. Captain Safety says:

    Well stated MKC. I surely sympathize with “D F SAYS” and sense that it is a case which WC was designed for. I have seen many, many employees who were injured and fell into the WC system, and followed their doctors instructions, got better, and came back to work. I have also on the other hand, seen employees that appeared to fight everything at every turn, with all sorts of rationale, and fall into the abyss of hiring a lawyer, going before the board, changing doctors like others change their underwear, and end up with a settlement. Much of that settlement is disbursed to lawyers, doctors, etc., leaving that employee with less than half of what they settled for, which is soon gone. The vast majority of these cases, appeared to have overtones of fraud, with the nearsighted thought of the employee to get a windfall of cash. I have spoken to a couple former employees who definately had second thoughts, without recourse, of their actions. As I spoke to each one I had empathy, but came away with the idea they now regret not cooperating and following the doctors recommended care, one was even enfluenced by a crooked doctor. They have since found out that once the cash is gone, and the doctors have sliced and diced, provided continual medication, it makes it very difficult to find employment.

    As a Safety Professional, it is neither satisfying nor disappointing that those who fight at every turn in the pursuit of “mo money” with a “screw the company” attitude usually end up with nothing in the end – it “just is”- after all it’s a chosen path, and the consequences (+/-) come with the decisions we make.

  55. There are times when I believe posting this info gives others ideas on how to beat the system. Example: in one of my facilities a woman; who sat on our Safety Committee; was witness to several discussions related to less than honest WC claims. We had testimonials from our insurance carrier on what to look for related to fraud and how people typically use back injuries as a hard to prove injury that usually has little defense from the employer.
    After hearing how people were able to get paid while feinting back related injuries; she commented to one of her coworkers: “I’m going to get me some of that free money”. She proceeded to drop to the bathroom floor, falling on her tail bone and claimed a slip and fall back injury. (an almost identical senario from one of our insurance carrier examples) The cruel twists to all of this was that her coworker came forward to dispute her claim, the floors were coated with an anti-skid material, and her drop to the floor caused a disc compression that required extensive surgeries and permanent back and nerve damage.
    The pursuit of “easy money” can have its consequenses.

  56. Brian, thanks so much for sharing that info and I totally agree with you. I’m just so baffled at the thoughts of these people who “try to” and sometimes succeed in their scams. Getting “some of that free money” isn’t all that free, when you think of the price to be paid, such as life long pain & suffering (as it appears to be in the case you mentioned). There’s always a price to pay for being deceitful; it will come back and haunt you one way or the other.

  57. i am on workers comp in ca i get photograped everywhere really sick of it my former workers com doc would not take calls from insurance co so that i could get pt he accused me of being a pil popper and doc shopper he gave me darvocet that made me puke on street then would not see me for a week .i went to er and that made him yell at me he did not know my name or even where i worked he needs to be off the chartis mpn yesterday when i take a pain pill i can bend over and get something of the floor i my car someone took a photo of that if i take no pain medication getting out of a chair is excruciating if i take it is a wee bit easier… my employer dislikes me and is painting me as a maingerer i just want someone to fix my torn tendon and move on

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