Announcement

Collapse
No announcement yet.

California WC fraud without a DWC-1?

Collapse
This topic is closed.
X
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • California WC fraud without a DWC-1?

    How did identity thieves illegally activate fraudulent workers’ comp insurance benefits based on my identity without forging/falsifying the form that the employee has to complete and sign? In California, it is a DWC-1.

    I discover that while I was on vacation months ago, crooks employed by the out-of-state corporation that runs the California medical plan I purchase through salary reduction, illegally used my identity for a false government claim (a workers’ comp 5020 form). That form was only completed enough to include my identity and the crooks ignored the details for which the form exists, such as proving a work related injury.

    That form does not explain the insurance fraud, just proves they illegally accessed my confidential information. From what I read, they would have been required to send that other form, a DWC-1, to get WC benefits issued with my identity. However, they did not, according to the Calif. Dept of Industrial Relations. So, how did they do it?

    I thought the corporation and the insurance intermediary would correct the problems and consequences caused by the criminals employed there, and appreciate knowing what I discovered. That is the opposite of what happened after I sent a letter with evidence proving the crimes and the identity of the crooks within the corporation. The corporation and the health plan did things to my health records to try to conceal the earlier crimes and now my health care records and employment records a mess.

    The employer claims innocence, but how is that possible? Based on what I have read about the WC protocol, didn’t someone at the employer also have to intercept the information that would have tipped me off months ago that my identity was used for insurance fraud? I cannot get them to remove the fraudulent worker’s comp insurance and I still have no idea about what it claims about me.

    I am so shocked that California and federal laws exist to prevent Workers’ Comp fraud, but make no effort to stop these predators. Is the health insurance and the worker’s comp. insurance industry so corrupt that any big employer and big insurance company can operate like gangsters and “contract’ a crime? That is what the facts add up to (which take more than a couple paragraphs) and why I am as worried. I contacted law enforcement and got nowhere. All I have is an identity theft report. The government agencies keep referring me to another government agency, while none has stopped the crooks that are now mucking with my medical care because I reported their crimes. What actual protection exists? Citizens have no civil rights. I cannot afford to compete with the health plan and employer by paying an attorney and waiting years for my health records to be corrected. I am in more danger now from the mess they made of my records because of claims fraud and their cover-up.

    I thought I might find other threads with this same fraud, but did not find anywhere the crooks were this malicious or desperate. Their crimes started when the economy began tanking. I appreciate any ideas.

  • #2
    When an EE files a claim for WC benefits with the employER, the ER files with their IC...unless they are legally self insured. So I don't see where there could be any comp benefits paid. Also, the ER/IC has the right to control the medical in a comp claim...by sending the IW to a doctor of thier choice.

    You can notify the DWC fraud unit, or SCIF of this, but I wouldn't expect too- much in return. They may or may not investigate... the Dist Attys don't go after this unless there is a hugh amount of money involved. Their budgets just don't warrant chasing after a WC fraud. DA's are after making a name for themselves... elected office.

    If these people accessed your personal health care benefits... the carrier is holding that loss. It's very difficult for a Dr/provider to check the identity of a new patient. Treatment is offered, and the insurance cards issued for identification are copied...and the IC billed. Patient walks. If the treatment was provided at a hospital emg room... even less of a change for recovery. Medicare/Medicaid gets hit with those bills.
    I discover that while I was on vacation months ago, crooks employed by the out-of-state corporation that runs the California medical plan I purchase through salary reduction, illegally used my identity for a false government claim (a workers’ comp 5020 form). That form was only completed enough to include my identity and the crooks ignored the details for which the form exists, such as proving a work related injury.
    If the intent was to gain access to a WC benefit... what you describe doesn't make sense (to me anyway). What could these people gain through WC ?And how could you be harmed by a fraudlent WC claim ?

    Comment


    • #3
      additional info, the Perps' M.O.

      Originally posted by CAIW View Post
      If the intent was to gain access to a WC benefit... what you describe doesn't make sense (to me anyway). What could these people gain through WC ?And how could you be harmed by a fraudlent WC claim ?
      Thank you for your reply.

      The crimes of medical ID theft and WC fraud by the Preps were not for self-enrichment through payment of false medical claims, They illegally activated WC benefits through the illegal use of my medical ID because they could thereafter conceal medical malpractice by proxy. If that is not familiar, a good explanation is in The 2006 World Privacy Forum report MEDICAL IDENTITY THEFT: The Information Crime that Can Kill You. http://www.worldprivacyforum.org/med...titytheft.html

      Since a DWC-1 was never used by the Perps, the Dept of Ind Rel had no way to know at the time that a crime occurred. I presumed that greater safeguards existed. If my understanding of you information is correct....
      • The DIR relies on self-regulation, even though that can be an invitation or fraud ~, as in this case where the employer, health plan and insurance intermediary are the perpetrators, so there was no person remaining to blow the whistle.
      • There is no protocol to the WC paperwork for fraud prevention or any oversight when an employee initiates WC and paperwork, specifically the completion of a DWC-1 first by the employer and then by an employee, is never sent to the Dept of Industrial Relations.


      Since I thought the Perps could not get their crime past the DIR, I could not understand how they pulled off the crime, if...
      • Without the opportunity to decline or accept WC benefits through some process, such as the DWC-1, the Perps were presenting themselves to be my agent, when they were not and could not do so without a prior written agreement, which also addressed the conflict of interest. The Perps cannot secretly contract with my medical identity for any reason, without my written permission.
      • The Preps never acted like an employer by giving me a DWC-1 with the employer’s portion already completed. They could not because I did not have an injury and had they tried, when I returned from vacation I would have rejected it and reported the fraud attempt. Instead, they used the time when I was on vacation to conceal from me their illegal access/use of my medical identity to activate fraudulent WC illegally with my medical identity. Not very “employerly.”

      Comment


      • #4
        The crimes of medical ID theft and WC fraud by the Preps were not for self-enrichment through payment of false medical claims, .
        Sorry, that doesn't make sense...'' were not for self-enrichment through payment of false medical claims'' then ''They illegally activated WC benefits''... if not for self enrichment/money paid in another persons name...where are you seeing fraud here ?
        because they could thereafter conceal medical malpractice by proxy.
        Medical malpractice on WHO ?
        Since a DWC-1 was never used by the Perps, the Dept of Ind Rel had no way to know at the time that a crime occurred. I presumed that greater safeguards existed. If my understanding of you information is correct....

        The DIR relies on self-regulation, even though that can be an invitation or fraud ~, as in this case where the employer, health plan and insurance intermediary are the perpetrators, so there was no person remaining to blow the whistle.
        The DIR/DWC does not pay any comp benefits. How could an employER, GHP, or IC perpretrate a fraud against themselves...The ER and IC's are the ones who pay the benefits. How could you defraud the DIR/DWC ?
        Without the opportunity to decline or accept WC benefits through some process,
        I don't believe you understand the basic concept of WC. When there is industrial injury, the ER carries the liability. The law demands legal self insurance, or purchase of a policy of coverage from an IC. It's not up to the EE/IW to accept or deny benefits. If you/IW would rather pay for your treatment out of your pocket, I suppose you are certainly free to do that. The law requires a DWC-1 to be filed by the IW with the ER. The ER files the claim with their IC. Only if there is need for treatment further than basic first aid, or time loss, would the injury be reported to the DIR/DWC.

        Fraud in WC is basically a EE/IW filing a false claim...an ER not paying the premiums due by mis reporting wages or mis classifying the EE's job duties, or a medical provider billing for services not provided...those are examples of fraud.

        they used the time when I was on vacation to conceal from me their illegal access/use of my medical identity to activate fraudulent WC illegally with my medical identity.
        To what end. IF your ER is a ''perp'' here, in collusion with an IC...there is NO PLACE to get any money. The ER would be acting against itself.

        There may very well be opportunities for medical ID theft. But in WC, the ER/IC has the ability to control the medical costs in a claim by directing the providers used, and the treatment itself through the UR process. The ER would know who the EE/IW is they are sending for treatment.

        If there is medical ID theft and your information is used by another party to access treatment from a Dr, or hospital, that would be an entirely different scenario and crime. And, you could suffer some privacy damages, and find difficulty getting the issues straightened out. I don't see a monetary loss by someone such as yourself through your description of this situation.
        Frankly... it's not making sense to me. There is no WC fraud here. None that I see anyway.

        I think for discussion purposes you are in the wrong message board.

        Comment

        Working...
        X