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Worker's Comp Fraud North Carolina

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  • #16
    If he was a company founder or owner/partner/proprieter/formulators of an LLC/corporate officer, then chances are very good that WC does not apply to him as he would specifically opt to be covered.

    Unless you have seen the medical records you do not know that this perspn lied about how the injury occurred. It would be the VA's responsibility to deny if they should not be covering the claim. If they accept the claim, they pay the claim.

    It sounds like you are getting your information at best 3rd hand if it came from a friend who was not the employee in question. There is no way you have anything near enough information to call this fraud of any kind. You don't even know where the injury occurred or where treatment was rendered.

    Not to mention if the courts have already been involved, if there was a violation of some kind, it would already have been addressed. The lawyers and judges know the law far better than you do as well as the exact circumstances of this case. Why you are involving yourself in a situation where you only have a small part of the story and at best 3rd hand knowledge I have no idea.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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    • #17
      Tower, your understanding of the "exclusive remedy doctrine" is incorrect.

      This doctrine means that the injured worker's exclusive (only) remedy against his employer is the work comp law. It means he is not allowed to sue his employer in tort or for negligence, which is a form of torts.

      Exclusive remedy doctrine has absolutely nothing to do with whether the injured worker used the VA system or any other system to get health care.

      In fact, if an injured civilian worker uses the VA system for health care, and then later the employer is found liable under work comp for the injury, the VA is entitled to be reimbursed by the employer or its insurance company. So there is a remedy for the taxpayers.
      Bob Bollinger, Attorney
      Board Certified Specialist in NC Workers' Compensation Law
      Charlotte, NC

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      • #18
        That's what I said in my second post.

        Personally I could care less about the fraud, I was just making the case that the VA was entitled to the re-imbursment. That's all.

        No one else here wanted to discuss it, just make personal stabs!

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        • #19
          Originally posted by Tower Pro View Post
          That's what I said in my second post.

          Personally I could care less about the fraud, I was just making the case that the VA was entitled to the re-imbursment. That's all.

          No one else here wanted to discuss it, just make personal stabs!
          You were the one taking personal stabs at us regular posters, suggesting you were holding our hand while it was your question.

          You received plenty of accurate information, you just didn't like the answers.

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          • #20
            Personally I could care less about the fraud, I was just making the case that the VA was entitled to the re-reimbursement. That's all.
            Ok...but you said..in your second post As the situation I described it is in fact a fraud commited against the Federal Government as Worker's Comp is the 'exclusive remedy' of on the job accidents and the VA is entitled to re-reimbursement by the companies carrier, as explained to me by a Fed. Law investigative attorney. , there is reason other posters are replying.

            Your understanding of "exclusive remedy" is not only incorrect here... you don't know, or haven't provided, whether this "IW" is in fact covered under the ER comp policy...this is a 'founding partner'...apparently not an "employee" for injury/comp purposes.
            As such, free to seek treatment at the VA, under his/her own health coverage, or out of pocket.
            My thoughts are that they may have commited fraud against a government healthcare provider in an effort to maintain a no injury status w/ thier Ins. provider, and to this day have had a stance of denial to any other workplace injuries. (other claims have been made) Any thoughts? .
            What difference does it make what thoughts may be held by posters here... IF the VA has knowledge there may be another party holding liability for this injury...it's up to them to file a lien, same as would be the case for Medicare/Medicade.
            No stake for me. It's bassically the same as using a PHP or dissability sources for work related injuries. The carrier when found to be untimately responsible must pay back for services rendered according to the W's comp laws and/or a judges findings.
            That's not true either... when there is delay/denial in a work injury claim, it's at the prerogative of any carrier to pay benefits, and up to that carrier to file a lien against the claim. I know of no 'law' that requires reimbursement.
            case is unique in that the work related injuries were in fact never reported to the carrier as well as the state W's comp board, but had been recorded in a court of law to be a work related injury. And this is considered a felony in most states.
            If there was never a reporting of the injury to the ER carrier, or comp board...how did this ever get to a court of law...to be determined a work related injury?

            I think...in your two posts of 07-08-2011 04:57 AMTower Pro
            , you actually did become...well, somewhat 'aggressive'. IE. I love you guys that need someone to hold your hand to do the discovery for you. Yet, there continued to be discussion on your topic.

            No one else here wanted to discuss it, just make personal stabs! ....aw c'mon... in your first post you asked "Any thoughts?"... I'd have to agree with HRinMA...you simply don't like the thought process here. Yet, you still haven't provided any additional, factual information regarding your "issues"...

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