Announcement

Collapse
No announcement yet.

Worker's Comp Fraud North Carolina

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

  • Tower Pro
    started a topic Worker's Comp Fraud North Carolina

    Worker's Comp Fraud North Carolina

    Doesn't apply to me, but curious. Friend of mine told me this story. An employee from N.C. was injured on the job, he is a Naval veteran, a founding member of the company, instead of reporting the injury to the company's Ins. provider he received surgery from either the State of Virginia or the VA hospital in Virginia (not sure wiche one). I'm not sure of the state or location that the injury occured. But, I do know that N.C. considers the worker's comp policy as being the exclusive remedy for workplace injuries. Also note that his brother and company CEO is a former Ins. adjuster. 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?

  • CAIW
    replied
    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"...

    Leave a comment:


  • HRinMA
    replied
    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.

    Leave a comment:


  • Tower Pro
    replied
    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!

    Leave a comment:


  • complwyr
    replied
    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.

    Leave a comment:


  • ElleMD
    replied
    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.

    Leave a comment:


  • Beth3
    replied
    Originally posted by Tower Pro View Post
    I love you guys that need someone to hold your hand to do the discovery for you.

    Why are you moderating/commenting in the worker's comp section being that you apparently have no clue as to what it is and how it works.

    Anyone who knows even elementary W's comp knows these things to be true.

    Another fact is that is is illegal to lie to a healthcare provider/doctor in the state of Virginia as to what caused your injuries. Google THAT.

    And all providers/doctors ask you as to causation for thier reports.

    I think you take some kind of offense in regards to the military issue, and I don't care.
    How do you know that the entity that provided the medical care didn't bill the employer's worker's compensation insurance carrier??? You're throwing around a lot of definite opinions about fraud against U.S. taxpayers when you clearly don't know all the facts of the situation.

    Leave a comment:


  • Alice Dodd
    replied
    Well, since you have all the answers, and we apparently don't know anything, I'm not sure why you're posting here. Do you have a legal question or are you here to inform us of the law that you can't cite? This is a volunteer board, and so far you're just wasting our time.

    Leave a comment:


  • HRinMA
    replied
    Do you know that a claim can be denied by w.c. so then the employee's own insurance covers the injury? Not all claims are cut and dried and sometimes an injury may happen on property but not be covered (which happened at my company recently)

    How do you know that the Hospital isn't billing under wc? My employees go to their own doctors if they prefer but bill to wc not their insurance.

    Worker's comp also varies by state. So you can't use a blanket statement about wc and have it cover every state. Some states don't even require a business to carry it.

    You have been insulting posters who have taken their own time to answer you. You have insulted our resident wc expert who knows far more than you ever will and a poster who attended law school.

    If government policies alarm you so much (as with the bailout) then you should be writing your congresspeople, state reps, sentators and president. Being worried about third hand knowledge of a situation does not help it at all.

    Also when you are up in arms about misuse of the Vet hospital, keep in mind that the man you are talking about served your country! In my opinion that gives him the right to use the Vet Hospital whenever he needs.

    Leave a comment:


  • cbg
    replied
    And I think you need to realize that you do not necessarily know all the facts. Which is why we kept asking who you are in this scenario.

    Real life example: Some years ago my then-employer received an internal complaint of age/race discrimination on behalf of a third party. "Liz" complained that "Betty", who was the oldest woman in the all-female department and the only minority, should have been promoted into a supervisory position instead of "Cindy" who was younger (though still over 40) and Caucasian. Betty had been there longer than anyone else and was clearly qualified. From Liz's point of view it was a no-brainer. What Liz didn't know was that the position had been offered to Betty, who turned it down saying she didn't want the extra responsibility, and recommended Cindy as having better qualifications (which, in truth, she did).

    So perhaps you should consider that maybe there are facts that you don't know about the situation. Since you are not a participant it's not a guarantee that you know all there is to know about it.

    Leave a comment:


  • Tower Pro
    replied
    BTW, yes taxpayers have a clear stake in such matters.

    Have you forgotten the AIG bailout so quickly. Another case of the Ins. companies passing the buck to the American people.

    So any relief given to the Ins. companies when liability is clearly thier's is a mistake and unjust.

    Leave a comment:


  • Tower Pro
    replied
    I love you guys that need someone to hold your hand to do the discovery for you.

    Why are you moderating/commenting in the worker's comp section being that you apparently have no clue as to what it is and how it works.

    Anyone who knows even elementary W's comp knows these things to be true.

    Another fact is that is is illegal to lie to a healthcare provider/doctor in the state of Virginia as to what caused your injuries. Google THAT.

    And all providers/doctors ask you as to causation for thier reports.

    I think you take some kind of offense in regards to the military issue, and I don't care.

    Leave a comment:


  • Alice Dodd
    replied
    Again, you have provided no citations to support your claims. Sorry, but being a taxpayer doesn't give you the right to be in everyone's business. And if it did, you'd be pretty busy distracting yourself with what you think everyone is doing wrong. And you stated you're hearing about this secondhand anyway. Sounds to me like you need to get a life.

    Leave a comment:


  • Tower Pro
    replied
    Also, the VA has the right/ability to place a lein on the carrier in the event they are in fact found liable.

    But, the Fed never goes after 'fraud' cases unless they are in excess of millions of dollars. So, no real danger of any litigation taking place.

    And, most states have agreed to the Fed to comply with the sharing of information regarding these situations.

    If it became say 'epidemic' then no doubt legislation would most likely follow.

    Leave a comment:


  • Tower Pro
    replied
    1. employee, yes
    nothing more

    2. I never claimed there is a law 'prohibiting' care from anyone.

    3. As a taxpayer, **** right it's my buisiness, your buisiness, everyone's buisiness.

    WC goes to the liability of the ER, your serviceman has shifted the liability to the VA/taxpayer... knowlingly doing so, where there is reasonable expectation of another party holding liability could be fraud against the federal gov't.

    Also there is what's called the 'exclusive remedy doctrine'. It exists in all states, It is the backbone of the W'c comp system.

    Also, failing to report to the state W's comp board if done en-mass can skew the system alltogether changing rates, changing coverage statutes, etc...
    Last edited by Tower Pro; 07-07-2011, 07:56 PM.

    Leave a comment:

Working...
X