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Worker's Compensation Fraud Texas

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  • Worker's Compensation Fraud Texas

    Would it be worker's compesation fraud if I went back to work while the insurance carrier is on Christmas Break? Currently, I am not collecting any financial benefits because the carrier cannot pay benefits due to Christmas Break. However, I do need some kind of income. What should I do?

  • #2
    Either you are well enough to go back to work or you are not. If you are, then you should be going back to work and not relying on workers comp for your income. If you are not, then you have no business going back to work until you are.

    You will seriously damage your case if you try going back to work just for the Christmas break and then collecting workers comp again once the break is over.
    The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

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    • #3
      Agree with cbg. If you are well enough to work, why are you relying on
      workers comp/collecting workers comp?
      Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. Leo Buscaglia

      Live in peace with animals. Animals bring love to our hearts and warmth to our souls.

      Comment


      • #4
        Yes, this would be fraud. If you are working during a period when you would not otherwise be getting benefits but then suddenly can not work again once benefits can resume, you are BEGGING for a fraud claim. 99.9 times in 100, you will lose. Big time. I've had employees try this over the summers when they aren't otherwise entitled to benefits as they do to work summers. You don't want to go there. Trust me.

        If you are capable of working, then you really need to be doing so as collecting/filing for TTD while able to work is also fraud. You risk jeopardizing your whole claim, not to mention criminal charges if you are not totally honest in this.
        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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        • #5
          I know you have posted about your ongoing issue and I can't remember this detail. Are you currently receiving replacement wages from W/C? If so, the fact that it is a holiday break would not affect you being paid. Holidays are not a suprise to companies so payroll and issuing of checks is planned around the closed days.

          So if you are issued a check every week or biweekly from W/C, then it will continue even with the holiday.

          Comment


          • #6
            Originally posted by HRinMA View Post
            Holidays are not a suprise to companies so payroll and issuing of checks is planned around the closed days.
            One would hope so. I was working for a manufacturing company in the 1980s who on Friday evening decided that they wanted to be closed for the rest of December. Most of the employees had already left for the day and had no idea that they were not supposed to report to work the following Monday. Management really meant everyone, which included payroll. Management had not figured out that not having payroll work at least part of the time meant no paychecks, including for them. Worse, no advance notification meant no timesheets for work already done. And this was back when we had to issue accounts payable checks to make tax deposits. Plus year end is always the busiest time of year for payroll.

            I am not a big conspiracy theory fan. In my experience, most bad actions can be easily explained by gross incompetence. I am however a big believer in Parkinson's law.
            "Reality is that which, when you stop believing in it, doesn't go away".
            Philip K. **** (1928-1982)

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            • #7
              Originally posted by DAW View Post
              One would hope so. I was working for a manufacturing company in the 1980s who on Friday evening decided that they wanted to be closed for the rest of December. Most of the employees had already left for the day and had no idea that they were not supposed to report to work the following Monday. Management really meant everyone, which included payroll. Management had not figured out that not having payroll work at least part of the time meant no paychecks, including for them. Worse, no advance notification meant no timesheets for work already done. And this was back when we had to issue accounts payable checks to make tax deposits. Plus year end is always the busiest time of year for payroll.

              I am not a big conspiracy theory fan. In my experience, most bad actions can be easily explained by gross incompetence. I am however a big believer in Parkinson's law.
              DAW, you have the best stories. I am amazed by some of them, including this one.

              Comment


              • #8
                If you are drawing work comp wage replacement money while you are actually working and earning wages, then that would be fraud.


                Here in NC we have found that most of the fraud in work comp seems to be on the employer side. I keep hoping to nail one for cheating one of my clients. If the employer cheats by more than $1000 it is a felony here.......
                Bob Bollinger, Attorney
                Board Certified Specialist in NC Workers' Compensation Law
                Charlotte, NC

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                • #9
                  the insurance carrier is on Christmas Break? Currently, I am not collecting any financial benefits because the carrier cannot pay benefits due to Christmas Break
                  To tell ya the truth, IMHO, that is BS... the carrier could face penalties for unreasonable delay in paying TTD or PPD indemnity benefits, or any delay in authorizing medical care... I think it would be the rare, rare ocassion for any IC to do what you are suggesting here.

                  You are due benefits when they are due...in all states.
                  Forget about your idea of working during a break in benefits... only your Dr can make the determinate to release you to RTW... if you do RTW... yes, you could be charged with attempting to defraud the IC in accepting benefits you know you are not entitled to.

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                  • #10
                    I asked this question because I did receive a check for $764 of one moth's back wages. I was told that would be all I would get until I get an impairment rating. The $764 only lasted for the month of November. However, I will not get any money unilt after the impairment rating. That will not happen until April of this year because worker's compensation is trying to find me a replacing designated doctor. They have until Jan 15, 2012 to get another designated doctor and until March to reschedule my designated doctor's appointment. I do not have any money at all between December 2011 and April 2012. I was not looking into your normal type of work. The kind of work that I would like to do I cannot say over the internet. However, it ain't exactly illegal under the table type of work either.

                    Thank You.
                    Last edited by QueenInez19; 01-01-2012, 05:13 PM.

                    Comment


                    • #11
                      Originally posted by ElleMD View Post
                      Yes, this would be fraud. If you are working during a period when you would not otherwise be getting benefits but then suddenly can not work again once benefits can resume, you are BEGGING for a fraud claim. 99.9 times in 100, you will lose. Big time. I've had employees try this over the summers when they aren't otherwise entitled to benefits as they do to work summers. You don't want to go there. Trust me.

                      If you are capable of working, then you really need to be doing so as collecting/filing for TTD while able to work is also fraud. You risk jeopardizing your whole claim, not to mention criminal charges if you are not totally honest in this.
                      I have been totally honest but my claim was pending for 2 years before I was granted $764 for one month's of back wages. My thought was, "I could have been doing something else in those 2 years to make more money than $764." My injury was that I had a muscle strain in my right forearm. It was only, technically speaking, cared for once by a treating doctor within those 2 years. Up until this very day it is not completely healed because I was told that I have a legion around the area that did not heal properly and that is the reason my arm still is in pain. Honestly, "Who can live off of $764 a year? Or $1200 a year at that?" That is all that the carrier is willing to settle for.

                      Also, I mentioned in another posting that "I am originally from Colorado and not Texas." You are probably thinking, "Well...what does that have to do with anything?" Because in Colorado I use to commit a lot of sins to make a living. Texas I do not know if those sins apply to working? For example, in Colorado it is legal to sell marijuana (a sin). Texas it is not and nor is it considered to be a form of employment. I did stuff kind of like that to make a living in Colorado when I was in desperate need like this worker's compensation claim. Let me break it to you plain and simple, I use to work as a private escort to make extra cash but doing that ain't exactly taxable, considered to be a normal form of employment, or illegal in Colorado. So would it be considered fraud if I did it again in Texas?
                      Last edited by QueenInez19; 01-01-2012, 06:27 PM.

                      Comment


                      • #12
                        So would it be considered fraud if I did it again in Texas?
                        ANY TIME you are receiving benefits you know you are not (legally) entitled to...it is fraud.
                        You can "work" anytime you are able... the law requires you report those wages, yes, even if 'illegal', to IRS and if the situation demands...to the WC carrier, or any other IC's paying you benefits based on wages. (even wait staff in restaurants/bars ect that do not report their tips is illegal)

                        FYI... regardless of what the State says...it's illegal in ALL states to sell controlled substances, including marijuana. (a 'sin' goes to religion... not state/federal law...)

                        If you are not receiving WC wage replacement, you are free to 'work' at any job that is within any restrictions place on you by your treating physician...
                        My injury was that I had a muscle strain in my right forearm... Honestly, "Who can live off of $764 a year? Or $1200 a year at that?" That is all that the carrier is willing to settle for.
                        The carrier won't pay wage replacement, TBI's, unless your Dr says you cannot perform your usual/customary job function. If you've been released to a light duty/modified job, and there is wage loss, you would be eligible for those benefits if your ER offers the light duty job.
                        The carrier won't pay PPD indemnity until you have been rated.

                        Talk to your Dr about those restrictions if any.
                        If you get a release, you can go to work.

                        Not really enough info about the claim... you are only concerned with performing "unconventional work" and fraud. Understandable...I suppose, but you're going to have to let the system work it's way though... litigation takes time.

                        Comment


                        • #13
                          I'm glad we have you, CAIW, to answer the more involved WC questions.
                          Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. Leo Buscaglia

                          Live in peace with animals. Animals bring love to our hearts and warmth to our souls.

                          Comment


                          • #14
                            You had a muscle strain 2 years ago in your forearm that you only saw a doctor for once and you have been off work for 2 years?? Seriously? I have to say, your chances of getting much from this claim are dismal. For one, even if you broke your arm, it just isn't going to be worth much as far as PPD goes. If you haven't been consistantly treating for the injury, you are going to have major problems demonstrating that any symptoms you have 2 years later are related. If you are off work for 2 years because of a muscle strain in one arm, you are going to have a near impossible time proving that there was no work you could perform. Selling drugs and being an "escort" are illegal and those "employers" do not pay into the WC system. It was illegal in CO and it is illegal in TX. In either case, if that was your employment and legality aside, neither would be precluded by a muscle strain in the forearm. If you were working at either of these "jobs" in the past year, you aren't going to be entitled to benefits from WC during that time.

                            My suggestion is to get thee back to work. Any legal work. If you want to pursue medical care, you still can but wage loss over the past 2 years is another matter. I can't tell you what to do, just share my opinion of the situation. The fact that you moved voluntarily and have already had 2 lawyers quit on you does not go in your favor either.
                            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.

                            Comment


                            • #15
                              Thanks everyone. I don't sell drugs but that was an example because I do have friends that have medical marijuana license to sell marijuana in Colorado. They make good money doing it. Escorting in Coloradoa actually is not illegal because I spoke with a detective about it. He said depend on the types of services that are included in escorting it is not illegal. In Colorado there is a half service and full service escort. Half service is legal. Full service is not. I was a half service but we never filed any W-9 forms for taxes because there was never a base pay just tips.
                              Last edited by QueenInez19; 01-05-2012, 09:49 AM.

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