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Worker's Compensation Fraud Texas

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  • QueenInez19
    started a topic Worker's Compensation Fraud Texas

    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?

  • QueenInez19
    replied
    Thanks everyone for your help.

    Leave a comment:


  • ElleMD
    replied
    I would recommend a lawyer if the company/ IC is asking you to sign something. If nothing else, you need to know what you are signing and how this will affect your claim, life and employment in the future. Given that 2 attorneys have essentially fired you as a client, your chances of finding a 3rd to fight the claim yet again are slim to none. However, my impression is that they paid a small amount from just after the accident (the $764 souds like a week or two of lost wages) and may offer a small settlement to make the claim end. Paying a couple hundred bucks to a lawyer to review the settlement agreement and explain its terms to you can save you a lot of heartache and trouble in the future. If you can't afford it, check with some of the law schools in the area as most have legal aid clinics at low or no cost.

    Leave a comment:


  • HRinMA
    replied
    Originally posted by rear-ended
    Hey QueenInez,

    I know you probaly dont want to hear this,,,,but,,,,I think it is time to start looking for a lawyer. I never wanted to hear that or even hire one, but there comes a time when you do need one. If you look long and hard, you maybe able to find one that will help. They dont charge any money up front, most of them anyways. Hope things work out for you.
    Rear-ended, your case was very different from QueenInez. You had many concrete facts to give a lawyer. While I would never tell someone not to get a lawyer, it seems the OP does not have much of a case. It has been two years and she was only seen by a doctor once.

    Leave a comment:


  • CAIW
    replied
    Now is it a lot more clear about the financial bind I am in because while I have to wait for all this stuff to happen I still need to be able to make a living for my family because I am a single mom.
    What is your PTP/Primary Treating Physician saying here?
    Im thinking you have been released to return to work... but for some reason are disagreeing and requesting a DD... the first DD is "missing", and a substitue is being arranged.

    If this is the case, you can and should be going back to your pre injury employer and discussing a return to work. If the ER cannot bring you back... apply for UI/Unemployment Ins benefits..>BUT, as you have not worked in the past 2 years.... I doubt you'll have any base wage to pay UI on.

    Forget about what is legal/illegal in Colorado..you live in TX now.

    I agree with ElleMD in saying ''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.'', a muscle strain would have resolved by now, or at least one would have to suppose this is the case.
    You should not expect too much more than 1% or 2% in a PPD rating. That won't pay much more than the value of your food stamps.
    My kids are kinda in that obese catigory. No one can feed kids like that on $200 a month. Especially not when they are growing too.
    I don't want to get too much into your personal "stuff", but since you brought this up... possibly this would be a good time, considering your budgetary constraints... to adjust your children's eating habits, and hopefully get the obesity issues under control. That would be in the best interests of your entire family.

    Good luck to you...I hope you are able to find suitable work soon.

    Leave a comment:


  • Betty3
    replied
    Those of you who haven't might want to review OP's posting history
    for additional information.

    Leave a comment:


  • TSCompliance
    replied
    Wow, I've been away from LLT for a while, and when I finally come back, this...this is the only active thread?

    This must be a joke. A "half-service escort" goes out on worker's comp due to a strained forearm? How can that not be a joke?
    I recommend you switch to using the other hand and get back to work to support your obese children. Or perhaps save your arms altogether and switch to full-service?

    I smell a troll.

    Leave a comment:


  • ElleMD
    replied
    1. Are you capable of performing any work at all for which you are qualified (and which is legal)?

    2. If yes, you need to do so.

    3. If no, why not? Is it due to this 2 year old muscle strain or for some other reason?

    Leave a comment:


  • QueenInez19
    replied
    Originally posted by ElleMD View Post
    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.
    No I have not worked either one of those. Gratefully, since I have been in Texas I have not returned to escorting at all. I just need another income to help me get by and pay all my acrrude bills (since this case). I just got compensability this past December. I was only granted $764 of TIBS (temporary income benefits). Now everything is at a halt because now I am waiting on a change of designated doctors because the last one left when it snowed in Amarillo on Dec 5 of last year. Now I am like, what am I suppose to do financially because I have 2 kids and they are suffering here? We get food stamps but that is not enough. That is only $200 a month. We all eat more than $200 a month worth of food. My kids are kinda in that obese catigory. No one can feed kids like that on $200 a month. Especially not when they are growing too.

    However, I am suppose to go to an impairment rating but I do not know when that is the part that has been on a halt. I was told that may not happen until March of this year because worker's comp has until the 15 of Jan to get another designated doctor and 30 days after that to reschedule the appointment. That is why I said earlier it will not be until after the impairment rating is when I will start getting impairment benefits for a month. Now is it a lot more clear about the financial bind I am in because while I have to wait for all this stuff to happen I still need to be able to make a living for my family because I am a single mom.
    Last edited by QueenInez19; 01-05-2012, 10:06 AM.

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  • QueenInez19
    replied
    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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  • ElleMD
    replied
    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.

    Leave a comment:


  • Betty3
    replied
    I'm glad we have you, CAIW, to answer the more involved WC questions.

    Leave a comment:


  • CAIW
    replied
    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.

    Leave a comment:


  • QueenInez19
    replied
    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.

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  • QueenInez19
    replied
    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.

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