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THE WORK COMP BLOG

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Workers Compensation Fraud by Employees Gets Lots of Press while Fraud by Employers Costs Big Money

We see regular media reports of employees filing false workers compensation claims, collecting benefits while their Facebook page shows them partying the night away and other actions inconsistent with legitimate disability. Unfortunately, those cases do happen, but it’s not just employees who are trying to work the system. Employers do it too, all too often. How big a problem is it?

In 2011, a New York Supreme Court grand jury estimates the cost to the city and state of New York is approximately $500 million in the local construction industry because employers misclassified the type of work their employees did to get lower workers’ compensation premiums, according to the website Property Casualty 360. The grand jury looked at applications for, and audits of, workers’ compensation policies.

The NY grand jury examined the vulnerability of New York’s workers’ compensation insurance system to employer fraud and misuse and found that the largest losses were from unpaid workers’ compensation premiums, with personal income tax, withholding, unemployment insurance and various other business taxes accounting for the rest. More egregious fraud involved employers misclassifying workers, who are required to be insured under the system, as independent contractors rather than employees, according to New York County prosecutor Cyrus Vance.

Vance is quoted as saying New York’s workers compensation system is vulnerable because it requires employer self-reporting, and is “easily abused by unscrupulous employers who misclassify employees.” He says the grand jury determined, “Employers can easily lie about what work a particular employee performs, for example, reporting a roofer as a clerical worker, and thus paying a significantly lower premium.”

Dishonest employers get lower workers compensation premiums and those lower costs can give them a competitive advantage, according to Vance. “Overall, premium fraud generates an unfair business environment in which honest business owners cannot compete with rogue employers and are either forced out of the market or dissuaded from entering it in the first place,” Vance says.

In 2012, an estimated 30,000 North Carolina employers broke the law by not having the proper workers compensation coverage. If you believe your employer is engaged in workers compensation fraud, you can report it to the North Carolina Industrial Commission Fraud Investigations Section by calling (888) 891-4895.

If you are injured at work and your employer doesn’t have the proper insurance coverage, you still may have options to seek compensation for your injuries. Contact my office for a free consultation so we can discuss your situation.

P: 828-252-2852

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FREQUENTLY ASKED WORKERS' COMPENSATION QUESTIONS

Q. Can I be disabled under WC guidelines if the only problems I have are psychological in nature?

A. Yes. WC law recognizes mental or physical ailments that prevent you from working at your pre injury job or other “suitable” employment making similar earnings. Disability that results from pure mental difficulties are compensable but generally have to be supported by treating mental health care professionals.

What if I have problems after I settle my claim?

DOL Website/p Employment Discrimination Bureau Most insurance companies will try to clinch or close out the claim when they offer a settlement. This means you can never reopen your claim and cannot get any more medical treatment paid by the carrier. Other settlements can be reached that allow you to reopen the claim for at least a two (2) year period after settlement if your condition changes. Whether you should "clinch" or leave the case open for the two (2) year period is an important decision that should not be made without consulting a lawyer.

Q. What if my work injury causes or exacerbates my depression or other mental illness?

A. Work injury related depression and other mental impairments may be compensable under NC Law. Our appellate courts are regularly expanding the consideration of mental and physical ailments that result from your employment and/or inability to work after a physical injury. If you believe your work injury caused or deepened any mental difficulty you might have possessed before or after the actual injury, you should fully discuss your thoughts with your mental counsellor. The Industrial commission is increasingly aware of and open to the concept that mental ailments can be as significant as physical ones.

Q. Do I have to allow my Rehabilitation Provider in the examining room while I am being examined by my doctor for a workers’ compensation claim?

A. No. Workers have an absolute right to a private examination by their doctors. The NC Industrial Commission does encourage the worker to allow the provider to meet with both the worker and the doctor immediately following the examination when the doctor discusses his/her findings and makes his/her recommendations for treatment. This will allow everyone to be aware of and understand treatment plans and expectations.

Q. Can I draw Workers’ Compensation benefits if my work injury only aggravated a pre existing condition I had?

A. Yes. North Carolina Workers’ Compensation law does NOT mandate that your disabling condition be caused by your accident. You may be eligible for Workers’ Compensation benefits if your work injury aggravates, accelerates, or significantly contributes a pre existing condition that makes you unable to return to your job. The law that applies to pre existing condition changes regularly. You should consult a qualified lawyer to discuss the current law on this complicated subject.

Q. How long do I have to file a workers’ compensation claim?

A. As soon as possible, you should file a Form 18 (Notice of Accident or Injury) with the Industrial Commission and employer informing them that you wish to make a claim. While N.C. law requires this Form 18 to be filed within thirty (30) days, an absolute time limit of two (2) years may be applicable to your claim depending on the facts. After your claim is settled, time limits also exist for reopening the case.

Our Video Library is not closed-captioned.  Instead of embedding our videos, we have created posts for them, where full transcripts of can be found.
Click on the links below to view the video and its transcript.

Workers’ Compensation Overview on Vimeo

Workers Compensation Overview

Workers’ Compensation Injuries and the Complex nature of the law on Vimeo

Workers’ Compensation Injuries and the Complex Nature of the Law

Waiting Periods for Workers’ Compensation Benefit Payments

Waiting Periods for Workers’ Compensation Benefits

NC Workers’ Compensation Elements of Settlement

NC Workers’ Compensation Elements of Settlement

Settlements of Workers’ Compensation Claims on Vimeo

Settlement of Workers’ Compensation Claims in North Carolina

Pre Existing Conditions and Work Comp in North Carolina

Pre-existing Conditions and Workers’ Compensation Claims

NC Workers’ Comp Covers Many Different Kinds of Injuries

NC Workers’ Comp Covers Many Different Kinds of Injuries

Reopening Workers’ Compensation Cases

Reopening Workers’ Compensation Cases

Can’t Return To Work After an Injury

Workers’ Compensation Benefits When You Cannot Return to Work

Specific Traumatic Injuries

Specific Traumatic Injuries Under Workers’ Compensation

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David Gantt and his staff handled my disability claim and they were excellent. I highly recommend him, he is the best in Western North Carolina. Mrs. Kelly Reaves 5.0 stars November 5, 2019

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I was very satisfied with David Gantt’s expertise and knowledge in all aspects handling my case. He dealt with all the paperwork and contacted all necessary providers to get my medical history – it was extremely hassle free! He communicated and counseled me on what to expect – being very forthcoming (he’s a straight shooter)!…

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Wonderful client services..very friendly and willing to go the extra mile to help clients. highly recommend him for anyone needing assistance for the Disability SSI. ~T.D.

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