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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. When is my first WC disability check due?

A. WC law requires the insurance company to pay you 66% of your pre injury gross wage for each week you are unable to work. The first check is due on the 14th day after the injury. No compensation is due for the first seven (7) days of lost time unless you are out of work over twenty-one (21) days. If you miss more than twenty-one (21) days of work, a check for the first week of missed work becomes due.

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.

Q. If I make a settlement in a personal injury arising out of a work injury, do I have to pay the workers’ compensation insurance back for money they have already paid me?

A. Sometimes. NC law is very complicated on these obligations. A Superior Court Judge can be asked to set what, if any, lien is due the workers’ compensation insurance carrier when a settlement is proposed on a civil lawsuit over the same accident. Once the Superior Court Judge sets the amount of the lien that is due, the NC Industrial Commission will issue an ORDER concerning disbursement of future workers’ compensation payments. You should consult a specialist in workers’ compensation law to avoid potential liens and pay back requirements.

Q. What type of physical ailments are considered disabling under WC law?

A. The key to the question of whether you are disabled under WC law or not is based on how the physical or mental ailment(s) you have impact your ability to earn money. No exact listing or threshold exists in NC law for what determines a disability. If you are unable to work at the same job you held down before the accident, you are likely disabled under our law. NC law recognizes both physical and mental disabilities.

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

A. NC law requires you to file a written notice of accident with the NC Industrial Commission within thirty (30) days of your injury. You should file the claim regardless of the extent of injury since many small hurts can become major injuries over time. Since the Courts are forgiving of late filings up to two (2) years from the date of accident, you should not hesitant to file your claim even if more than thirty (30) days have passed. While reporting claims can cause some grief from employers, more heartache happens when insurance companies refuse to pay medical bills and other damages because of late filings.

Q. What if I cannot return to any gainful employment because of my work related injury?

A. If you can never return to any type of work because of your workers’ compensation injury, the Industrial Commission can award lifetime benefits. These benefits can include payment of your compensation rate for the rest of your life, plus future medical treatment associated with your WC injury. If the treating doctor determines you are disabled and never able to return to any work, you should apply for Social Security disability as well as any other applicable private or group disability plan. Since some disability benefits are offset or deducted by WC benefits, you should consult an experienced lawyer to minimize these reductions in net payments to you.

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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