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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. 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.

Q. How do lawyers get paid for handling WC cases?

A. Generally, lawyers will charge a contingent fee of 25% of the settlement. Contingent fees are payable only if the case is successful. While most fees are set at the settlement of the case, some fees are collected while the claim is pending. Charging legal fees at any time without approval of the NC Industrial Commission is a Class 1 misdemeanor crime in our State. Most lawyers will advance the expenses of a claim with the understanding that these costs will be recovered when the matter is settled.

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.

Q. Can I draw private disability checks while also receiving workers’ compensation checks for disability?

A. Yes. The terms of your private disability checks are contractual and control whether these payments are pro-rated or changed by the receipt of workers’ compensation checks. NC law requires full payment of workers’ compensation checks regardless of private disability and/or Social Security checks for the same disability.

Q. What if my workers’ compensation doctor assigns a permanent partial impairment (P.I.) rating for my injury?

A. When a doctor releases you from care, a permanent disability rating may be assigned to your injured body part. A rating means that you will never again be 100% healthy in that body part. Whether you can return to work depends on the severity of your injury and how that injury affects your ability to handle the physical demands of your work. If you are able to return to making the same wages as before your work injury, this rating may be your only compensation. However, if you are not able to earn the same pre-injury wages, your rating will not represent your only compensation. Your impairment rating is only one factor the Industrial Commission and NC Law will consider in determining what damages the work injury caused you. NC Law permits you to select the most favorable method or compensating you for the injuries and loss of earning...

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.

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Contemporaneous Workers’ Compensation and Social Security Disability Claims

Contemporaneous Workers’ Compensation and Social Security Disability Benefit

Compassionate North Carolina Social Security Disability Lawyer

David Gantt describes his History in Helping People with Workers’ Compensation and Social Security Disability Cases

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November 2019 AVVO Review

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2019 Google Review

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2019 Google Review

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Google Review 2019

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2019 Google Review

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Avvo Review 2019

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2019 Google Review

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2019 Google Review

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