Workers’ compensation claims are investigated to prevent fraud. What is workers’ compensation fraud?
Basically, it is when someone:
- Fakes or exaggerates a work-related injury
- Misrepresents a non-work-related injury as a work-related one
- Works while collecting workers’ comp benefits.
While most workers’ comp claims are legitimate, fraud does happen. Unfortunately, fraudulent claims take resources away from the workers who truly need them; also, they can make it harder for deserving people to receive benefits.
To combat fraud, employers, insurance companies, and the Ohio Bureau of Workers’ Compensation investigate to make sure that the people receiving workers’ comp benefits are actually injured, and actually deserve the benefits.
If you are applying for workers’ comp benefits, or facing an investigation, you need to know what workers’ compensation investigations look for. That’s because even truly injured workers can make mistakes that look like fraud—accidentally sabotaging a very real claim. You don’t want to get caught in the net that’s meant for fraudsters and scammers!
Let’s look at workers’ compensation investigations: what they look for, how long they take, and when to call an attorney.
What Do Workers’ Comp Investigations Look For?
According to the BWC, workers’ comp investigations often start because of certain “red flags,” like when the injured worker:
- Isn’t available to answer calls at home or attend exams and appointments
- Files a claim at the end of seasonal or temporary work
- Performs physical activities that are inconsistent with the limitations they reported from their injury
- Has a history of filing claims
- Has no eyewitnesses for their claimed injury (or the witnesses have conflicting accounts of what happened)
- Continues to work despite claiming “total disability” benefits
- Gives their prescribed narcotics to other people or tries to get multiple prescriptions from health care providers
In addition to the workers’ comp claim documentation submitted by the employee, investigators may examine things like:
- Surveillance of the worker by investigators
- Surveillance tapes from the employee’s workplace or from places the employee frequents
- Photos, videos, and status updates/posts posted on the employee’s personal social media pages, or the social media pages of the employee’s family and friends
- Text messages, GPS data, and other cell phone data
Investigators may also talk to the employee, the employee’s supervisor and colleagues, and other potential witnesses.
Is the Injury Real, Exaggerated or Fabricated?
Investigators look for any evidence that suggests that an employee hasn’t been injured at all—or if they have, that the injury isn’t as serious as the employee said.
For example, in one now-famous case, a Florida woman was convicted of workers’ compensation fraud after investigators discovered evidence from workplace surveillance tapes. While the woman said that a ceiling sprinkler fell down and hit her on the head, the tapes showed the sprinkler falling onto the woman’s desk. The tapes then showed the woman hitting herself with the sprinkler head.
In another example, a California firefighter plead guilty to workers’ comp fraud. While he was, in fact, injured, he was accused of lying about and exaggerating his physical disabilities after the injury.
Is the Injury Really Work-Related?
Investigators also look for proof that an injury wasn’t work-related. (Remember, workers’ compensation claims only cover injuries that happen at work or in the course of your job duties. You can learn more about this topic in a previous blog post.)
Here is a recent example: a Washington man claimed he hurt his hand at his manufacturing job. However, multiple witnesses contradicted his story—telling investigators he actually hurt his hand punching someone in a bar fight. Then, investigators found the man’s text messages talking about faking the claim.
Is the Employee Still Working?
Finally, workers’ comp investigations seek to determine whether the injured worker is working another job or misrepresenting their income.
In Ohio, for example, a man was found guilty of workers’ comp fraud after investigators discovered he was working for a tree service company while receiving “total disability” benefits for a previous injury.
How Long Is This Going to Take?
The BWC starts the process of gathering information and investigating a claim immediately after receiving the First Report of Injury. Then, they decide to accept or reject the claim within 28 days.
If your claim is accepted, you can start to receive benefits right away. However, if your claim is rejected, the appeals process will take longer.
Finally, if the BWC has evidence of fraud, investigators will often refer the case to local authorities for prosecution. (Obviously, this is not something you want to face!) Criminal investigation of workers’ compensation fraud can take months or even years, with serious penalties for those convicted.
When Do You Need a Workers’ Compensation Attorney?
Having a qualified workers’ compensation attorney on your side can be incredibly helpful—especially if you have a complex case, need to appeal a rejection, or are facing a workers’ compensation investigation.
If you are concerned about the investigation—for example, if the insurance company isn’t returning your calls, or you believe you might be under surveillance—calling an attorney would be a good idea.
An experienced attorney, like the ones at Casper & Casper, will help you gather the evidence you need to prove your workers’ compensation claim. An attorney will also advise you on what to do (and what not to do) during a workers’ comp investigation to improve your chance of success.
To get the help you need with your claim, call Casper & Casper today.
When it comes to personal injury cases, it’s not just physical injuries that count. Did you know that you can also be compensated for psychological injuries?
If you developed a psychological injury in an accident or traumatic event caused by someone else, you can seek compensation—just as you could if you had broken a bone or had internal bleeding.
Let’s talk about psychological injuries, including what they are and how a personal injury lawsuit can provide compensation for them.
What Are Psychological Injuries?
To put it simply, psychological injuries are those that affect a person’s mental and emotional health. Psychological injuries include conditions like:
- Traumatic brain injury (TBI)
- Panic disorders
- Stress-related illnesses
- And more
Psychological injuries can be directly caused by a physical injury to the brain. Traumatic brain injury (TBI) is an example of this: a physical injury to the brain can result in changes to a person’s mental state, causing symptoms like anxiety, aggression, confusion, and difficulty remembering things (just to name a few).
Psychological injuries can also be caused as a result of injury to a different part of the body. A serious, disabling injury can very negatively impact a person’s quality of life. As a result, that person might develop depression or a stress-related illness, for example.
Finally, psychological injuries can occur even without a physical injury occurring. For example, someone might develop insomnia or PTSD from a traumatic event (like a car accident), even if they escaped with few serious injuries.
Psychological injuries can be very serious—no less severe than a physical injury. These conditions can have a big impact on a person’s quality of life—making it difficult to enjoy favorite activities, perform daily tasks, or even make a living. Also, some psychological injuries are so severe that they cause physical symptoms. (Anxiety, for example, can cause headaches, dizziness, and an upset stomach.) You deserve compensation for a psychological injury.
Damages for Psychological Injuries
In personal injury lawsuits, we refer to the compensation that you can receive as “damages.”
What do these damages cover? Well, damages may be awarded to cover things like:
- Medical bills (including the cost of care you’ve already received and care you estimate you’ll need in the future)
- Lost income (including wages for work you missed and paid time off—like PTO and vacation—you used, as well as estimated future wages if you are no longer able to work)
- Mental anguish and emotional distress
If you are suffering from a psychological injury, these damages might be awarded to cover things like doctor’s appointments, diagnostic tests, treatment by a mental health provider, and the distress you’ve experienced because of the condition.
The amount of damages you can receive depends mostly on how severe the injuries are. For example, a broken bone would receive lower damages than an injury that caused internal bleeding and required surgery. A physical injury that healed quickly would receive lower damages than one that caused a chronic issue or permanent disability. Psychological injuries are compensated in a similar way.
Do You Have a Case?
Cases with psychological injuries can be trickier than ones with physical injuries alone.
Unlike physical injuries that you can actually see, it can be harder to quantify psychological injuries. Basically, it’s hard to tell how bad the injury really is.
On top of that, due to the stigma around mental health, many people don’t always get the treatment they need for a psychological injury. This means that there is less evidence to prove the injury later.
As a result, psychological injuries can sometimes be harder to prove, and harder to get deserved compensation, in a personal injury lawsuit. For this reason, it’s especially important to have a good personal injury attorney in a case involving psychological injuries.
A qualified attorney can evaluate your situation and tell you if you have a case, as well as what damages you might expect. Your attorney can also help you gather all the evidence you’ll need to show that you are truly suffering from a psychological injury—gathering documentation to prove your diagnosis, treatment costs, and the injury’s effects on your life. Finally, your attorney will use this evidence to argue for the maximum compensation you deserve for your injuries.
Contact Casper & Casper Today
If you experienced psychological or physical injuries because of someone else’s carelessness or negligence, we are here for you.
The personal injury attorneys at Casper & Casper have extensive experience helping people just like you receive the compensation they needed to put their lives back together.
If you’d like to talk about your case, contact us for a free, no-obligation virtual consultation. We’d be happy to discuss your options and let you know how we can help you. Call us today.
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