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swcolorado
March 12th, 2011, 07:19 PM
I am really struggling with something right now and just don't know what to do. I have an employee that I think is cheating the system on a workers comp claim. She said she fell on the ice and hurt her neck. I have seen the doctors report and they say she has a neck strain and that's it. She's telling people that she either broke her neck or blew out her disc or something. I know that's not true. This has been going on for 5 months now and she still isn't working full time. She can do everything but come to work; she can bowl, travel, etc etc. She gets very upset at me if I try to say something about whether her claim is valid. She is actually making more money by being on work comp that when she normally works because they take no taxes out.
My question is this...how do i treat her? I really don't want to have anything to do with her and am appalled that, as a Christian, she's cheating the system. It doesn't seem to bother her one bit. Am i supposed to counsel her and just deal with the fallout? I have have a hard time not being very, very angry at her.

RuntheRace
March 12th, 2011, 08:52 PM
What I say comes not from supervisory experience, but the experience of being the co-worker of folks "working the system."

You said she is your employee- I take it your responsbility in this situation is as her supervisor. Of course, your first place to turn is prayer for wisdom and guidance. We have some similar situations at present within our department and my supervisor turned to both HR and a labor relations attorney to determine what options were open to address the situation, what had to be done, and how to document everything so that the "i's were dotted" and the "t's were crossed." Review any company policy on sick time/disability. So I would receive much counsel from whatever sources are available (including your boss unless you own the company) before I attempted to cousel her in any way. I am certain that if she is claiming there are numerous duties she cannot perform that your company has a right to a doctors statements to document these things for both her and your protection- and be prepared that if she indeed is manipulating the system that she has probably found a doctor who for the right fee will sign whatever waiver she needs.

As far as the broader issue of worker's comp fraud- if you have actually witnessed her doing things that her "injury prohibits her from doing" most states I believe have anonymous hot-lines where such activity can be reported. I am not encouraging that or encouraging such reporting, just reminding you that many states have such as avenue to report such activity

Acts5:41
March 12th, 2011, 08:56 PM
Well, the Bible says not to steal.

Claiming you cannot perform an activity you can is breaking commandments. And breaking the law.

I would report her; it should be easy if she is out bowling and all. We have at least one investigator at work who does this fulltime.

In fact, he approached my husband and I one day. "I just helped arrest someone for filing a fraudulent work injury claim. When we were cuffing him, I told him I knew a blind man in a wheelchair who went to work every day, and worked hard. I told him he could learn something from you!"

True. My husband is multiply-disabled. So am I. We work very hard, as much and as hard as we can, running our own business.

It makes me very angry when people fake disability. I don't feel qualified, as a result, to advise you on the relationship; other than to say don't act too different if you report her.

Grtful1
March 13th, 2011, 12:04 AM
If your worker's compensation carrier is not part of your company but a separate company, you may be able to suggest to the adjuster that they may want to do some Subrosa on her (this is where they secretly videotape her doing things she shouldn't be doing).
The nuts & bolts is what the treating doctor puts as her restrictions. If the doctor gives her a weight restriction of, say 5 lbs., and you know that she uses a 10 lb. bowling ball, then she is in trouble if they capture that on videotape. (just an example.)
She can be prosecuted for insurance fraud and be required to pay back any money that she has untruthfully taken.
It all depends on what the treating doctor writes in the report.
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We are called to be examples to this world and, while I know we all fall short, the fact that she's so "in your face" about it could make her witness hard for others to overcome.

Glory in print
March 13th, 2011, 12:31 AM
I am really struggling with something right now and just don't know what to do. I have an employee that I think is cheating the system on a workers comp claim. She said she fell on the ice and hurt her neck. I have seen the doctors report and they say she has a neck strain and that's it. She's telling people that she either broke her neck or blew out her disc or something. I know that's not true. This has been going on for 5 months now and she still isn't working full time. She can do everything but come to work; she can bowl, travel, etc etc. She gets very upset at me if I try to say something about whether her claim is valid. She is actually making more money by being on work comp that when she normally works because they take no taxes out.
My question is this...how do i treat her? I really don't want to have anything to do with her and am appalled that, as a Christian, she's cheating the system. It doesn't seem to bother her one bit. Am i supposed to counsel her and just deal with the fallout? I have have a hard time not being very, very angry at her.If she really is cheating the system, then you should hire some legal counsel (to make sure your protected before you take any action against her) and then deal with her accordingly... I think you would be doing the wrong thing by letting her get away with it... Not only is she ripping of the system she is also ripping you off because without her working full time that's one less worker you have working for you... I would question if someone really was a Christian and lived easily with this kind of deceit with no remorse at all... The bible makes it clear a thief and a liar can't enter the kingdom of heaven well at least an unrepentant one can't.

HugsFromJesus
March 13th, 2011, 07:36 AM
I was a nurse before I became disabled and believe me I tried every kind of job and different hours I could before I applied for SSD. To me, it was humiliating, because most people want to be a productive member of society, at least the honest ones do. I am one of them.

One of my jobs was medical managing Workers Comp injuries from start to finish. I worked for a firm that either insurance companies or employers would hire us to follow a workers comp. injury from start to finish. We were all nurses and as the cases came in, we would get assigned to them individually. I usually had a case load of about 30-40 injuries at a time, always some being resolved and others just starting. I worked from home and traveled alot during alot of the days.

To start, I would be handed a file with a name and where this person was, either in the hospital or at home. I would do an initial visit immediately, I usually aimed for their homes as you could tell alot about someone from their environment. This initial visit was very extensive. Many of the claimants had attornies attached to them and those always raised red flags as to why someone would get a lawyer on board so quickly, with an injury that hadn't yet truly been diagnosed properly yet.

Most of my cases were in center city Phila. and alot of the claimants were State workers, as the State was a huge client for the company I worked for. I would access their injuries and go to their Dr. appts. with them and have the Dr. send me a report on their findings after they examined them. I always got second opinions with some of the best known specialists in Phila. Nobody ever refused my presence in the exam room, but I always gave them privacy and told the Dr. that I would speak to them after the appt. in their offices. Some claimants wanted me to stay, they were so overwelmed, I was their "friend" in their time of need. When I used these specialists which I would get to know very well from all my repeat visits with different clients, I felt more assured of the validity of their claims than when they came from their own Dr. The nurses always exchanged info on the best of Dr's and PT's and we would then take each others advice and use them. We especially wanted reports sent to us in a timely fashion.

I would visit their surgeons if they needed surgery, I would visit their Physical Therapists while my claimant was doing PT, I would visit their attornies with them, I would visit their places of employment and talk with their bosses about what they expected upon their return and whether they could come back light duty and for how long etc. I was their advocate if they were legit because I took care of setting up all appts., arranging for transportation and doing all the things that they were not up to doing because of their injury and they loved me as I saved them many headaches.

The frauds I could spot a mile away. They resented me. Even though I always had the claimants sign off on releasing their medical records to me, I would find out some of these Dr's were sending only what they wanted. There is great fraud going on and in many cases the Doctors and the claimants were working together and the Dr. would get 10% of the claimants checks by keeping them disabled in writing. Some Doctors would have 100's of workers comp. injury fraud patients and from the ones I found out about, they lost their licences and/or werein prison.

I would put surviellence on suspecting claimants and the detectives would video them and more times than not they were caught. One had 8 under the table jobs, some in plain sight. They just didn't care. But the attornies were shrewed and would get them off by saying "yes, they were videotaped for 4 minutes, not for 8 hours", which never made sense as they were doing work in some cases that in those 4 minutes they used more strength than in 8 hours of their normal jobs. The judges were a piece of work in many cases also. The whole system stinks because it is abused so much and nobody cares.

What broke my heart were the claimants that truly had catastrophic injuries due to neglect from the employers and it wouldn't even occur to them to get an attorney. They just had faith that they would get better and they were very loyal to their employers. Even though I was not suppose to do it, I would tell them to get an attorney and get what is due to them. Some employers have very dangerous working conditions and they should be accountable.

I find it very suspect that your employee does not feel remorse and also that she tells people or people witness her doing things that conflict with her disability. I know the ones that were really injured didn't want to beat the system, they felt bad about their jobs. This is normal behavior, especially from a Christian.

At the beginning I was getting old cases that I had to follow up on as these people were out on disability for years and the State wanted to know why, so I would start all over with them. Sometimes the State created their own problems as they wouldn't hire enough adjusters and these files I was handed these claimants hadn't seen a Dr. for years. Their injuries (most of the time there wasn't one) were just ignored and they got away with alot. Then all of a sudden I came on the scene and I could see the panic in them. Finally the State got smart and started giving us the cases from day 1 so that we could create a care plan for them that was honest and beneficial in weeding out the scams.

Every month I would have to submit to the State a detailed summary of all the activities of the claimant that month and I had alot of claimants at a time. I would include what appointments did they have, PT, do they cancel alot, what their health care providers were saying about their injuries and expected outcomes for every turn of events. I would dictate it and the secretary would type them up and mail them.

I am wondering if you are not the owner of your company, if the owner would be able to hire a case manager and get this settled once and for all, because sometimes it is cheaper to get to the nuts and bolts of these injuries(?) because they can go on for years and years and it is really cheating the employers and the system.

I know as a fellow Christian you don't feel like you want to make waves but this employee is in essence lying to everyone involved and doesn't seem to care. I would confront her in the nicest way possible and ask her how she thinks God would want her to handle her situation. Sorta like a WWJD!

Are there other aspects of her demeanor that appear Christian-like because this appears very suspect? The fact that she doesn't care is very strange.

Sorry for the long post, I am long winded. I just wanted to let you know that these places existed. When I worked at this in the 1980's-90's I could name you 10 Medical Management firms, now I have no idea if they are still in business, with the ecomomy the way it is. It wasn't cheap for anyone to turn a file over to us but in the long run we saved them alot of money.

I am praying for your situation, it is a tough one to be in. :pray