WC injustice

T · July 2003

I have previously posted regarding this situation.

I have an ee on wc. When I placed him on FMLA he was told to contact the er weekly, which he has not done. I then wrote him a letter telling him to contact us weekly and to call during working hours, because if he did call it was always late in the evening or after 8:00 p.m. When we try to contact him, he never answers the phone, however, if we call him from a cell phone, he will answer.

I have discovered that he is going to school at a college (at least a 45 minute drive to get to this school) to get his cdl license. The doctor will not put him on light duty because ee says he is in constant pain and can not drive back and forth to work (35 minute drive). I have also seen the ee taking his wife to work (25 minute drive). I have talked to my ins. carrier about this and he says there is nothing we can do unless he is working at another job and is receiving wages. This doesn't seem fair, actually the whole wc red tape bull isn't fair, anyway, surely there is something we can do about this?

Also, the letter I sent him about contacting us weekly also stated that his insurance premiums have gone up and he needs to start paying those and he has keys to his dept. that we need. He has not responded to the letter.????

aingram · July 2003

Have you thought about having a private investigator? If this is a worker's comp case, you could get him for fraud. If you are self-insured, all you have to do is tell your carrier that you want it done and they should comply. I have used this method several times and have stopped worker's comp abusers. Hope this helps.

Amanda

Don D · July 2003

Your insurance carrier has nothing to do with FMLA. I assume the insurance carrier was referring to Comp. If you have someone out on FMLA and the certification you made was based on a medical conclusion that the ee could not drive to work, then you should consider sending the ee for a second, employer-paid, examination. If the ee is out because he cannot drive, but is driving and attending a rigorous driving school, I would proceed to cancel the FMLA approval.

T · July 2003

I placed him on fmla after his wc injury.

My wc insurance carrier said it would not be worth hiring an investigator because we're not claiming the ee is working. The insurance carrier said wc fraud is when you're ee who is on wc is working for someone else and receiving wages.

I placed him on fmla because he is out with his own serious illness (hurt on the job, back/shoulder injury). All this is very confusing. I just want to stop him from receiving wc wages. I know he can work if he's driving back and forth to school. His light duty release would only be sitting in front of a computer and doing paper work, no heavy lifting.

LindaS · July 2003

I would talk to someone higher up than the claims adjuster you are currently working with. I have utilized invetigators in the past and it is amazing with the information they can find. For the claims adjuster to inform you that the investigator is not worth it is unbelievable. The EE is currently receiving TTD payments based on information provided by his physician yet has been seen engaging in the behavior his physician says he cannot do so if you can get proof that he is able to engage in that behavior, you may be able to force him back to work and stop the payments. The other option is to have an IME done to determine what the current status is of his injury. You can then make the determination what he can and cannot do and get him back to work.

Margaret Morford · July 2003

Don't forget that he must be sitting in class a certain number of hours per day. An investigator should be able to get his class schedule and find out he's taking 6 hours of classes per day, etc. The person above is right. You should go above the person you're dealing with and make your WC carrier investigate this claim.

Margaret Morford
theHRedge
615-371-8200
[email]mmorford@mleesmith.com[/email]
[url]http://www.thehredge.net[/url]

Don D · July 2003

I frequently read that so called comp-claims analysts give really erroneous opinion statements. It's as if they recruit somebody, give them a couple hours training and turn them loose on us employers. And that's exactly who they are being turned loose on, US.

That is an inaccurate statement by the comp staff member. I agree with immediately going over his/her head. Also tell that next level person exactly what you were told, when, by whom. And I wouldn't go through that junior level person to ask them to have their supervisor call me. It mysteriously won't happen. Comp fraud has thousands of times been proven in cases of bull riding, fishing, shooting hoops, changing car oil, roofing a house, skateboarding, painting on a scaffold and pushing a car down the street. And NONE of those activities represented working for another employer OR drawing a wage, only screwing the system. You might be screwed twice in this scenario; once by the employee and again by the comp 'expert'.

T · July 2003

Thanks everyone for your input. First thing Monday morning I will be contacting my WC carrier.

T · July 2003

Well, I didn't wait until Monday. I just talked to my case managers supervisor and they are getting an investigator right on this case.

I also have updated news on the ee. He is now living in Houston from Monday - Thursday and driving back home (1 1/2 hr trip) on Thursday evenings. I sure hope we can stop this kind of "fraud"???

WC injustice

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