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strong armed by WC carrier
DOI 2/2010
My husband was injured in a motor vehicle accident while on the job. The other driver was at fault. Back in 11/12 the WC carrier submitted an alleged fraud claim as a result of surveillance. The video never showed anything out of his limits set by his doctors and in fact confirmed his injury in many instances. There were a total of 159 video edits and it also included commentary that had no supporting video (things they claim happened and didn't and places they claim he was and he wasn't). Their IME was in his favor and then the doctor rescinded his initial report saying that my husband must have lied. But he also said in the commentary "the claimant is seen pounding his legs which could be an indicator of radiculopathy." After the fraud claim, (which they claim 41 instances = $410,000 in fines + all amounts paid out and are seeking repayment) they terminated his TTD payments without approval from the state and have denied further treatment plans, medicines, but continue to pay the doctors).

Because of the MVA, there is a 3rd party liability. The girl that hit him, her insurance is paying out on her policy. Our attorney drafted a letter to the WC regarding the $20,000 3rd party claim (because of subrogation) informing them that 80% would go to my husband, 20% to me, less attorney and court fees. The WC sent a letter back accepting and also proposed that if he stops further claim, they will drop all charges! It makes me sick to think that this has been their intention from the get-go. They have wanted to scare him into submission. And now they have him right where they want him.

He also has 2 other potential recovery claims from our underinsured motorists coverage (as well as the company vehicle). His doctors have unofficially rated him at near 100% disability.

What should we do? I HATE the fact that they are gonna get away with committing their own fraud. It's not about the money. WC is limited anyway and with the other bodily injury, etc. insurances, he/we should be okay. It's about the principle. He doesn't want to give in. But even if the hearing officer rules in his favor (attorney thinks there's a 90%+ chance they will) the WC will file an appeal and can appeal all the way to the district courts, which could draw this out for years to come. And the fact that there is a slim chance that he loses because we all know there are stupid people everywhere and leaving it to our legal system is certainly a gamble we are struggling with what to do.

Losing sleep.....
you need more information on the consequences of not settling.
will your husband's attys stick with the decision to continue fighting the case?
how far will they go? will they want off the case during the appeal process?
how will you and you husband make out if it does take another 2 years?
generally the settlement offers come more frequently and with higher amounts the more likely there will be a court hearing and unfavorable judgement. is this the first offer?
if there is a 90% chance of winning the first round what is the likelihood of a better offer later?
you seem angry that they offered to drop the charges?! would you even consider a settlement if they didn't drop the charges?

what about also including in part of the settlement a written statement from them that there was no fraud and an apology?
it's also fraud to falsely deny benefits?
has your husband counter filed?
has he filed for penalties?

these are the types of discussions your husband should be having with his atty.

Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
WC loves to play games and get us to be mad and upset. This works for some because we get so ready to be done with them we settle for anything they offer. One of the best things for this is to know your not alone. I know that doesn't provide allot of comfort but remember getting mad and upset is what they want. They do this because they want to save money. Once we get hurt it is a numbers game to them and they sometimes would spend more trying not to pay you. 1171 has some very good advice that will help. Will say a prayer
Thank you for your feedback. The attorney has said he'll see it through to the end whatever we decide. I am angry. He has been yanked every which way by these &#$@*! and continue to suffers daily. I'm not angry that they offered to drop the charges. They've only offered to do this because they're gonna take the money he will get from the no-fault claim to reimburse themselves. I understand that's the law. This is not an offer coming from WC. They offered no settlement, just to drop their fraud claim if he doesn't continue to fight them with the state labor & industrial relations board. He has never been "charged" for criminal fraud. I'm not sure I understand your question: you seem angry they dropped charges...would you consider a settlement if they didn't drop charges...again, they're not offering a settlement. They are accepting the subrogation money and then proposing to drop the claim if he walks away.

How he got to this point: they denied an implant procedure and portable 10's unit. He requested a hearing. Went in for the hearing, they introduced the video. Hearing officer was only to rule on the above mentioned issues, went beyond that scope, WC ran with it. Husband received notice from the state, he submitted all his evidence (drs. statements, mri's, etc.), counter claims, penalties, etc. in January......still waiting for hearing on fraud allegations. In March, husband's attorney submitted letter to board re: terminating TTD; requesting emergency hearing to reinstate. WC requested that everything be merged for one hearing, state obliged......August, still waiting for hearing. This is not the 1st offer, 1 1/2 years in, early in treatment they offered a settlement. Attorney advised that it was premature and felt that there were other treatment options to try. Surveillance commenced soon there after, for 8 mths and then they waited 4 months after it ended to submit it to the state; only after hearing was requested on behalf of my husband.

When you ask how will we make out, if you're asking what could come his way in terms of a settlement at the end, statistically the attorney figures somewhere in the $50,000 range with back pay and rating between 5-10% whole body (state is very frugal). I don't know what penalties (if) would be. If you're asking how we'll personally make out, we'll survive.....we've burned through our substantial savings, making it now on my salary from 2 jobs, but it's a struggle. Emotionally, it's draining and there's always a dark cloud hanging over our heads. He is paranoid and rarely wants to go in public for fear someone is following and will take things out of context and twist it as they've already done. I know it's difficult for anyone to grasp the scope of the fraud WC has committed without giving every detail and allowing you/discussion board members to view the video and other information for yourselves. I can only tell you that those who have viewed it are astounded at what WC has done (including former WC workers). That's why we are really torn, we want to hang in there, but it's also tempting to lift that dark cloud and move forward on the other claims and chalk this up to a life experience.

I really appreciate the points you have brought forward and will definitely pose the questions to the attorney.
(08-10-2013, 01:09 PM)Manley2 Wrote: WC loves to play games and get us to be mad and upset. This works for some because we get so ready to be done with them we settle for anything they offer. One of the best things for this is to know your not alone. I know that doesn't provide allot of comfort but remember getting mad and upset is what they want. They do this because they want to save money. Once we get hurt it is a numbers game to them and they sometimes would spend more trying not to pay you. 1171 has some very good advice that will help. Will say a prayer

Thank you Manley2! It's really sad that there are so many going through the same issues. Yet, we know it is a reality. I do feel, with their proposal to drop the fraud claim, that the scales have possibly tipped somewhat in his favor. My question as my brain goes 280 on this, they stopped TTD (11/12) without approval based on fraud, but yet now they're willing to drop the fraud. Isn't that an admission of some sort that they terminated TTD fraudulently??? Like I said, our heads are spinning. We want to weigh everything to make the most informed decision possible.
The insurance company's put injured workers thru their games to try and get us to back down on our.

I was injured 2005, bilateral knees and lumbar spine. I was sent to 13 doctor's on the knees because the insurance company kept trying to get a doctor to say I did not need a knee replacement, which never happened but did delay the surgery for 3 years due to being tied up in court.

I am also involved in the settlement process due to an auto accident, not work comp related. I recently received a letter from the other driver's insurance company say they would not pay because my injury was for the cervical spine which had been previously injured and resulting in surgery/2011.

The injury per the auto accident had nothing to do with the cervical spine, the auto injury was for the thoracic spine.

Point is the insurance company grasp for anything that will reduce their liability.

And the cervical spine injury was caused by the treating work comp doctor the appointment previous to being place at MMI.

There are two discussion forums, the off topics forum is where injured workers chat and support each other.

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