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Work Comp Lien with Fradulent Amounts
#1
Hello all, thank you in advance for your help. I have found many answers on this board and you have helped me greatly in navigating the difficulties of workers comp.

I have an open comp case in NJ. I settled a 3rd party case for my injury and have a settlement. My work comp carrier has provided my lawyer with a lien sheet.

I went through the lien sheet and found MANY errors that were (not surprisingly) all in the carriers favor. I have started to collect information from doctors and facilities on what they requested for payment, and what the workmans comp carrier (who will remain nameless for now) actually paid. So far, I am over 11k in overcharges. I asked my lawyer to request all bills and receipts form the comp carrier for the lien, and they have been dragging this out for about 3 weeks so far. Some of the doctors offices that I have called have even told me that they got a call from the carrier for copies of the bills as well (I guess the carrier doesn't keep copies either electronic or hard copies).

So, my lawyer is kind of not putting any pressure on them as the settlement amounts are in an escrow account, so he knows that he will get paid (also, forgot to mention that my 3rd party lawyer is NOT the same as my WC lawyer). My question is, are there any laws that prevent the WC carrier from trying to charge fraudulent amounts? I called the state of NJ workman's comp fraud line, and they stated that they don't handle this (as it isn't an employee filing a fraudulent report). Is there anything that anyone can think of that I can do in this case? Any agencies that anyone can think of?
 
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#2
there are civil/criminal laws against fraud-insurance and otherwise.
you just have to have copies of the carriers actual check payments before releasing any monies to them.
there is no fraud until they have actually received payments for which they were not entitled.
you should talk to your civil atty about the verification process.
you can subpoena their billing and payment records and only pay what is supported.
usually the lien is required to be "proofed up" before any civil settlement and subrogation is approved. it can be sticky after the fact.
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.
THANKS FOR POSTING.
 
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#3
Thanks for the response 1171

I have a request for copies of all of their bills and cancelled checks, and they state that they are "getting them together". I hope that it will be an easy process..... well maybe just a quick process will be good enough Smile.

If I have my lawyer subpoena the records, do they have a time frame which they have to get the records together by? I have a feeling that the insurance company is trying to "wait me out" to get me to just okay the amount that they are requesting.

My lawyer said that "we usually just take what they state as fact and everyone just signs off on the lien".

It pays to read each and every line and check them against your own records (in my case, it was as simple as checking the dates of service against my calander.
 
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#4
like most things a reasonable time frame is up to the court to decide.
at some point just petition for a release of the balance of the withheld amounts with your objections to any of the unproved items.
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.
THANKS FOR POSTING.
 
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#5
Thank you again 1171 for your advice. I will update this thread with my outcome (in case it helps others)
 
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#6
(06-17-2015, 06:52 PM)samistheman Wrote: Thank you again 1171 for your advice. I will update this thread with my outcome (in case it helps others)

When are you going to update this?
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.
THANKS FOR POSTING.
 
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