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Is this workers compensation fraud?
#1
Would this be considered insurance fraud by the employer? I’ve called the DA today and they said it’s the department of insurance who looks into it. The department of insurance said its the wcab.

I’ll keep it simple so I don’t confused anyone.


Date of incident: 1-1-18(this is the date of the alleged misconduct)
Date of injury: 2-1-18
Date of termination: 2-10-18
Date of denial: 2-20-18

I was terminated on 2-10-18 for misconduct. On 3-10-18, the employer submitted a separation letter to Edd and the IC showing the last day of work as 2-10-18. They also noted that day as the date of last misconduct.

Which entity or agency can investigate this? I feel the employer willfully changed the date to try and avoid increase in premiums and to avoid paying benefits. I strongly believe the adjuster is aware and participated to cover it up.
 
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#2
You need to contact an attorney to help you with this to determine if it is fraud. Not enough facts by listing dates. For example if an employee stoled money from a cash register, then had an injury claim and after they the employer found out about the theft, the termination would be warranted. No one on this site could answer these types of questions. I know you are upset about what happened to you. I think you are just going to have to wait and see what the judge rules on these issues. Try to get an attorney in the mean time. Don't let it upset your holidays.

It is illegal for an employer to discriminate against you because you requested workers' compensation benefits or because you have a work-related disability. This is prohibited by California Labor Code section 132a, the federal Americans with Disabilities Act (ADA) and the California Fair Employment and Housing Act (FEHA).

https://www.dir.ca.gov/fraud_prevention/...-Fraud.htm
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#3
(12-06-2018, 07:38 PM)California_Help Wrote: You need to contact an attorney to help you with this to determine if it is fraud. Not enough facts by listing dates. For example if an employee stoled money from a cash register, then had an injury claim and after they the employer found out about the theft, the termination would be warranted. No one on this site could answer these types of questions. I know you are upset about what happened to you. I think you are just going to have to wait and see what the judge rules on these issues. Try to get an attorney in the mean time. Don't let it upset your holidays.

It is illegal for an employer to discriminate against you because you requested workers' compensation benefits or because you have a work-related disability. This is prohibited by California Labor Code section 132a, the federal Americans with Disabilities Act (ADA) and the California Fair Employment and Housing Act (FEHA).

https://www.dir.ca.gov/fraud_prevention/...-Fraud.htm


Its past the statue so an attorney wouldn’t help. I’m working with Department of Industrial Relations currently. I just wanted to make know in case there is a trial.

The misconduct is not in the handbook and the business has been conducted that way for many years. It was a closed file that was approved and documented by another HR rep.

I think I contacted Feha already but I didn’t have these facts.

Thanks
 
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#4
I am very sorry for what happened to you and hope the judge rules in your favor at your hearing.

In the mean time I HOPE you are getting the things together to apply for that benefit we discussed above. If you qualify for it, it is a check for 5 grand. You can apply online too. If you are having issues with applying I will try to help.

I know it can be hurtful and devastating to feel like your employer is taking advantage of you (especially when all you did was get hurt at work). The HR department is there to protect the company, not the employee. I hope one day you will look back at this and be thankful to not work there anymore. Usually when employers do the things you have described, they do not value their employees. Remember that this time in your life, the struggles you are going through is temporary.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#5
[quote='California_Help' pid='168527' dateline='1544206363']
I am very sorry for what happened to you and hope the judge rules in your favor at your hearing.

In the mean time I HOPE you are getting the things together to apply for that benefit we discussed above. If you qualify for it, it is a check for 5 grand. You can apply online too. If you are having issues with applying I will try to help.

I know it can be hurtful and devastating to feel like your employer is taking advantage of you (especially when all you did was get hurt at work). The HR department is there to protect the company, not the employee. I hope one day you will look back at this and be thankful to not work there anymore. Usually when employers do the things you have described, they do not value their employees. Remember that this time in your life, the struggles you are going through is temporary.
[/quote

I believe this is just another stepping stone I have to overcome to be a stronger person and better person. To still have a roof over my head is a miracle on its own since I’m two months behind. It gives me strength to know that there’s at least one person who isn’t pointing fingers at me. I think its important for a person to have a conversation with another person or one can lose sight of reality.

I havnt been able to go see an I&A officer to help me apply. I can’t afford the parking fees and I’m beginning to think they aren’t really there to help me.

I should be receiving the report any day now. There’s a few attorneys that is willing to take my case but I’m not if it will be what he said during the evaluation.

Thanks California help.
 
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#6
California help? My report came in but I don’t know what it all means. It’s well over 20 pages. I think it says I’m not p&s and need more treatments.

It says if employer can not accommodate modified duty then ttd is reasonable
 
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#7
(12-08-2018, 08:15 PM)Lostandconfused Wrote: California help? My report came in but I don’t know what it all means. It’s well over 20 pages. I think it says I’m not p&s and need more treatments.

It says if employer can not accommodate modified duty then ttd is reasonable

Usually the last few pages is where the doctor writes patient if patient is P&S or not, but it sounds like you found it.

Your former employer is using the argument you were terminated with cause and denying TTD. Since you are in contact with the defense attorney you can reach out to him and state you received the report and want to know if they are going to now pay you all TTD owed. If he is not then I would recommend to hire an attorney. I think you have a court date soon over this issue, but you can always try to work things out with the defense attorney beforehand.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#8
(12-09-2018, 12:04 AM)California_Help Wrote:
(12-08-2018, 08:15 PM)Lostandconfused Wrote: California help? My report came in but I don’t know what it all means. It’s well over 20 pages. I think it says I’m not p&s and need more treatments.

It says if employer can not accommodate modified duty then ttd is reasonable

Usually the last few pages is where the doctor writes patient if patient is P&S or not, but it sounds like you found it.

Your former employer is using the argument you were terminated with cause and denying TTD. Since you are in contact with the defense attorney you can reach out to him and state you received the report and want to know if they are going to now pay you all TTD owed. If he is not then I would recommend to hire an attorney. I think you have a court date soon over this issue, but you can always try to work things out with the defense attorney beforehand.

Yes, I will have a better chance to hire an attorney. I know that they can get really busy but what are a few things to look for when choosing an attorney. I would prefer to find one that will do the intake. I went to several appointments and I never saw the attorney. I feel that it would be better to meet in person other than a picture on the web.

I havnt contact their attorney yet. I’m still putting together my evidence so I can send it to the qme. All they have is the separation letter from the employer and they’ve sent it to everybody. I guess some people just believe it’s true if it’s on paper. The IC and the employer has been printing and writing whatever they feel will benefit them.

Their most recent denial letter doesn’t have any labor codes nor medical evidence. It just says to contact the adjuster if I didn’t agree. He doesn’t take my calls and forwards everything to his attorney. Isn’t this system great?

Hopefully they ran out of tricks.
 
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