On April 6, the Court of Appeals denied a North Carolina workers’ compensation claim made by a 78-year-old truck driver named Louis Watkins. The plaintiff had brought an action against his employer, Trogdon Masonry, and his employer’s insurance company, Stonewood Insurance.

Background on this intriguing case

On May 8, 2007, the Plaintiff drove a trailer to a mechanic shop to replace a flat tire. While waiting for authorization to repair the tire, Mr. Watkins fell on his left hip, leading to an injury known as an acetabular fracture. While being treated for the broken bone, the Plaintiff was tested and found to have blocked coronary arteries. Although he claimed (and an expert physician testified) that a heart attack did NOT cause the fall, his employer and his employer’s insurance company contested his North Carolina workers’ compensation claim by filing a Form 61 with the North Carolina Industrial Commission. The defendants argued that the Plaintiff’s heart condition DID cause his injury — in other words, that the injury resulted from an idiopathic condition and not from his employment.

On August 25, 2008, a Deputy Commissioner found on behalf of the Plaintiff and awarded him compensation. But the Defendants appealed and, on March 23, 2009, managed to reverse the North Carolina workers’ compensation benefits. The Plaintiff then appealed to the Court of Appeals, which examined the claim pursuant to the North Carolina Workers’ Compensation Act. In particular, the Court of Appeals looked at the definition of “compensability,” which is a three-part definition:

1) A Plaintiff’s injury must be caused by an accident.
2) The Plaintiff must show that he or she sustained an injury “out of” employment.
3) The Claimant must show that the injury was sustained during the course of employment.

The Court of Appeals concluded that “competent evidence in the record supports the Commission’s finding of fact… we affirm the Commission’s denial of Plaintiff’s claim for workers’ compensation benefits.”

This case illustrates how difficult it can be to get benefits, even when you have been injured at work and you’ve been be able to convince the NCIC that you should get benefits. For help with your matter, connect with a reputable, trial-proven North Carolina workers’ compensation attorney ASAP.

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Watkins v Trogdon Masonry

North Carolina Court of Appeals

Most North Carolina workers’ compensation fraud cases pale in comparison with two breaking stories out of California.

The first involves a San Jose man named Daniel Nelson, who allegedly bilked the CA State Compensation Insurance Fund out of nearly $60,000 by failing to report $600,000 in payroll for his businesses (Monster Magic LLC and Worldwide Attraction). According to the DA’s office in Santa Clara County, an investigation began shortly after it was discovered that Monster Magic and Worldwide Attractions had failed to report nearly $80,000 in payroll for the 2006 calendar year. But the amount of underreporting turned out to be nearly 10 times that much — all told, investigators found over $614,000 in underreported payroll. Nelson was arrested by deputies in Alameda County and held on a $50,000 bail. If convicted of California workers’ compensation fraud, he could face a $50,000 fine and a jail sentence of up to five years.

Meanwhile, in a separate matter, a man named Mitchell Zogob faces a decade in California prison for collecting nearly $5 million in fraudulent California workers’ compensation insurance premiums. Zogob pled guilty to a gamut of offenses. Experts who followed the case interpreted the sentence to be a shot across the bow to other would-be workers’ comp defrauders.

How does North Carolina workers’ compensation fraud impact employees, employers, insurance companies, and the economy as a whole?

When someone bilks the NC workers’ comp system, everyone ultimately pays. Fraud does two things. First, it removes money from the system that could (and should) go to deserving claims. Second, it encourages insurers and watchdog agencies to vet claims more thoroughly. Thus, claimants with legitimate grievances often must go through extensive hurdles to collect their (rightly-owed) benefits.

Indeed, occasionally, legitimate claims get flagged as “false positives” for fraud. If you or a family member has been wrongfully accused of North Carolina workers’ compensation fraud, or if you need help with anything else regarding your workers’ comp matter, look to an established and peer-reviewed NC workers’ comp law firm near you to get strategic advice.

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San Jose Man Arrested for Workers’ Comp Insurance Fraud

OC man gets 10 years for $4.6m insurance fraud

Most North Carolina workers’ compensation cases that this blog covers pertain to local events — debates about insurance coverage, fraud schemes, and occupational disease and injuries that relate specifically to North Carolina industries, such as tobacco (covered in a recent post), or tech (e.g. incidents out of the Research Triangle). But for this week and next week, we’re going to do a two-part investigation into a breaking story out California that may have serious implications for North Carolina workers’ compensation policy.

As reported in the New York Times last week, the National Football League and its insurers have been embroiled in a dispute over whether ageing football players should be entitled to California workers’ compensation for dementia. Already, due to California’s peculiar laws, several hundred former NFL players have filed for comp in CA. An NFL player who played even one game in California can file a claim for cumulative damage… even for injuries sustained years or even decades ago.

Point is, California has become a battleground for the NFL workers’ comp debate.

The newest wrinkle involves a dispute over the cause of dementia in NFL players. The New York Times story discussed the case of Dr. Eleanor Perfetto, the wife of Ralph Wenzel, an NFL lineman who played in the 1960s and ‘70s and who’s been hospitalized with severe dementia. Dr. Perfetto and her supporters contend that Wenzel and other NFL players in his generation (and afterwards) sustained cumulative damage playing football and that this damage caused (or at the very least exacerbated) the dementia.

If Dr. Perfetto’s claim on Mr. Wenzel’s behalf leads to a ruling in her favor–experts guess it would be about a $1 million settlement–it would open the door to dozens of similar claims. The Times’ story suggests that, all told, this could lead to over $100 million in claims. This money would not come from state coffers; it would come from the NFL and its insurers. Given that the NFL rakes in more $8.5 billion a year, this might seem like “a drop in the bucket,” but $100 million is $100 million, and experts expect a significant battle over this.

Dr. Perfetto claims that her husband’s care costs over $100,000 a year and that evidence significantly supports the theory that playing in the NFL increases the likelihood of getting dementia. For instance, in a recently conducted NFL commissioned study (published last September), players between the ages of 30 and 49 reported memory related problems at more than 19 times the normal rate for their age group. In addition, West Virginia University and Boston University researchers have discovered “traumatic encephalopathy” in the brains of diseased former NFL players — a telltale sign that cumulative football-related head trauma can in fact lead to dementia.

If you or a loved one has been suffering from an occupational disease or an injury sustained at work, it may behoove you to talk with a North Carolina workers’ compensation lawyer ASAP to develop a strategy for how to collect money owed to you. Take proactive action today to ensure that you collect the benefits that you and your family need to move forward and level your budget.

More Web Resources:

In N.F.L. Fight, Women Lead the Way

Ex-NFL Players Pursue Workers’ Comp

North Carolina workers’ compensation policy experts are exploring the deep ramifications of Massachusetts’ special senatorial election. On Tuesday the 19th — nearly one year to the day after President Obama’s inauguration — Republican Scott Brown defeated Democratic incumbent Martha Coakley in a competition for the late Senator Ted Kennedy’s seat. Brown ran specifically to provide the 41st vote for Republicans in the Senate — thereby depriving Democrats of the votes they need to squash a Republican filibuster of the proposed Democratic healthcare bill. The implications coming out of the Massachusetts election are many and are profound.

We’re going to talk a little bit about how specifically they might influence North Carolina workers’ compensation policy. The Democratic healthcare bill that was pushed through the senate over Christmas (with 60 Democrat votes) would have significantly altered the US healthcare system on both federal and state levels. How precisely such a reform might have influenced North Carolina workers’ compensation benefits, insurance pricing, and so forth would be difficult to predict — the law of unintended consequences, after all, suggests that it’s not easy to make determinations of this nature before, during, or even after the fact.

Nevertheless, one might assume that massive healthcare reform would have significantly changed the landscape for employers, employees, insurers, and state regulators alike. Scott Brown’s election, however, throws a new wrench into an already wrench-filled situation. Democrats still have a number of options at their disposal to push through some form of healthcare reform. If they succeed, this obviously could change the landscape of North Carolina workers’ compensation insurance policy. If they abandon their efforts — or at least delay them — it could have other, very different implications.

The only certainty in this fluid and fast changing situation is the certainty of uncertainty. In other words, the chaos surrounding whether or not a national healthcare bill may or may not pass ITSELF will likely have an impact on North Carolina workers’ compensation system, even if it’s an indirect one and one that’s difficult to measure precisely with our current statistical tools.

Theoretical considerations aside, if you or a loved one has a practical North Carolina workers’ compensation question regarding your benefits, insurance rules, deadlines, filing requirements, etc., connect with a veteran North Carolina workers’ compensation attorney asap.

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Scott Brown victory speech

Republican Filibuster of Health Care Bill?

Bloggers who follow North Carolina workers’ compensation fraud cases have been riveted by a scandal out of San Francisco, California that’s captured national headlines.

Here is the nitty-gritty:

High-ranking Department of Corrections official John Smiley and his wife have been arrested for a workers’ compensation fraud following a shootout at a San Francisco swingers club.

Mr. Smiley alleged that one of his parolees shot him and that he deserved $2.4 million in workers’ comp benefits. His sympathetic co-workers also set up a golf tournament to rake in funds for him, netting him $30,000. In addition, John and his wife’s mother made a website, on which he expanded on his lie that a parolee shot him.

The truth, according to investigators, was a lot more salacious and twisted. Apparently, Smiley and his wife had gone to a swingers club, connected with another couple, and Smiley had sex with a female partner. But during intercourse, his condom broke open, and the woman’s partner became enraged and shot him.

If the allegations against the Smileys are true, not only is it a black eye for the Department of Corrections but is also a wake up call for North Carolina workers’ compensation fraud experts to double-check to make sure they are doing due diligence.

Individuals who make false allegations about injuries and occupational disease to game the North Carolina workers’ compensation system cause problems for everyone else. Insurers must raise rates to make up for costs, employers must carry more insurance, and employees who actually deserve benefits may have to jump through more hoops and may see fewer benefits over the long term.

Unfortunately, due to the prevalence of North Carolina workers’ compensation fraud schemes (and schemes in other states), legitimate claimants suffer undue harassment. If you or a loved one is having trouble dealing with an insurance company, an employer, or even with the North Carolina Industrial Commission, you might want to connect with a credentialed and vetted North Carolina workers’ compensation lawyer ASAP to go over your concerns and figure out a plan of attack.

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John Smiley

Smiley Website

North Carolina workers’ compensation policy analysts and lawyers have been closely following a breaking story out of Butte, Montana involving a Homeland Security worker who attempted to rob Montana’s workers’ compensation out of almost $30,000.

40-year-old Richard Hannum pled guilty last Wednesday, according to the AP, of pretending to have injured his back while working as Transportation Security Administration (TSA) officer at a Montana airport. Hannum had claimed that he wrenched his back while lifting luggage and that this had caused him to be permanently disabled. But one of his workers’ compensation doctors saw him walking around a mall normally and without pain. The doctor alerted authorities, who followed him and ultimately videotaped him engaging in normal activities – which belied his claim that he was bedridden.

Hannum’s case is interesting, in particular, because it falls under federal jurisdiction. He didn’t collect his money from the Montana workers’ compensation system – he collected directly from the Department of Labor and Homeland Security.

Some North Carolina workers’ compensation fraud cases involve the defrauding of federal coffers as well. But these cases are rarer, and they can be legally more significant.

As this blog has discussed many times, North Carolina workers’ compensation fraud hurts not only the state system, insurers, and employers, but also beneficiaries. When someone steals money from the limited North Carolina workers’ compensation benefit funds, it has a ripple effect. With less money to go around, insurers, employers, and even state and federal overseers of workers’ compensation claims will be more dubious in the future of all claims. This means more invasive investigations and longer wait times before claimants can collect their benefits. So cracking down on North Carolina workers’ compensation fraud is ultimately in everyone’s interest.

That said, if you have been accused of North Carolina workers’ compensation fraud – and you are legitimately hurt – or if you are having trouble with other aspects of your claim, it’s probably a wise move to retain a reliable NC workers’ comp attorney as quickly as possible. A good representative can help you strategize and explain what to do and what not to do when confronting parties like your employer and the responsible insurance company.

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Richard Hannum

Butte, Montana

North Carolina workers’ compensation stories often revolve around injuries associated with office jobs, such repetitive stress problems or occupational damage people suffer while working lines at factories. But today we will focus on one set of workers that receives scant coverage in the press – tobacco workers.

The Farm Labor Organizing Committee (FLOC) recently marched through downtown Winston-Salem to demand justice and fair treatment for the state’s tobacco workers, many of whom immigrated from Mexico to work for far below the minimum wage. These workers toil under extremely strenuous conditions – according to one source, nine people died working the North Carolina fields from heatstroke over the past two years. Many others get sick from nicotine poisoning they get from harvesting crops. Still others get sick from exposure to pollutants and chemicals or endure repetitive stress injuries.

Unfortunately, remedies for these laborers seem few and far between. With double-digit unemployment afflicting North Carolina and many of the state’s industries and businesses still reeling from the fallout of the Great Recession, it seems unlikely that major political action will be taken to resolve the plights of beleaguered farm and tobacco workers.

Nevertheless, options may exist. If you or a co-worker has been hurt on the job – whether you got hurt on a farm, at a factory, or in an office – you may be entitled to collect workers’ compensation benefits to pay for your medical care, time off of work, and other costs. Explore your options today by connecting with a competent and well-respected North Carolina workers’ compensation attorney near you.

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Farm Labor Organizing Committee (FLOC)

NC tobacco workers

According to North Carolina Employment Security Commission figures, the state’s jobless rate leaped to 11.1% in January, the highest unemployment rate for NC since 1976. North Carolina workers’ compensation and unemployment systems have been struggling under the weight of the demands from so many claimants. In January, more than half a million residents claimed to be unemployed – over the past year alone, the number of unemployed North Carolinians has jumped by 124,000, and experts fear that this number may continue to grow. The Commission found that the state gained approximately 7,000 jobs in January — but more than 8,300 people lost their jobs — a net loss. When you crunch the numbers, approximately 800,000 North Carolinians went for some stretch last year unemployed, and the number of underemployed (those who don’t have enough work) is likely much higher.

So is there any silver lining? According to North Carolina workers’ compensation analysts, perhaps. Although the state owes nearly $2 billion to the United States Labor Department (as of mid-March) for payback of unemployment benefits, NC actually has an above average unemployment rate for the country. This is good news, in the sense that it hopefully does not portend a greater or longer-term national lull in jobs. Also, North Carolina’s population has grown over the past decade, so it’s not really fair to compare the historically high unemployment numbers (~500,000 people unemployed today) with similar numbers from the past, since the worker pool today is bigger. Finally, analysts point to “green shoots” that indicate that the economy – both national and regional – may be on the rebound.

If you are an unemployed, underemployed, or workers’ comp dependent N.C. resident, you are probably less concerned with statewide problems than you are with your own personal dilemmas. How can you get your insurance company to meet its obligations to you? How can you prevent your North Carolina workers’ compensation and unemployment benefits from being denied or rolled back? What should you do about a recalcitrant or uncooperative employer? How should you handle your doctors’ visits?

To get immediate assistance with these prickly issues, connect today with a qualified North Carolina’s workers’ compensation attorney. Get professional guidance to avoid making costly mistakes that could endanger your benefits and prevent you from acquiring the critical funds you need to keep you and your family afloat.

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North Carolina Employment Security Commission

500,000 unemployed in North Carolina

Most North Carolina workers’ compensation matters that this blog covers are local or national. But today we turn our attention to a fascinating case out of Australia involving a pilot for the airline Qantas. This story’s applicability to North Carolina workers’ compensation concerns may be somewhat indirect, but it’s a gripping one, so we had to include it!

Background

A pilot named Bryan Arthur Griffin flew for Qantas in the late ‘70s and early ‘80s. During that time, he developed a mental illness related to obsessive compulsion and anxiety. Mr. Griffin felt a tremendous urge to crash the airplanes he was flying. He heard a voice inside of him telling him to turn off the engines, to cry and scream, to intentionally ignore crew instructions, and so forth. On one flight to Singapore, he developed an urge to crash the plane that was so strong that he had to physically immobilize his arm to avoid killing a whole plane full of people.

Throughout his ordeal, Mr. Griffin was repeatedly looked at by doctors and evaluated by Qantas. Amazingly, the doctors and the airline allowed him to continue to fly for over three years. Not only did allowing Mr. Griffin to fly potentially endanger passengers and crew, but doing so also caused health problems for Mr. Griffin, who became more anxious, depressed, and compulsive as his stint as a pilot wore on.

Eventually, an Australian Commissioner in charge of adjudicating workers’ compensation matters won a judgment for Mr. Griffin for $160,000 for all of his pain, anxiety, and compulsive problems. Qantas also had to pay for his legal and medical fees.

Have you or a family member ever been forced to work at a job that’s caused you anxiety, depression, or compulsion? Your on-the-job injuries and occupational diseases may be covered by North Carolina workers’ compensation.

Take the first step to filing a claim today by connecting with a reputable North Carolina workers’ compensation attorney for a confidential and free consultation. Understand your rights – and your employer’s responsibilities – so you don’t endanger yourself or others at work.

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Qantas

Bryan Arthur Griffin