North Carolina workers’ compensation fraud is a profound and seemingly indelible problem that saps much needed resources, degrades trust in the system, and leads to hardship and chaos for dependants. Why, then, do so many people continue to perpetrate this crime?

For example, let’s look just over the border to West Virginia, where last week, owners of an Apple Dumplin in Oak Glen, West VA, Keith McBride and Lois Ventura, got hit with three charges of workers’ comp fraud. Investigators with the workers’ compensation fraud prosecution unit tracked the couple since July. Here’s the scoop. The 51-year-old Ventura was hurt last August at her former job at Big Cheese Pizza. She collected workers’ comp benefits as a result of that claim. All good. But then, in violation of the benefits arrangement, she started running an Apple Dumplin with her boyfriend, Mr. McBride, and continued to “receive cash and medical benefits through the workers’ compensation program.”

When questioned about his girlfriend’s allegedly fraudulent activities, McBride “reportedly misrepresented the facts of the case by stating that he was the sole owner of the business and had no knowledge of the workers’ compensation benefits Ventura was receiving.” Not a good move. Now both Ventura and her boyfriend face counts. On November 3, at their arraignment, they both pled not guilty. A court date has been set for January 10.

Obviously, based simply on news reports, you should avoid leaping to judgment. Unless you probe the back story, evidence, and other relevant details, it’s probably wise to withhold “convicting people in your mind,” if only to hone your ability to see life objectively.

For the sake of a discussion, let’s assume the charges are correct. What lessons can we extract?

First of all, the story suggests that a significant number of North Carolina workers’ compensation fraud cases probably result from unplanned errors and inappropriate innovations. In other words, while some people plan workers’ comp fraud far in advance, many people simply “stumble into it” because fraud is easier and faster than operating ethically.

Often, people who are simply trying to “scrape by” come to believe that somehow they have been wronged by the system and that they “deserve” to break the rules.

The story also suggests that many workers’ comp beneficiaries do not receive enough training to understand the limits of what they can and cannot do. People might know that violating workers’ comp rules is somehow “wrong” in the abstract, but they may not know the specific punishments that are likely to meet them if they commit a crime.

For excellent guidance, no matter what your situation, connect immediately with a qualified and compassionate North Carolina workers’ compensation law firm.

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Apple Dumplin couple hit with workers’ comp fraud charges.

As this North Carolina workers’ compensation blog has opined numerous times, when individuals or institutions perpetrate workers’ comp fraud – or any other kind of fraud – “downstream” effects on workers, employers, insurers, and governmental institutions can be profoundly damaging. Indeed, the North Carolina workers’ compensation system works, when it does, because various parties trust one another to act fairly and in good faith.

That’s why it’s so disturbing to read stories like a recent account from Tulsa, Oklahoma, where a local attorney pled guilty last week to embezzling more than $1 million from his clients and conspiring to commit workers’ comp fraud.

According to the Oklahoma Attorney General’s Office, 61-year old Fred Schraeder will receive a “five-year deferred sentence and will pay more than $36,000 in restitution, $500 in fines and a $100 victim’s compensation assessment… Schraeder must surrender his law license and isn’t eligible to reapply while on probation.”

Schraeder did not act alone. He apparently had an accomplice, William Anton, who was sentenced in August to pay over $700,000 in restitution and serve “four consecutive sentences totaling 35-years, with 25-years suspended.”

The Attorney General’s Office claims that Schraeder and Anton embezzled money from clients between 2004 and 2009. They stole from their “personal injury benefits, insurance settlements and workers’ compensation benefits.” Over 49 victims were identified by the Attorney General’s office.

This disturbing story highlights how important it is for sick and injured people to work with trustworthy North Carolina workers’ compensation law firms. Just because an attorney or a law firm boasts a pretty website and ostensibly credible qualifications does not mean that the team will be a “best fit” for you. Before you select your law firm, ask many questions, really research your prospective firms, and make sure you choose a firm that has a reputation for ethical behavior as well as for getting good results in complex cases similar to yours.

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Oklahoma attorney embezzles over $1 million dollars from clients

Charges filed against Schraeder and Anton

Maybe you’ve been on North Carolina Workers’ Compensation for months or years as you work feverishly to heal your life, your finances, your body, and your stamina. Or maybe you are only exploring workers’ comp options. At some point, most likely, you will have to face the “end of the line” as far as your benefits are concerned.

Whether you consider this “fair” or not – whether you have legal means to fight the end of your benefits or not – you need to make adjustments to your lifestyle, budgeting, and possibly career path to accommodate the transition. Make no mistake: the transition can be quite difficult. You’ve gotten used to a certain way of living, a certain way of thinking about your income, and certain habits and expectations. Even if you’ve known that the “dry up” was coming for months or years, you can only prepare so much in the abstract.

When the reality hits – when you stop getting checks — you must make due with far less money. You may panic and potentially even make bad or dangerous decisions that can imperil your body, your recovery, or worse. Indeed, financial panic often drives uninformed, desperate people to commit crimes like North Carolina Workers’ Compensation fraud – crimes that can be prosecuted as felonies and lead to substantial prison time as well as the catastrophic destruction of your professional life.

The process of weaning yourself off benefits does not have to be agonizing, however. The more planning you can do, the better. And don’t simply focus on “planning your finances.” Focus on the psychological preparation. Understand that you will need some time to adjust to your new reality and to accommodate for the stresses of the transition. Maybe set aside some “special treats” for yourself during the transition. For instance, plan an inexpensive vacation (e.g. camping trips in the woods or meditation retreat) or spend some time with your family or close friends – a so-called “staycation.” Or give yourself permission to indulge in a treat, like a fun meal out, or fancy new gadgets from Apple or your other favorite tech product purveyor. (Obviously, don’t spend beyond your means when you get these “treats”.)

All that said, the doom and gloom you are feeling maybe a bit premature. Investigate your resources by connecting with a compassionate, skilled and thorough North Carolina workers’ compensation law firm.

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After Your Benefits “Dry Up”

Transitioning to Life with a Reduced Income Stream

Few people dream of committing North Carolina workers’ compensation fraud. But the temptation to “cheat” on your paperwork and collect a little more than you might be legally entitled to can lead to life-changing disasters.

Witness the fate of 31-year-old Patrick Rosenzweig, a New Yorker charged on October 6 with attempting to defraud The New York State Insurance Fund out of $3,973.24. According to a report in a local newspaper, The Wayne Post, “[Rosenzweig] was charged with workers’ compensation fraud, making a fraudulent statement in workers’ compensation insurance applications, offering a false instrument for filing the paperwork and grand larceny.”

Rosenzweig now faces a smattering of felony charges. If convicted of any of them, he could face over a year in jail… all for trying to obtain workers’ comp while he was still working.

What can the Rosenzweig ordeal teach us? First of all, note the cost benefit analysis. Assuming he had gotten away with this alleged scam, he would have collected an extra $4,000. But he didn’t, and he now faces huge fines and possibly significant time behind bars. Assuming he ordinarily made something along the lines of $60,000 a year, and he gets three years of jail for the felonies, he will be out close to $200,000 for committing a crime that would have only netted him around $4,000.

All this is to say that North Carolina workers’ compensation fraud does not pay off.

That being said, one can still be sympathetic and compassionate here. Hurt workers often lack the job training, skills, and resources to make ends meet. If you are a mother of two who got hurt at work – not badly enough to receive workers’ comp, but badly enough to struggle with day-to-day activities – you might be tempted to break the law and lie on your paperwork. The impulse comes from a place of wanting good help. Instead of making reckless, illegal decisions, however, make responsible choices.

For instance, connect with a North Carolina workers’ compensation law firm to review your options for getting more compensation or to find other resources to make ends meet.

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Canandaigua Man Charged with Workers’ Comp Fraud

Making the Most Out of Your Reduced Income

What can be done to reduce or even eliminate North Carolina workers’ compensation fraud?

To solve this dilemma, we need to look beyond our state’s borders and pick apart relevant news stories, data, analyses, and arguments compiled by experts. It’s all well and good to theorize about different methods to deal with, manage, or punish North Carolina workers’ compensation fraud. It’s another story altogether to operate in the “real world” and get good results.

Even “small scale” cases of fraud can yield surprisingly relevant and far-reaching lessons, if we understand how to appreciate these stories in context. Consider a small bore story about workers’ comp fraud in Des Moines, Iowa. As the AP reported on September 23, the president of DES Staffing, Dinesh Sethi, plead guilty last week to wire fraud: “He acknowledged that he participated in a scheme to defraud Travelers Insurance and Liberty Mutual between 2006 and 2009 by giving the insurers’ false information to calculate the firm’s premiums…he and his Director of Finance shifted payroll from high-premium job classification codes to lower-premium codes such as clerical workers.”

Per the plea arrangement, Sethi’s five other charges have been dropped, and prosecutors will not go after either his company or his family. He will face sentencing at the end of December.

So is it really possible for us to extrapolate from this small case and learn more widely applicable lessons?

Maybe so.

Here are three lessons:

Lesson number one: Outsized punishments can affect criminals who commit even small, technical crimes.

In the grand scheme of things, Sethi’s wrongdoings (or alleged wrongdoings) are relatively tame, if you measure them against other criminal acts, like felony murder, vehicular manslaughter while DUI, and massive multimillion-dollar Medicare schemes. But he could still face jail time and other career-ending punishments for what he did.

Lesson Number Two: Schemes can go on for a while before the authorities step in, but con artists are never safe.

According to the AP article, Dinesh and his finance director perpetrated fraud for approximately four years before getting busted. The long arm of the law, however, finally caught up.

Lesson Number Three: It’s almost always worth the time and effort to ensure you are operating fairly, ethically, and legally.

Many people who commit fraud do so inadvertently, or at least without knowledge of the consequences. A sick mother on workers’ comp leave, for instance, may take a second job to try to earn a little extra money for her family, oblivious to the fact that taking the second job violates her workers’ comp arrangement.

To protect your rights and ensure that you stay within the bounds of the law, always consult with an experienced North Carolina workers’ compensation law firm.

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Des Moines exec pleads guilty to insurance fraud

Ankeny man pleads guilty to insurance fraud

Policy wonks and ethicists in the North Carolina workers’ compensation community have been riveted by a case unfolding in nearby Waynesboro, Pennsylvania. Allegedly, a local police officer there stole over $22,000 workers’ comp checks over an eight-month period (from September 7, 2009 to May 3, 2010). The officer, Derrick Lange, hurt himself in an August 2009 foot pursuit and had to see a hand specialist for ongoing pain in his hand and wrist. After a specialist advised him to stay off of work after surgery, Lange began collecting workers’ comp payouts. But Lange later made an agreement that allowed him to collect his regular salary as long as he turned over the worker comp checks that he had collected.

Apparently, the 31-year-old officer ignored the terms of arrangement and actually deposited the checks into his bank account. Eventually, the insurance company that represents the Waynesboro Municipality caught on and alerted local authorities, who arrested Lange on Tuesday, September 7th and held him on a $15,000 bail. A September 21st preliminary hearing has been scheduled. Lange faces charges of theft by failure to deposit the funds that he received.

As this case illustrates nicely, abuses of the North Carolina workers’ compensation system can take many forms and can be years in the making. Individuals who defraud the system or cheat insurance companies or lie about their injuries can not only suffer grievous legal consequences – including having money stripped away from them and having to serve jail time (in some cases) – but they also endanger the efficacy of the entire system. For instance, an act of fraud has a “ricochet effect” throughout the system: insurers tend to trust claimants less and so they subject them to more bureaucracy and more invasive follow up. When money gets siphoned out of the system, employers and insurers try to make up those costs by doing things like cutting benefits, jacking up rates, and scrimping on service to save.

All this is to say that, if you or someone you care about wants to pursue a claim, make sure that you “dot all the Is and cross all the Ts” and that you stay away from anything even vaguely resembling illicit or unethical action. All that said, just because you play fair doesn’t mean that your employer or a responsible insurance company will play fair with you. To that end, if you are having trouble with any aspect of your claim, connect with a competent and battle proven North Carolina workers’ compensation law firm to develop a strategy to get the compensation due to you efficiently and quickly.

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The saga of Derrick Lange

Waynesboro police officer Derek Lange arrested for theft after allegedly stealing more than $22,000 in worker’s compensation checks

The fight to qualify for, collect, and utilize North Carolina workers’ compensation benefits to pay for your post accident/injury expenses can be dreary, annoying, drawn out, and full of ups and downs.

This holds true even if you have a high-caliber North Carolina workers’ compensation law firm on your side, fighting to protect your rights. But what if, after your case seems resolved, you still don’t have enough money – even after the workers’ comp is incorporated into your budget – to pay for the bare necessities? What options do you have?

Obviously, you might want to talk to your law firm about getting more benefits, extending your existing benefits, or searching for other social service programs to fill the gaps. But you also should consider other strategies and tactics to either lower your expenses or pump in new income in a way that doesn’t violate the terms of your North Carolina workers’ compensation arrangement.

You can find gazillions of articles online about how to penny pinch, coupon clip, and otherwise tighten the belt on your home budget. So we won’t ramble on about that.

But you might be surprised by the different ways you can reboot your productivity by tapping into latent talents, skills, and passions. For instance, say you spent 22 years working a difficult welding job outside of Raleigh. One day, a piece of equipment malfunctioned and gave you severe burns, lacerations, and few broken bones. In short, now you can’t – or you won’t – go back to your old welding job. So now what?

Well, let’s think. Maybe you’ve always had a passion for NASCAR. You’ve been a huge NASCAR fan, you know all the great drivers’ names and stats, you obsess over events, take your family hundreds of miles to see the big races, etcetera. If so, you might explore how to turn that passion – and your deep knowledge of the sport – into a money-making venture that could yield a second or third income stream for your family.

Of course, if you do enter into a business venture, be sure that it’s allowed by your workers’ comp arrangement. Otherwise, you can get into trouble for workers’ comp fraud – and that can lead to a revocation of benefits and other punishments, like jail time.

But assuming you do this correctly, you might be surprised at how many of your secret passions, hobbies, and skills you can leverage to rebuild not just your sense of excitement and joy about the world, but also your financial possibilities. We will talk more about the nuts and bolts of how to do this in our next workers’ comp post…

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Tighten Your Budget

Rediscover Your Passions

On August 26, 48-year-old Nicki Lee Buxmann of Sacramento was sentenced to jail for federal workers’ comp fraud. Our North Carolina workers’ compensation analysts react…

According to an article in the Sacramento Bee, Buxmann allegedly suffered injuries while working the United States Postal Service and obtained workers’ comp benefits from the Department of Labor.

While she collected those benefits, Buxmann owned and operated the TNT Takeover/MMA Boxing gym in Roseville, California. This was in violation of her sworn statements that she was not working and earning no income. When news of Buxmann’s alleged workers’ comp violations reached federal overseers, the inspector general of the USPS launched an investigation. According to the Sacramento Bee, “An undercover agent caught Buxmann teaching defensive tactics techniques, replacing light bulbs, cleaning windows, and sweeping exercise mats.” U.S. District Judge Garland E. Burrell, Jr., sentenced her to five months in prison, 36 months of supervised release, and restitution of nearly $105,000.

When someone like Buxmann defrauds the North Carolina workers’ compensation system, everyone in the system loses. Workers’ comp works only when all the players involved – including government entities, insurers, employers, and employees – trust that the system is fair and equitable. Plus, when $105,000 “disappears” from workers’ comp coffers, that money must be compensated for. Typically, the money lost through fraud is replenished by increased taxes, higher insurance premiums, and so on.

Of course, individuals who are hurt often want to get back to work quickly. The question is: Will taking another form of income replacement violate the terms of your workers’ comp? There is no way to answer that in the abstract. That’s why it’s so important to get good legal advice. A North Carolina workers’ compensation law firm will help you understand all you can (and cannot) do to supplement your income, get back to work quickly, and generally augment your career, your injury/illness notwithstanding.

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Nicki Lee Buxmann fraud

On Monday, a woman named Michelle McKee was sentenced to 2 years in prison for defrauding the Colorado workers’ comp system out of $25,000. North Carolina workers’ compensation experts and analysts are closely following the story, as it may have relevance to in-state cases. According to a local news report, McKee had been working as a housekeeper at a hotel, when she hurt her ankle. Although she claimed the injury was work related, an insurance investigation found that McKee had been bragging to friends about cheating the workers’ comp system. She also allegedly admitted to hurting herself not while at work but while out partying (she twisted her ankle after stepping off a curb). The state’s senior assistant Attorney General convinced the court that Ms. McKee had made false statements to collect money – a felony charge. In addition to her 2-year jail sentence, Ms. McKee now faces $25,000 in forced restitution to her old employer, Pinnacol Assurance.

As this blog has often discussed, North Carolina workers’ compensation fraud matters create tensions throughout the system and ultimately harm all major players involved: insurance companies, employers, legislators, and genuinely injured employees. It’s this latter category that is most vulnerable – subsequent to fraud cases like this one, legitimately hurt workers will likely have a harder time in Colorado collecting benefits without hassle. When insurance companies and employers grow suspicious of claimants, they tend to require higher burdens of proof and conduct longer investigations as to the veracity of claims.

If you’ve been the victim of undue harassment, frustration, or non-compliance by your employer or your employer’s insurance company, it may behoove you to seek out the counsel of a North Carolina workers’ compensation attorney to figure out how to resolve your situation adequately, get the benefits you want, and get these issues off your mind so you can focus on recovering and fixing your financial circumstances.

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Michelle McKee

Colorado workers’ comp system

Congress’ investigative arm, the Government Accountability Office (GAO), wants to clamp down on North Carolina workers’ compensation fraud (and workers’ comp fraud throughout the country). According to the official GAO website, the government is seeking information about beneficiaries secretly working second jobs, overstating claims, or collecting money owed to a deceased worker.

In fiscal year 2009, the U.S. Office of Workers’ Compensation Programs paid more than a quarter of a million workers over $4.1 billion (disbursed through four programs) for workplace injuries and illnesses. Many of these workers resided in North Carolina. (To be more specific, only $2.73 billion was spent on federal workers or their survivors, per the GAO’s report.)

It’s nice to see the government trying to clamp down on North Carolina workers’ compensation fraud, since systemic abuse doesn’t just hurt “faceless” corporate entities and government agencies with big pockets. Fraud “pays forward” throughout the system and creates mistrust, frustration, gridlock, friction, and bureaucracy.

When insurers and employers become more suspicious of beneficiaries’ intentions and actions, they throw up more roadblocks to prevent getting scammed. Inevitably, legitimate claims get held up in the dragnet. What’s the most appropriate response to this kind of abuse? Should scam artists, schemers, and those who aid and abet workers’ comp fraud be punished harshly?

Perhaps a better solution would be to disincentivize fraud through some non-punitive way. A broad and deep analysis of typical workers’ comp fraud crimes, for instance, might reveal certain patterns of behavior and typical perpetrator motivations. Policy analysts could then work towards solving would-be perpetrators’ problems in advance to prevent them from turning to the dark side and seeking to exploit vulnerabilities in the system.

If you or someone you care about needs help with a benefits issue, a reliable, honest, and aggressive North Carolina workers’ compensation law firm can help you move forward.

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Government Accountability Office (GAO)

Fraud “pays forward” throughout the system

The political fracas that accompanied the recent debate (and subsequent passage) of North Carolina workers’ compensation reform drowned out a few curious and intriguing developments. Thanks to the reform – just penned into law by Governor Perdue – and a piece of legislation called the Patient Protection and Affordable Care Act (PPACA), states like NC (and the nation as a whole) are reassessing their medical billing systems.

North Carolina, for one, adopted new eBilling rules. The state joins Illinois, California, Minnesota, and Texas as part of a select, small group of states that has accepted the new “e-reality” of medical e-billing and moved away from traditional paper bureaucracy.

So what does this all mean? Will eBilling, in and of itself, radically alter the North Carolina workers’ compensation system?

According to many experts, eBilling is inevitable. The internet is altering every facet of our lives. And more and more people feel more and more comfortable paying bills online and even banking at institutions like ING Direct.

But will eBilling eliminate redundant and needless bureaucracy and thus streamline and smooth out hiccups in the system? One would like to think so. If you Google around, you can find countless examples of how eBilling solutions have improved trade, souped up customer service, and even made whole industries workflow processes work better.

On the other hand, eBilling does carry risk. Security, technology, and recordkeeping issues abound. One can easily concoct dozens of “nightmare” scenarios, in which workers’ comp beneficiaries get sucked into a vortex of bureaucracy – or even defrauded out of money or a social security number – due to an eBilling error, technological glitch, or hacking scandal.

Nevertheless, the time has passed for what-iffing. The new eBilling paradigm is upon us.

To make sense of your rights, opportunities, and “best practices,” avoid doing all of the legwork yourself, and turn to a trusted and experienced North Carolina workers’ compensation law firm to help you develop a strategy for the way forward.

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Patient Protection and Affordable Care Act (PPACA)

medical e-billing

The Friday before last, a Wake Forest man, Carl Delmas Fuller was charged in a North Carolina workers’ compensation scam. Fuller was arrested in Florida after the Florida Department of Financial Services Division of Insurance Fraud investigated fishy business practices and concluded that Fuller had scammed National Employment Services (NES) out of a whopping $2.7 million in premiums. NES slowly awakened to the duplicity. The company had believed that had bought insurance from an North Carolinian agent named David Walters who had been serving them through a company called Southeast Services Incorporated. But the company investigation realized that the certificates “Walters” provided were useless, that “Walters” in fact did not exist, and that there was no such entity as “Southeast Services Incorporated.” And indeed, all the checks sent to Southeast Services Inc. wound up in a Myrtle Beach mail box owned by Carl Delmas Fuller.

Both the FBI and the United States Attorneys’ Offices assisted the Florida Department of Financial Services in the investigation to North Carolina workers’ compensation fraud. Fuller faces two decades behind bars if he is convicted of all charges.

As this blog has discussed many times, when individuals like Fuller siphon money out of the system and destroy trust among the various parties (insurers, employers, employees, etc.) everyone suffers in an indirect way. At first blush, 20 years behind bars for a white color crime like fraud might seem “over the top” especially when you consider that rapists, murderers, and violent gang leaders often get a fraction of that jail sentence. The consequences of this kind of fraud can be far reaching and devastating. When the money leaves the system like this, beneficiaries who desperately need funds to pay for medical care, rehabilitation, emergency surgeries, etc. may not have access to the funds or may be unfairly challenged by insurance companies who’ve been “once bitten twice shy” when it comes to dealing with the workers’ comp system.

The big moral and philosophical lessons of the story aside, however, if you or someone you care about is struggling with an issue such as a bad faith insurer, an uncaring boss who won’t listen to your concerns, or simply a lot of red tape regarding your benefits, a North Carolina workers’ compensation law firm can provide tremendous assistance.

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Carl Fuller

Florida Department of Financial Services

A workers’ comp case way out in Aurora, Colorado has caught the attention of the North Carolina workers’ compensation community because of the heart breaking realities at the center of it all.

Martin Lobatos and his wife Belen Lobatos were indicted on 18-counts last Friday, after Colorado investigators alleged that the couple collected $140,000 worth of workers’ comp claims from Pinnacol Assurance. Lobatos worked as a roofer until September 8, 2008, when he sustained a terrible fall off of a ladder. He went back to work a month later but started complaining of ongoing vertigo and dizziness from his accident. Six months later, in April 2009, Lobatos’ doctors maintained that he had fully recovered.

Lobatos was fired and later collected a $20,000 settlement from Pinnacol Assurance. In the fall of 2009, however, Lobatos began experiencing more symptoms, such as memory loss, having trouble recognizing his children, dizziness, and a host of other frustrating problems. His doctors agreed. In March 2010, Lobatos claimed to be “fully catatonic.” And he allegedly acted catatonic in medical exams. But witnesses later saw him driving around, shopping, engaging in activities in a decidedly non-catatonic state. This evidence allegedly led to the investigation and ultimately to the allegations and 18 count indictment against Lobatos and his wife. If convicted of the crime, the Lobatoses could face fines of $750,000 each and a dozen years in prison.

Obviously, North Carolina workers’ compensation fraud (and such fraud elsewhere in the country) is an enormous problem, and perpetrators should be held to account. But is it really fair to slap these people with $1.5 million in fines and over 10 years in prison? Many homicide cases don’t get punished that severely. Again, this is not to say fraud shouldn’t be punished appropriately. But the punishment must fit the crime, and the context of the crime should also deeply inform the legal remedies.

What’s frustrating here is that many injuries that ultimately send people to seek the services of a North Carolina workers’ compensation firm don’t manifest immediately after an accident. A fall off of a ladder, for instance, may lead to a temporary concussion that seems to resolve after few weeks or months…only to give way to longer term, chronic, and confusing injuries months or even years after the fact.

Again, it’s impossible to weigh in on the Lobatos’ case without far more information. But victims of workplace accidents or illnesses should understand that they may go through a similar kind of rollercoaster – feeling bad after the accident, then feeling better again for a while, then feeling suddenly worse for no apparent reason. This is why it’s so important to contact professionals, like experienced law firms and good doctors, to build evidence, stay within the bounds of the law, and maximize your chances for getting the money and support you need to get back to work and support your family.

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Pinnacol Assurance

Martin Lobatos fraud

Whether you’ve recently been injured, and you need to collect North Carolina workers’ compensation benefits – or you’re a healthy individual who’s concerned with the North Carolina’s fiscal state, you want to stamp out workers’ comp fraud. When someone – or some company or institution – steals money from the North Carolina workers’ compensation system, you suffer, and the state in general suffers.

Often, the indirect effects are the most insidious.

Breaking news out of Ohio illustrates the seriousness of this crime. According to woio.com – an action news team based out of Ohio – On April 29th, a man named Luiz Paneto pled guilty to a fourth degree felony for defrauding the Ohio workers’ comp system. Paneto was ordered to pay over $24,000 in restitution and nearly $20,000 in investigative costs.

In 2001, Paneto got hurt at work while performing a general contracting service. Shortly thereafter, he began to collect living maintenance and temporary total disability benefits. In 2007, he was granted permanent total disability.

In 2009, however, the Ohio Bureau of Workers Compensation’s Special Investigations Department received a tip off that Paneto had been doing home remodeling and labor – the same heavy work that he had being doing prior to his 2001 injury.

Per www.woio.com: “[the special investigations department] conducted surveillance and Paneto was seen walking, lifting heavy construction materials, driving his truck, and performing work as a home remodeler… in April 2010 [he] admitted to working in violation of his receipt of BWC benefits.”

Now look: $43,000 is not a tremendous amount of money, especially when you consider the millions of dollars that flow through the North Carolina workers’ compensation system every year.

But every case of fraud essentially pokes holes in people’s trust in the system. Stopping fraud is more than about simply preventing funds from being siphoned off. When fraud happens, suspicion ratchets up, and the system degrades.

If you or someone you care about has been dealing with a benefits issue – or an uncooperative insurer or employer – leverage the resources of a North Carolina workers’ compensation firm today to get results.

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Luiz Paneto fraud

Experts in the field of North Carolina workers’ compensation spend a lot of time ruminating about how to identify and stamp out fraud. When parties bilk the system out of money, not only do the costs ultimately get passed on to insurers, employers and employees who need benefits, but the bonds of trust that hold the system together also weaken.

To that point, the Ohio Bureau for Workers’ Compensation has its hands full dealing with a case of workers’ comp fraud out of Butler County. A chiropractor pled guilty last week to fraud and agreed to pay $104,000 in restitution payments as well as $5,000 to cover the cost of the investigation. Dr. Gary Berner took the plea deal to stop an impending trial. His Back and Spine Center had been at the center of a probe. Dr. Berner and three other employees of the Back and Spine Center faced multiple charges, including workers comp fraud, forgery (32 counts), theft, and racketeering. The other three employees have already been convicted of workers’ comp fraud – Dr. Berner’s trial will start up on March 29th. Dr. Berner, along with his partner, Dr. Bruce Holaday, allegedly developed a scheme to bill for services even after being banned to provide said services to hurt workers.

Obviously, in cases like this, unless you read the investigation very carefully and examine all the arguments that both sides make, you can’t really come to a clear determination. For instance, did the chiropractor and his co-workers harm their patients, or did they simple bend the rules in a relatively benign way? Hard to tell from a simple news account.

All that said, there is a “broken windows” aspect to consider. The “broken windows” theory of crime management suggests that, when a city, store, or other place winds up in disarray (e.g., lots of broken windows, trash on the floor, etc,) it becomes easier for people to “misbehave” and commit criminal acts. Likewise, when chiropractors get away with committing forgery, fraud, and theft, other doctors – who might be “on the fence” about whether to commit fraud or not – may take the plunge and commit illegal actions. Thus, as a precaution, it may be useful to severely punish those who skirt the law.

This debate aside, what’s important to remember is that the workers’ comp system should help injured workers heal and support them and their families. If you are having difficulties navigating the North Carolina workers’ compensation system, you don’t have to keep plugging away on your own.

Connect with a reputable and skilled North Carolina workers’ compensation law firm to go over potential solutions today.

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“Broken Windows” theory

Dr. Gary Berner workers’ comp case

Many North Carolina workers’ compensation news stories involve subtle and arcane discussions about insurance rates, employment policy, and the state’s fiscal strategy. This blog wanted to take some time out to examine two more “down to earth” stories that should hopefully pique your interest and stir up discussion.

1. First on the docket: crazy workers’ comp fraud case.

On February 23rd, the Louisiana Workforce Commission reported an arrest for workers’ comp fraud. The owner of Streamline Framing Incorporated, Richard H. Woodle, allegedly engaged in “willful misrepresentations by an employer and unlawful practices” and was hit with felony charges. A local news outlet reported that the business owner made false reports to his workers’ comp insurer for three years to get out of paying his workers’ comp premiums. By lying to his insurer, “it is estimated that Woodle avoided paying hundreds of thousands of dollars in premiums.” The man could face a decade behind bars for felony workers’ comp fraud.

2. Story No. 2: KFC retaliation.

A KFC worker claims that his employers retaliated against him for filing for workers’ comp.

Most North Carolina workers’ compensation claims (and claims from other states) involve straightforward scenarios. An office worker gets carpel tunnel syndrome and then seeks benefits to pay for her hand surgery, for instance. Or a hurt dockworker struggles with an insurance company to get fair payment for his disability.

An Illinois worker at a KFC has filed suit in Madison County Circuit Court, alleging that his employers fired him for filing a claim. Michael Franklin managed a KFC on Johnson Road for more than 8 years. Last January, he reported an injury to his employer and made a claim pursuant to the Illinois Workers’ Compensation Act. 11 months later, his employer fired him. Franklin wants Morgan Foods to pay him $100,000 for compensatory and punitive damages.

If you or someone you love has been engaged in a fractious dispute with an employer or insurance company over your benefits or another workplace issue, it may behoove you to get a free consultation from a reputable North Carolina workers’ compensation law firm.

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Streamline Framing Incorporated workers’ comp fraud

KFC retaliation case

Whether you’ve been on North Carolina workers’ compensation for two weeks or eight years, with your doctor’s blessing, you’re now ready to start looking for part-time work again. This blog post will give you ideas about how to make this transition as painless and productive as possible.

1. Don’t violate the terms of your North Carolina workers’ compensation arrangement

If you take certain work while on workers’ comp, you may violate the terms of your benefits. Not only could you lose your benefits as a result, but you could also get in trouble for North Carolina workers’ compensation fraud. Penalties for fraud can include fines as well as jail time, so play it safe.

2. Don’t go “all in”: Test your limits, and work incrementally towards a full return

For instance, say you twisted your knee badly on a construction site. Your orthopedist and physical therapist helped you recover full function of the damaged joint. Now you’re tempted for financial reasons to get back on site and start drilling holes (or whatever) again. Careful! A too-early return to work could undermine the sensitive reconstruction efforts.

Your basic process should be: “Start small. Test. Ramp up a bit. Test. Ramp up a bit more. Test again.” And so forth. Yes, it can be frustrating to have to hold back when you “know” you could handle more. But the goal here is not a one-time push or exertion – it’s the ability to engage productively in the work that you love for as long as you want to do that work. If you shortcut the recovery process, you may make it difficult, if not impossible, to recover fully.

3. Pay attention to medical issues that snag your attention

Often, in our desperation to return to gainful employment after an injury or illness, we ignore or subconsciously repress feelings of pain, uncertainty, and anguish. Especially if your family is depending on you to produce — and your coworkers and employer are counting on you to “step it up” in the wake of your recent time off — you may be tempted to go faster, harder, or more vigorously than your body is ready for. Don’t ignore your body!

One way to identify your subconscious feelings about your work is to keep a journal. Write down your experiences after every work shift. Note any chronic or acute pain or even general odd feelings you have about your job. Often, these written descriptions of your day-to-day work will give you clues to help avoid re-injury and even speed up your recovery. For instance, you might notice that a specific kind of bending exacerbates your pain. If so, talk to your boss about not having to do that bending work anymore.

4. Get advice you can trust

Is your employer giving you a hard time about your benefits? Are you caught up in insurance red tape? Are you confused about something you read on the North Carolina Industrial Commission (NCIC) website? If so, a qualified North Carolina workers’ compensation law firm can give you insight and guidance about how best to proceed.

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North Carolina Industrial Commission (NCIC) website

going back to work “too soon”

Many in the North Carolina workers’ compensation community have spent some serious time looking over the $1.5 million settlement award handed out to prison guards at Menard Correctional Center in Illinois. In case you haven’t been following the news, this massive case has drawn attention throughout the nation not just because of its size but also because it represents (to some pundits) an example of systematic waste.

55 workers – most of them guards – will collect between $22,000 and $120,000 to pay for damages stemming from chronic hand, wrist, and elbow injuries they sustained while locking and unlocking manual crank wheels and keys. Approximately 10% of guards at Menard experienced serious repetitive trauma. The prison’s warden, 35 year-old David Rednour, will collect more than $75,000 not because of injuries he sustained at the correctional center but because of injuries he sustained at an earlier job working for the IL police department.

The $1.5 million settlement – and, in particular, Mr. Rednour’s settlement – has angered many local Illinoisans, including State Senator Kyle McCarter, who responded to the news with this passionate statement: “The abuses and the fraud in the workers’ compensation system in Illinois have gotten out of control and are costing tax payers more than they ever will know… we have to take a strong stand against this while helping out workers who are legitimately hurt on the job. The fraud and abuse has got to go. It’s driving business out of the state.”

Rhetorical opponents of the Senator in Illinois (and here in the North Carolina workers’ compensation community) would likely retort something to the effect of: “Yes, sure: abuse and fraud corrupt the system and generate problems for everyone touched by it. That said, is there a better way to deal with the costly and painful occupational injuries that these workers are stuck with? And if so, what is it?”

Unfortunately, debates over workers’ compensation often devolve into essentially political tantrums. One side says the workers’ comp system is bloated and corrupt. The other side says that benefits are essentially always appropriate.

Instead of this unproductive conversation, it might help to look for ways to shortcut problems. For instance, what if the injured correctional facility workers got better treatment for their repetitive stress problems? A growing body of evidence suggests that repetitive stress injuries are not merely “local” injuries. Rather, they involve chronic distortions of muscle, soft tissue, bones and ligaments. Therefore, they should be treated not necessarily with an array of modalities, such as strength training, trigger point massage, and enhanced body awareness.

The point here is that, rather than see cases like the Menard case devolve into shouting matches, let’s quit the blame game and get on to the business of drafting creative and results-oriented solutions.

To that end, if you or someone you care about has been struggling with a benefits-related issue, get immediate and confidential help from a top level North Carolina workers’ compensation law firm.

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Menard Correctional Center

Debate over Menard Compensation

The typical case of North Carolina workers’ compensation fraud involves only one kind of crime. But a breaking case out of the Bronx has been getting special attention throughout the workers’ comp community for its sheer complexity. On December 15th, New York police arrested 60-year-old Rosa Rivera, after prosecutors investigating her for federal tax fraud discovered that she had collected over $135,000 in workers’ comp benefits from New York State illegally. Ms. Rivera’s compounding legal woes illustrate just how seriously the government takes any fraud. Her story serves as a cautionary tale for those who have been toying with the idea of skirting the workers’ comp laws, rules and regulations.

It all began in 2002. Rivera, who had been working as a bookkeeper, hurt her elbow, ankle and knee at work. She claimed the injuries prevented her from working. The NY Workers’ Compensation Board awarded her $400 a week in benefits. Meanwhile, in 2004, right under the nose of authorities, she began operating an income tax filing service out of her home. She ran this business for 5 years, until she was stopped in October 2009 and charged with fraud for filing false tax returns for her business. In September, Ms. Rivera pled guilty to the federal charges and got ordered to pay restitution in excess of $150,000. She also faces a two year probation.

Now, with this additional workers’ comp fraud charge — a fraud amounting to $135,000+ allegedly purloined from the New York State Insurance Fund (NYSIF) — she may face up to 7 years behind bars. Her hearing at a Suffolk County Court has yet to be scheduled.

Defrauding the North Carolina workers’ compensation system – or any state system – can get you in serious trouble, even if you plead things like hardship or extreme circumstances. For instance, Ms. Rivera’s benefits of $400 a week certainly could not be considered lavish by any standards – particularly by New York City standards. So it’s understandable that individuals on worker’s comp might want to find ways to supplement their income. But if you skirt the law or bilk the system by lying about your injuries — pretending they’re worse than they really are — not only do you cheat the legitimately injured, but you also create hostility and distrust amongst the various participants in the NC workers’ comp system.

If you’ve been having trouble with an insurance company or employer — or with the bureaucracy in general — a qualified North Carolina workers’ compensation law firm can provide crucial, timely guidance. Empower yourself today by getting a better education in workers’ comp rules.

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New York State Insurance Fund (NYSIF)

Rosa Rivera’s Double Trouble – Tax Fraud and Worker’s Comp Fraud

On December 8, New York police arrested Kevin Schwebke, a 26-year-old corrections officer, for felony grade workers’ comp fraud. North Carolina workers’ compensation pundits and others who follow stories about fraud and corruption in the world of workers’ comp, have been hotly discussing the legal and even moral implications of this matter.

First, the facts. Schwebke had been working at the Coxsackie Correctional Facility in 2009 when he got into an accident on the job that damaged his ankles. After undergoing surgery, Schwebke went on workers’ compensation. Up until Wednesday, he had amassed $34,000 in payments. Meanwhile, Schwebke continued working for the Cairo Police Department on a part-time basis – in violation of his workers’ comp arrangement. The Chief of Police, Chris Sprague, said that he had not been aware that Schwebke had been collecting workers’ comp.

If convicted of the class E felony charge, Schwebke could face a seven-year state prison sentence. He will appear at Albany County Court to face the charges at a later date.

This seemingly simple case has some very interesting implications. Let’s just say that the 26-year-old did in fact lie about his physical condition to collect the $34,000 illegally.

Is it really fair to punish someone for this level of minor fraud with seven years in state prison? Doesn’t that seem somewhat excessive, from a common sense standard? Obviously, you don’t want to reward workers’ comp fraud or encourage it in any way. But at least theoretically, it’s odd that someone who commits such a relatively minor crime (from a purely monetary standpoint) should be subjected to such a harsh potential jail sentence, especially when you consider that much more serious white collar crimes, like corporate fraud and embezzlement, often carry less punitive consequences.

On the other hand, North Carolina workers’ compensation fraud is a profound problem, not just in terms of the money it leeches from the system but also in terms of the culture of distrust it creates. When insurers can’t trust whether claimants are telling the truth, they ratchet up investigations and force legitimately hurt workers to jump through more hoops. When stories like Schwebke’s break, employers become more suspicious of their workers. It’s hard to quantify how all this distrust percolates through the system, but the toxic atmosphere surely drains time, resources, and money and makes it more difficult for the system to function effectively – that is, to rehabilitate legitimately hurt workers and get North Carolina’s workforce up and running at maximum effectiveness.

Have you been having trouble collecting your benefits due to your employer’s lack of cooperation or an insurance company’s recalcitrance? Whatever your issues, you may benefit greatly from engaging in an free confidential consultation with a reliable North Carolina workers’ compensation law firm today.

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Kevin Schwebke’s arrest

Corrections officer accused of fraudulently accepting $34,000 in workers comp

When policy analysts, insurance companies, employers, and employees come together to work on problems with the North Carolina workers’ compensation system, they inevitably look at things like cost control, red tape cutting, and the elimination of fraud. But the experts often overlook global solutions that could yield profound good for every entity in the system. This essay takes a look at some mechanisms that employers and employees can institute at their workplaces to boost productivity and efficiency without making employees work harder or longer.

This may sound like an impossibility. But good research suggests that these principles can be broadly applied to serious benefit for North Carolina workers’ compensation professionals.

1. The Pareto Principle (also known as the 80/20 rule)

A 19th Century economist named Pareto made the observation that 80% of systems often divide according to a kind of 80/20 principle. 20% of people in a population will own 80% of the population’s wealth, for instance. Similarly, 20% of the activities that you do at work will generate 80% of your profits. And so on. A careful deployment of the 80/20 rule in your office can eliminate time wasting and potentially dangerous repetitive activities and replace them with productive activities that generate more profit and create less of a strain on workers.

2. Parkinson’s Law

As author Tim Ferriss points out in his book, The 4-Hour Workweek, “Parkinson’s Law” is an excellent companion to the 80/20 rule. What this law states basically is that a task will fill up the amount of time allotted for it. So if you ask an employee to do a report in six hours, he will finish that report in six hours. If you ask him to do it in two hours, he will finish it in two hours. And the difference in quality between those two results will actually be surprisingly quite negligible. This may be counterintuitive, but Parkinson’s Law does bear out in many different cases, at least anecdotally. So you could use this principle to streamline machining processes, prevent workers from typing too much, and limiting the amount of hours and energy you put into dangerous activities, such as scaffolding work on a construction site (for instance).

3. Get People Talking

The best solutions to workplace dangers often come from the people closest to the problems. Corporate management in the United States – and in North Carolina – tends to work on a top down level. In other words, the CEOs and other high executives dictate terms to the people lower on the food chain. But this kind of practice leads companies to turn a blind eye to persistent ground level problems. If these problems could be solved, not only would the company benefit, but the employees would also get more control over their activities and hours and enjoy their work more – and be less at risk for workplace injuries.

If you’ve been hurt at work – or if one of your co-workers needs help – you should look to a qualified North Carolina workers’ compensation law firm to discuss strategies and tactics to get benefits in a timely fashion.

Developing an efficient and resourceful response to your workers’ comp problems is almost certainly doable, and the faster you get good guidance, the faster you will be able to resolve the stress associated with your injury and recovery and move on with your life.

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Pareto Principle

Parkinsons Law

North Carolina workers’ compensation experts along with media analysts across the country are all talking about a momentous sentencing decision out of California. A Laguna Hills man convicted of perpetrating the biggest California workers’ comp premium fraud in history has been sentenced to a decade in state prison.

51-year-old Michael Vincent Petronella was ordered by the court to pay $500,000 in restitution to the CA State Compensation Insurance Fund on top of fines of equaling $550,000. In February, Petronella was found guilty of an unbelievable 33 felony counts of insurance fraud. According to an AP report, Petronella and his wife “fraudulently submitted 42 claims for uninsured workers and unreported $29 million in pay roll to avoid paying insurance premiums.” As a result of their scheme, the state lost millions in insurance premiums and over $250,000 in uncovered worker claims. At the same time, Petronella and his wife apparently lived a life of opulence. They owned 2 Ferraris, jewelry worth hundreds of thousands of dollars, and closets upon closets of apparel from luxury designers like Burberry, Chanel, and Gucci.

Petronella’s ex employees and the local Deputy District Attorney complained that the judge did not order even more forced restitution. The Deputy DA, who had asked that Petronella pay $35 million to California, said that “the court’s ruling establishes that it pays to commit fraud.” The DA wanted Petronella to spend 37 years in jail. She expressed contempt for the judge’s decisio: “[Petronella] has taken no responsibility for his conduct… when he gets out, he will do it again.”

North Carolina workers’ compensation policymakers pay attention to out of state fraud cases to understand potential industry-wide implications. Since this case against the Laguna Hills roofer may be the biggest in California’s history, the decision could indirectly inform future debates over the correct punishment for workers’ comp fraud.

Pulling back from the abstract, for a second, what might this case tell us about the rights and responsibilities of individual claimants? The biggest takeaway is that a claimant needs to be mindful of adhering closely to the rules. Even if you don’t “intend” to cheat the system, you can still be flagged for problems with your claim if, for instance, you shortcut your paperwork or miss a deadline.

If you’ve been dealing with issues regarding your claim, consult with a reputable and highly credentialed North Carolina workers’ compensation firm to strategize about the most efficient ways to eliminate the constraints on your benefits.

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Michael Vincent Petronella sent to prison

Roofing contractor gets 10 years for workers’ comp fraud scheme

Most cases of fraud – attempting to game the North Carolina workers’ compensation system, for instance – involve a certain degree of subtlety. For instance, this blog recently covered the sad case of a woman who got accused of workers’ comp fraud after she took a job as an exotic dancer to supplement her income – and then got caught by insurance investigators. In that case, what the defendant did was clearly wrong, but her circumstances seemed bleak and thus somewhat sympathetic.

A breaking case out of Massachusetts contains none of that kind of subtlety. According to Fox News in Boston, John Cloutier, a former prison guard who got on workers’ comp after getting injured on the job in July 2008, has been arrested for fraud. An insider tip revealed that he had been running half marathons and marathons – all while claiming that his lower back was permanently injured.

Here is the basic timeline.

* In July 2008, Cloutier allegedly got injured.

* Starting in January 2009, he started collecting workers’ comp benefits. The 45-year old collected $56,000 between last January and this March.

* After being out of work for half a year for his “lower back injury,” Cloutier ran half a marathon and then a full marathon at Walt Disney World in Florida. In September of 2009, Cloutier did it again – he traveled to California and ran another half marathon.

* In the midst of all this running around, Cloutier applied for disability retirement in June 2009 – an arrangement which would give him 72% of his former salary ($62,000) every year for the rest of his life – tax free.

Cloutier was arraigned on October 26 for fraud charges in Massachusetts Suffolk Superior Court and released on his recognizance. His next court appointment is July. If he is convicted of all the charges against him, he could face 5 years in prison as well as array of fines and other penalties.

It’s impossible to tell from a simple news story whether Cloutier actually committed this crime or not. That’s why it’s important not to rush to judgment on a person. But North Carolina workers’ compensation fraud cases (and fraud cases throughout the United States) do drain millions of dollars from the system. This money could otherwise go to people who legitimately struggle with lower back injuries and other occupational illnesses or diseases.

If you or a family member has suffered a problem that’s prevented you from working, connect with an experienced and responsible North Carolina workers’ compensation law firm to discuss potential remedies. A quality firm can help you make sense of your rights and your obligations, keep you strategically focused on maximizing your benefits and minimizing your hassle, and help you defuse constraints that may be preventing you from collecting your benefits.

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John Cloutier legal problems

Another story about the prison guard and his marathon fraud fallout

Last week, LAPD Officer Robert Yanez got arrested at police headquarters in downtown L.A. for workers’ comp fraud – provoking a lively debate among policy analysts and other North Carolina workers’ compensation experts. The 38-year-old officer got hurt in October 2008 on the job. After being ordered back to work by his doctor, he allegedly switched physicians and forged/altered his doctor’s notes to continue getting payments.

All told, the 11-year-veteran LAPD officer allegedly did this multiple times – he got charged with six total counts – and cost his department around $7,000. Officer Yanez was held at the Men’s Central Jail in downtown L.A. on $30,000 bail. If convicted, he could face seven years behind bars. According to a statement from the LA County DA’s Division of Healthcare Fraud, investigators discovered “probable cause to believe that Officer Yanez had received benefits to which he was not entitled.” According to news reports, the LA Police Officers Union is not representing him in this case, and Officer Yanez is on home duty until the investigation finishes.

North Carolina workers’ compensation fraud – and workers’ comp fraud throughout the US – drains millions of dollars from the system and creates problems not only for insurance companies and employers but also for employees who have legitimate claims. The workers’ comp system is designed to help legitimately hurt or ill people make ends meet until they can recover. Unfortunately, a few bad apples do take advantage of the system and even resort to explicitly fraudulent activities (such as doctoring a doctor’s note) to avoid having to go back to work.

In response to fraud cases like this one, insurance companies may put in place more cumbersome screening procedures; employers may get more suspicious of workers who make any claims; and injured employees may find it more challenging to make the system work for them.

If you have been unfairly charged with fraud – or if you are dealing with some other issue with your benefits – such as an employer not paying a legitimate claim or an insurance company gumming up your claim by stalling or using bullying tactics – you may benefit significantly from a free consultation with a North Carolina workers’ compensation law firm. Smart attorneys and their associates – who understand the system and the law – can reduce your level of uncertainty and stress and steer you on a course to maximize your recovery and maximize your benefits.

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Veteran LAPD officer accused of workers’ compensation fraud

LAPD officer accused of workers’ comp fraud

A few months ago, this North Carolina workers’ compensation blog reported about the case of Christina Gamble, a 43-year-old woman who got arrested on charges of workers’ comp fraud, after insurance investigators found that she had been stripping while collecting disability benefits, ostensibly because she had trouble “standing and changing positions.”

The 43-year-old Gamble waitressed at Red Robin Restaurant in 2007. She allegedly hurt her back at work. In 2008, a judge granted her disability benefits of $360 a week. All told, she collected $4,000+ in expenses and $23,000+ in disability payments. However, the restaurant’s insurance representatives hired private investigators to track down Ms. Gamble. They found her working as an exotic dancer at CR Fanny’s Gentleman’s Club in nearby Wilson. The PIs taped her stripping and used this evidence to prove that her workers’ comp claim was fraudulent.

Obviously, any North Carolina workers’ compensation fraud case hurts everyone else in the system. When people fake disabilities or play up injuries to get benefits, this not only drains resources that could otherwise be used to help people who really are injured – but it also creates a sense of mutual distrust. When insurers and employers lose trust, they tend to crack down by making the process more difficult and the investigations more probing, personal, and annoying.

All that said, in the case of Ms. Gamble, you have to feel some sympathy for this woman. It sounds like she has had a very hard go of it. It’s obviously impossible to know her full story just from a news report. But it is important to remember that North Carolina workers’ compensation fraud comes in many flavors – some people purposely bilk the system to take advantage of loopholes; other people just get into desperate straits and do desperate and stupid things.

If you or a family member faces problems collecting benefits, your focus is 100% on getting these issues resolved ASAP. To that end, you might be well advised to set up a free consultation with a local North Carolina workers’ compensation firm to explore your rights, build a strategy to get your benefits and to resolve any agita associated with your claim, and work towards building a sustainable financial future for you and your family.

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CR Fanny’s Gentleman’s Club

Bucks woman to stand trial in workers’ comp case

North Carolina workers’ compensation experts have been following a bizarre breaking story out of Chenango County, NY.

According to the Associated Press, a 53-year-old New York woman named Susan Tansosch has been ordered to pay over $60,000 in restitution to the United States Postal Service for workers’ comp fraud, pursuant to charges that she falsely claimed that she had no additional income streams – when she had been making significant money selling goats.

Last Wednesday, Judge Thomas McAvoy sentenced Tansosch to four years probation and forced restitution to the USPS for making untrue statements to collect workers’ comp benefits from the federal government. The Department of Labor abruptly ended Tansosch’s benefits – all because she sold goats on the side.

This story drives home a point that many North Carolina workers’ compensation claimants often forget. Namely, that you need to read and understand the fine print of your benefits arrangement. If you fail to abide by the terms stipulated, you could wind up in court, in trouble, and in debt to the agency or insurer that provided the benefits to you.

There is no way to tell from this AP story whether or not Ms. Tansosch knew that selling goats would violate her workers’ comp arrangement. But don’t think that, just because you settle your North Carolina workers’ compensation case, that the situation will be permanently resolved. Insurance carriers are businesses. They investigate claims — even after they have settled! — to make sure that claimants are/were telling the truth about their injuries.

Managing the legal complications of a debate over your benefits can be a draining chore – one that you likely do not have the training to handle adroitly. That’s why, even if your case is relatively simple-seeming now, you might benefit from a consultation with a reputable and proven North Carolina workers’ compensation law firm. As the old adage goes, an ounce of prevention is equal to a pound of cure. Smart planning can mean the world for your workers’ comp case.

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NY goat-seller must pay back workers’ comp

Woman sentenced after conviction

North Carolina workers’ compensation experts are all talking about the case of an Ewa Beach man, who got convicted in Honolulu last week for workers’ comp theft.

Jacob Belaski allegedly hurt himself while operating his Teixeira Trucking business. He fought for benefits from his insurance company, HEMIC. At the same time, he continued (on the sly) hauling materials to and from a cement factory. In the process, he earned over $100,000 – all while collecting benefits compensating him from being unable to work.

Investigators from the Honolulu Police Department’s White Collar Crime Unit discovered the scam and realized that Belaski had misrepresented his injury to his physicians, insurance company, and others. Mr. Belaski even testified under oath to being hurt. Mr. Belaski’s conviction of theft and perjury charges may dissuade others in the Aloha State from similarly trying to take advantage of the claims process to collect benefits illegally.

This blog has investigated a number of cases of workers’ comp fraud lately to try to highlight the shades and nuances of the law – and of the individuals who commit these crimes. It’s important not to paint these defendants with a broad brush. As we have seen recently, practically anyone can wind up as a defendant in a North Carolina workers’ compensation fraud case – from strippers to goat sellers to truckers.

If you cannot collect benefits, cannot deal efficiently with your employer or insurance company, or cannot figure out how to put your life and budget back together again after a significant injury or illness, you need good help. In particular, a qualified North Carolina workers’ compensation law firm can guide you towards good resources and ensure that you stay within the bounds of your benefits arrangement. A good attorney can also help you deal with uncooperative bosses or insurance companies.

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Case of Jacob Belaski

Honolulu Man Convicted in Hawaii’s First Workers’ Compensation Theft Related Case

The California Department of Insurance made a decision in early July to earmark $1.25 million to battle workers’ comp insurance fraud. Steve Poizner, the often-in-the-news CA Insurance Commissioner, remarked that “fraud creates costs that burden our economy at a time it can least sustain it.”

Those in the North Carolina workers’ compensation community have reacted strongly to California’s decision. Advocates of similar measures here at home argue that funneling money into fraud control can help the system be more functional and protect benefits to attend to the needs of truly injured workers. Opponents of stronger fraud control worry that antifraud dragnets might accidentally sweep up legitimate claims. For instance, take someone who ordinarily would qualify for North Carolina workers’ compensation for a hurt lower back. She might wrongly be denied benefits — or at the very least given an overly hard time to qualify for them.

If you or a loved one or a coworker has experienced problems collecting benefits from a non-cooperating employer or bad faith insurance company, you may have rights and legal means at your disposal that you may not even be aware of. To find out how to protect your interests optimally, connect with an experienced North Carolina workers’ compensation attorney ASAP. Whether you have been improperly identified as trying to defraud the system, or you are having a simple vexing issue with your workers’ comp, get good help now before it’s too late for you and your family.

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California Department of Insurance

County tentatively slated to receive $1.25 million for worker’s comp fraud

Kenneth Bullock, a St. Regis, New York man, has been charged with fraud in conjunction with a scheme that he allegedly had perpetrated since the early 1990s. North Carolina workers’ compensation blogs and analysts are closely following the story.

Background

Bullock worked as a mechanic in New York in the 1990s. While executing his duties, he hurt his back — or so he claimed. Bullock said that his at-work accident rendered him unable to keep servicing cars, and he was put on workers’ comp. While collecting benefits, he moved to Florida and took another mechanic’s job – in direct violation of his workers’ comp arrangement.

If convicted of scamming the system, Bullock could face seven years imprisonment for illegally collecting $39,000 in benefits. Allegedly, surveillance caught Bullock working at a shop – investigators were tipped off when his claims arrived with Florida postage. The Onondaga County Insurance Fraud office will handle the matter, since that location processed Bullock’s claims.

North Carolina workers’ compensation fraud drains hundreds of thousands (if not millions) of dollars of funds from an already over-milked system every year. It’s obviously in the interest of all parties concerned – from trial attorneys to insurers to employers to injured workers – to clamp down on scams and schemes. Unfortunately, many injured workers with very legitimate claims wind up under investigation for fraud simply because they fail to file paperwork correctly or because they engage in activities to “stretch” themselves – such as aggressive physical rehab.

If you or a family member or a coworker has been wrongfully targeted for North Carolina workers’ compensation fraud, and you need guidance to make sure that you can collect benefits (and not get punished for making an illegitimate claim); or if you simply need basic FAQs answered about how to deal with a difficult employer or how to fight back against a recalcitrant insurance company, get in touch with a credentialed and experienced North Carolina workers’ compensation attorney ASAP. Get good guidance upfront, so you don’t wind up in a protracted battle over your benefits.

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St. Regis man charged in alleged workers’ comp scam

Franklin County native charged with fraud

Last Wednesday, the multinational bank Wells Fargo was ordered to pay out $30 million to four non-profit entities, pursuant to a jury’s verdict that the bank participated in fraud. North Carolina workers’ compensation policy analysts have been reviewing the case to see whether it may have interstate implications.

The four non-profit entities — the Minnesota Workers’ Compensation Reinsurance Association, the Robins, Kaplan, Miller and Ciresi Foundation for Children, the Minnesota Medical Foundation, and the Minneapolis Foundation — all alleged that Wells Fargo essentially tricked them into believing that they were investing in low risk options, when in actuality the bank had been funneling their money into risky investments which blew up during the recent credit collapse. The jury found that the bank violated the Minnesota Consumer Fraud Act (and other laws). Punitive damages have yet to be assessed against Wells Fargo.

Representatives for the bank expressed disappointment about the decision, although it could have been worse for Wells Fargo. The non-profits asked for $400 million — more than ten times what the jury returned.

The litigation over punitive damages (and the potential Wells Fargo appeal) could stretch on for years – a not uncommon phenomenon in North Carolina workers’ compensation cases in which millions of dollars hang in the balance.

Most individual workers’ comp cases involving occupational diseases, injuries at work, and conflicts with insurers do not take as long to resolve and do not get nearly as complicated as the Wells Fargo case. Nevertheless, if you or a loved one faces friction getting benefits, dealing with an insurer, or managing the deadlines associated with your claim, connect at once with a reputable and experienced North Carolina workers’ compensation attorney to review your strategic options and make sure that you’ve dotted all your I’s and crossed all your T’s.

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Wells Fargo vs the non-profits

Minnesota Workers’ Compensation Reinsurance Association

A sad and disturbing fraud case out of Pennsylvania has North Carolina workers’ compensation policy makers and analysts furiously debating a number of moral and ethical quandaries.

Background

On April 29, authorities arrested 43-year-old Christina Gamble for workers’ comp and insurance fraud stemming from a claim she made in November 2007 that she allegedly made under false pretences.

The PA Attorney General’s office alleges the following:

Gamble had been working for the restaurant Red Robin, when she fell on November 9, 2007 and hurt her back. The restaurant alerted its insurance carrier. In November 2008, a judge awarded her benefits for workers’ compensation. She collected over $22,700 in disability benefits and $4,100 in medical expenses before being caught working in a new capacity – as an exotic dancer for C.R. Fanny’s Gentlemen’s Club and Sports Bar. A private investigator tipped off an agent of Highmark Insurance, which had been representing Red Robin. Since Gamble made her claim on the basis that she could barely move her back, her work as a dancer for hire obviously completely undermined her claim.

Gamble is due in court on May 7. If she is convicted of both accounts of insurance fraud and theft, she could face 14 years in jail and $30,000 in fines.

Workers’ comp and insurance fraud are obviously reprehensible. Enforcement of North Carolina workers’ compensation laws must be strict to ensure that people who do play by the rules get treated fairly and that system-wide costs don’t get out of control. Nevertheless, this case illustrates – or at least implies – how difficult it can be for some people to recover from bad injuries or occupational diseases. Here is a story of a waitress who presumably hurt herself and then did a wrong thing by stealing from her employer’s insurance carrier. But (likely) the news story does not give us the full human dimensions of Gamble’s struggle. As anyone who has personally dealt with North Carolina workers’ compensation issues can tell you, it’s not easy to handle insurance companies or to figure out how to correctly and efficiently get your life back on financially solid ground.

To that end, before you or a family member does something dumb like try to defraud an insurance company or misreport numbers on your workers’ compensation form, connect with an ethical, reliable, and results-proven North Carolina workers’ compensation attorney to discuss your situation in confidence. A free consultation can give you the strategic guidance you need to make wise and ethical decisions about how to move forward and recover from an injury, both medically and financially.

More Web Resources:

Christina Gamble fraud saga

Strip club no cure for her bad back

A relatively small felony case is turning the heads of top North Carolina workers’ compensation specialists. According to news sources, a 48-year old man named Richard Scepkowski pled guilty to felony workers’ compensation fraud after being caught working at an auto repair center. Scepkowski worked for the Transportation Security Administration (TSA) at Albany’s airport before claiming injury around July 4, 2004. He filed workers’ comp paperwork with the Department of Labor and collected a payout of nearly $20,000 from September 2004 through August last year. This amount is (relatively) minor as far as workers’ comp fraud cases are concerned. But since Scepkowski pled guilty to making false statements, he now faces an array of strict penalties.

How This Small Case Relates Back to North Carolina Workers’ Compensation Concerns

1. It illustrates how persistent the government can be in terms of rooting out fraud and punishing offenders.

Scepkowski got away with collecting federal workers’ comp for more than five years before getting caught. This shows that people who attempt to defraud the North Carolina workers’ compensation system will always be at risk for getting caught and facing severe financial penalties and potentially other punishments, such as jail time.

2. Even small instances of workers’ comp fraud will be taken very seriously.

A felony conviction can result in jail time and the permanent loss of certain privileges, such as the right to vote in elections.

3. The case shows how important it is to file your workers’ compensation paperwork carefully.

In this case, a claimant willfully deceived the DOL in his paperwork. Nevertheless, even otherwise well-intentioned claimants who make mistakes in their applications can get in big trouble – or at the very least lose hard-won benefits.

If you have any questions about the North Carolina workers’ compensation process or about your paperwork, connect ASAP with a reputable and experienced NC workers’ comp attorney to learn more about your rights and responsibilities under state and federal law.

More Web Resources:

Scepkowski case

Another story about Scepkowski fraud

Those who follow North Carolina workers’ compensation policy debates often closely analyze minor court cases because these cases inform the broader discussion. To that end, we will review the implications of a recent US District Judge’s decision to sentence a former US Navy employee for workers’ comp fraud by sending him to prison for 21 months and compelling him to pay nearly $0.25 million in restitution to the Department of Labor.

Background

Mark Correnti worked for the US Navy for years as a civilian employee. In 1989, he hurt his back. Starting in the year 2000, he began collecting $2,000 a month from the Department of Labor in federal workers’ compensation for his back injury. These payments continued through 2008, during which time he accrued over $0.25 million.

According to prosecutors, Correnti violated the Federal Employees Compensation Act by starting up a small business, Safe & Sound Storage, and collecting income from this business. At seven different times, Correnti denied that he was bringing in money from this business. (These false statements allowed him to keep collecting federal workers’ comp.) After being caught, Correnti pled guilty last November to charges of making false statements, and the US District Judge sentenced him in late April to the harsh terms outlined above.

Now, obviously, most North Carolina workers’ compensation claimants work hard to understand their obligations and to avoid putting up red flags that might indicate fraud or non-compliance.

Nevertheless, claimant errors and omissions can torpedo otherwise valid North Carolina workers’ compensation claims. In other words, even if you did legitimately hurt your back lifting an object at work, for instance, your claim could be invalidated or downgraded if you don’t follow the correct protocol.

Fortunately, you don’t have to go through the rigmarole of applying for and securing workers’ comp benefits on your own. By connecting with a vetted, strategically focused, and experienced North Carolina workers’ compensation legal team, you can save yourself a lot of hassle and increase the likelihood of collecting the maximum benefits.

More Web Resources:

Federal Employees Compensation Act

Mark Correnti case

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.

More Web Resources:

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

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.

More Web Resources:

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.

More Web Resources:

Richard Hannum

Butte, Montana

According to the Chicago Sun-Times, three individuals have been indicted for perpetrating a healthcare fraud in excess of a million dollars – the case has North Carolina workers’ compensation experts buzzing.

Details of the Crime

According to allegations, three individuals – Dr. Jacob Solomon, a chiropractor named Darwin Minnis, and a biller named Gary Strauss — collaborated from 2004 to 2007 to falsely bill over a million dollars worth of claims at a West Chicago doctor’s office. Strauss and Solomon have been slapped with one count of healthcare fraud. Minnis, who owned and ran the Maywood Spine and Joint Rehabilitation Center, faces 18 separate counts of fraud. The three inflated claims for insurance payments and workers’ compensation. They are due to be arraigned in federal court.

Many North Carolina workers’ compensation cases “rhyme” with this Chicago case. Often, one (or a handful) of individuals collaborate over a long period of time to slowly but surely bilk the workers’ comp system. In the short-term, the amount of money stolen is usually not enough to send up red flags. But over the long-term, this money can add up to something substantial. (This blog reported only few months ago about a local woman who netted tens of thousands of dollars before being busted for North Carolina workers’ compensation fraud.)

How do these fraud cases debilitate the system?

• First of all, any time someone drains money from the system, that shortfall must be made up through higher premiums, poorer care, and thinner benefits.
• Second, North Carolina workers’ compensation fraud creates an atmosphere of distrust. If doctors, insurers, employers, and employees cannot count on the system to be fairly run, they may choose to go around it or choose to ignore other pertinent and important rules of protocol.
• Finally, fraud cases – whether perpetrated by employers, insurers, or employees – create pressure on the parties that payout North Carolina workers’ compensation benefits to vet claimants more closely. Unfortunately, this enhanced vetting often snares innocent parties. For instance, someone who may have legitimately hurt his back in a work related lifting accident may come under close scrutiny by his insurance company. Many a legitimate claim has been denied because of this kind of irrationally strict vetting.

If you or a loved one has been battling over benefits, it is a good idea to speak with a knowledgeable North Carolina workers’ compensation lawyer as soon as possible. Good, strategic legal advice can help you compel an insurer to pay out a full claim and can end annoying and potentially illegal harassment. The more knowledgeable you are about your rights under the system, the easier time you will have of collecting benefits owed and recuperating from your injuries.

More Web Resources:

Maywood Spine and Joint Rehabilitation Center

Maywood Clinic Linked to Fraud

High profile North Carolina workers’ compensation experts have been vigorously debating last week’s settlement arrangement regarding compensation for 10,000+ plaintiffs who were exposed to toxic contaminants while cleaning up the rubble at the World Trade Center subsequent to the September 11, 2001 attacks.

According to the New York Times, US District Court Judge Alvin Hellerstein met with lawyers for the city and for the plaintiffs last week to go over the terms of the payout. Assuming 95% of the plaintiffs sign on to the agreement, the settlement will go forward. If only 95% agree, the settlement pot will be $575 million. If 100% of claimants agree, the pot will be raised to $657.5 million.

The New York Times quoted NYC Mayor Bloomberg saying that the arrangement was “a fair and reasonable resolution to a complex set of circumstances.” Both city lawyers and lawyers for the plaintiffs seem pleased by the arrangement. Under the terms, a special claims administrator will evaluate plaintiff claims, determine whether specific plaintiffs can participate in the compensation, and allot moneys to be paid out. Some people will likely be awarded only a few thousands of dollars. Others may qualify for over a million dollars.

Many plaintiffs fear that they might develop cancer or another chronic condition that might not manifest for a while due to their exposure, so the settlement stipulates that a special fund of over $23 million will be set aside to pay for their insurance policy costs.

The legal battle over how and whether to compensate victims who got exposed to chemical contaminants, particulate debris, and other hazards at the World Trade Center cleanup site has taken years to resolve. According to the NY Times, the battle cost the city over $200 million in legal fees.

A claims administrator is scheduled to start hearing cases in the middle of May. He or she will look at factors such as the severity of illness/injury suffered, whether the patient had any pre-existing conditions prior to working at Ground Zero, how long it took the patient to develop/report/diagnose his or her illness, and whether the patient has a history of smoking.

Judge Hellerstein also made an unusual decision to have “fairness hearings” about the reasonability of the settlement – fairness hearings are usually only held in class action lawsuits.

North Carolina Workers’ Compensation policy wonks have been blogging about this decision since it came down last week. On the one hand, the settlement does unclog the court system, and it provides a measure of significant recompense to injured victims. It also appears to be relatively balanced, and the extra measures to prevent fraud make a lot of sense, especially in light of the legal brouhaha over the September 11 Victim Compensation Fund.

That being said, the settlement is far from perfect, according to numerous North Carolina workers’ compensation experts. It took way too long to resolve this issue. One initial claimant actually died while waiting for the case to resolve, for instance. And the case consumed fantastic amounts of media oxygen and court time.

What should you do if you or a family member is struggling with a compensation case?

Rather than “going it alone,” connect with a qualified North Carolina workers’ compensation attorney to discuss potential remedies. The logistics regarding even simple worker claims can get extraordinarily complex, and small clerical errors can result in major problems with collecting benefits down the line.

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Terms of the $657.5 9/11 settlement

Diseases of Ground Zero

A former North Carolina Workers’ Compensation insurance agent, Terri Lynn Spence, has been sentenced to four years of supervised probation and a full year of house arrest (under electronic surveillance) for multiple counts of embezzlement, according to North Carolina officials.

North Carolina Insurance Commissioner, Wayne Goodwin, publicized Ms. Spence’s sentencing at a news conference. The 34-year-old Emerald Isle resident was ordered to pay more than $46,000 in court fees and restitution to victims of her scheme. All told, 16 different insurance companies and 43 individuals were financially impacted.

Ms. Spence “obtained property by false pretences,” according to investigators at the Department of Insurance, who contacted police officers in La Grange to bust the embezzler back in June 2008. Most of the policies embezzled were North Carolina Workers’ Compensation policies (along with some homeowners’ policies). State officials do not believe that Ms. Spence worked in conjunction with any other entity or syndicate. But her arrest, trial, and sentencing likely have not gone unnoticed by others who would seek to embezzle or otherwise defraud the North Carolina Workers’ Compensation system.

If you or a family member has had trouble collecting your North Carolina Workers’ Compensation benefits, or if you are having any issues filing paperwork, dealing with your employer, managing negotiations with your insurance company, or talking to your physician or rehabilitation specialist about billing, go over your concerns with a qualified North Carolina Workers’ Compensation attorney.

More Web Resources:

Terri Lynn Spence

Wayne Goodwin

Elevated North Carolina Workers’ Compensation costs concern everyone in the “employment ecosystem” – small business owners, employees, government agencies, insurance companies, and physicians alike. To bring down costs across the board, however, requires a holistic approach to problem solving. In this article, we will speculate about remedies that could be applied throughout this “ecosystem” – at little to no cost to employers, insurers, or employees.

1. Put in place systematic solutions to common workplace ergonomic problems.
How many North Carolina workers’ compensation cases begin at the keyboard? Carpel tunnel syndrome, repetitive stress injuries, and other soft tissue injuries abound in North Carolina – many of them no doubt due to bad workstation ergonomics. An employer can mitigate against risk of repetitive stress injuries by investing in more economic keyboards, for instance, more tailored workstations, and a program of regular breaks and stressing. The cost of such a proactive “war” against repetitive stress injuries would be minimal, and the benefits would no doubt be long lasting. Workers who are not exhausted from keyboarding and other repetitive tasks can work longer hours (thus making up any theoretical costs of ergonomic modifications). Fewer injuries would mean lower North Carolina Workers’ Compensation insurance premiums.

2. Better Alert and Response System to Control North Carolina Workers’ Compensation Fraud.
As the old saying goes, a few bad apples can spoil the bunch. Everyone loses when people cheat the system. But how do you get people the stop cheating? This is the $64,000 question. Better monitoring of claims might be a theoretically good solution, but when you incentivize insurance companies to look for fraud, these companies inevitably will turn up “false positives.” I.e., they will harass people who are legitimately injured – trying to get them to admit that they are not actually hurt. This is obviously terrible, and it results in many tragedies, some of which we have reported on this blog.

A better solution might be to build in a more robust tracking system to make sure that claimants stay honest. In addition, insurance companies and employers must recognize and respect the claimants who are actually hurt and go the extra mile to help them.

3. Involve physicians in more holistic patient care.
The fractured approach to patient healthcare no doubt exacerbates many medical problems. If a patient sees four doctors, chances are that each physician will require separate paperwork, and that the doctors will not communicate with one another about the patient. This needs to change. Implement across the board holistic treatment for injured patients, and we will see much better health care. This is obviously an enormous task. But if we really want to bring down North Carolina Workers’ Compensation costs, we need to start treating patients as whole people — and not just as carriers of individual symptoms they present with.

4. Better, more thorough and more regular data analysis of North Carolina Workers’ Compensation cases.

Organizations like the North Carolina Industrial Commission (NCIC) and other government agencies do track serious injuries and deaths at NC workplaces. But the amount of data that’s mined and shared about these accidents is extremely small, maybe even negligible, compared with what could be mined. We need to gather much more information – much more detailed analyses of various injuries and incidents. We must be able to share that information not only with government agencies, insurance companies, and fellow employers, but also with employees.
Do this kind of analysis, and we will no doubt be amazed at the kind of improvisations and “band-aid” solutions that emerge.

If you or somebody you love has been hurt or needs help with North Carolina Workers’ Compensation issues, connect with a qualified veteran attorney near you for a confidential consultation.

Most North Carolina workers’ compensation matters never wind up at trial. Usually, if there’s a dispute between a claimant and his or her employer or his or her insurance company, an arrangement can be ironed out.

However, in some cases, an insurance company or employer can act so egregiously that the only recourse is to pursue recompense in court. Here are some things to consider when debating whether or not to go to trial over your North Carolina workers’ compensation matter.

1. The process can be time consuming.

The judicial process is slow, sometimes aggravatingly so. You may be called into the courtroom multiple times over the course of months. You and your attorney alike may have a lot of logistical work to do to prepare. It can be months before a judge weighs in. So prepare yourself for a lot of starts and stops — and budget your time and patience accordingly.

2. Prepare for potentially brutal tactics.

Insurance companies can be quite aggressive — and even nasty — when defending decisions to deny coverage or to refuse to pay out a policy. In some cases, companies have actually videotaped plaintiffs on the sly in the hopes of catching them “acting uninjured.” These companies argue that they do this to prevent fraudulent claims, but if you are legitimately injured, this can seem to be quite a heartless tactic. Be prepared for assaults on your word and character, and work closely with your North Carolina workers’ compensation attorney to anticipate these tactics and defend against them accordingly.

3. How you dress and act in the courtroom counts.

In a perfect world, a trial would deal specifically with issues of law and nothing else. But human beings are susceptible to persuasion. How you conduct yourself in the courtroom, how you dress, how you articulate your stance, and how prompt you are to court proceedings can all dramatically influence a judge’s decision. To give yourself the best chances, dress appropriately (and soberly), be polite and attentive to everyone, think through your thoughts before speaking them out loud – particularly when you’re addressing the judge, and mentally rehearse your trial prior to the date, so you can envision the best possible outcomes.

4. Prepare both for victory and for loss.

To make the waiting period less excruciatingly stressful, anticipate both victory and defeat scenarios, and focus on tasks immediately at hand to avoid getting caught up in needless speculation. The judge’s decision will come, and when it does come, you (along with your lawyer) can piece together your best next steps of action.

5. Even if a verdict goes your way, the insurance company may still watch you.

Many North Carolina workers’ compensation claimants win at trial only to find themselves in hot water months or even years later. Insurance companies can follow you to make sure that you are as injured as you say you are. If you give an opening, companies may retroactively attack your claim. Again, there have been instances of insurance companies videotaping claimants to try to catch them in the act of “being healthy” in order to negate a claim retroactively.

All this being said, one of the best strategies to ensure victory is to connect with a reputable, trial proven, and results driven North Carolina workers’ compensation lawyer as quickly as possible to create a prepared and proactive strategy.

More Web Resources:

Preparing for Trial

Dealing with Insurance Companies who Videotape People

Here is a brief primer on North Carolina workers’ compensation fraud — including relevant laws passed by the North Carolina General Assembly as well as information, implications, and a toll-free hotline for fraud investigation.

Laws
In 1994, the state assembly passed the Workers’ Compensation Reform Act, which included statute 97-88.2 (outlining punishments for misrepresentation in a North Carolina workers’ compensation filing) as well as statute 97-88.3 (outlining punishments for healthcare providers who fail to follow the law.)

The following year, the state assembly changed statute 97-88.2 and empowered the North Carolina Industrial Commission (NCIC) to look into fraud violations of the 1994 WCRA.

In 1997, the North Carolina Assembly passed House Bill 618, which further amended two key statutes – 97-88.2 and 97-94 — to spell out increased penalties for fraud and misrepresentation under the Workers’ Compensation Act.

Today, the NCIC operates a hotline at (888) 891-4895 from Monday through Friday during normal business hours.

Who can be accused of conducting fraud? Parties including but not limited to:
• employees/claimants
• employers/managers
• corporate officers
• administrators of third party services
• insurance adjusters/agents
• lawyers
• providers of healthcare services
• rehabilitation providers

Individuals who commit North Carolina workers’ compensation fraud imperil the whole system. Fraud drains millions of dollars that would otherwise go to claimants with legitimate problems. That being said, not all cases are cut and dried. Some individuals may accidentally commit North Carolina workers’ compensation fraud simply because they fail to fill out paperwork properly or fail to follow bureaucratic protocol. It’s not that they try to cheat the system, in other words; it’s that they do not understand how to operate within it effectively.

This isn’t to say that there are not some bad eggs out there who intentionally game the system. However, if you or a family member has been accused of this crime — or if you’re in need of other kinds of assistance filing or moving forward with your North Carolina workers’ compensation claim — it may behoove you to connect with a knowledgeable attorney right away to discuss your concerns in confidence. A free consultation with a reputable attorney can put you on a strategic path to maximize your benefits and minimize your hassle.

More Web Resources:

NC Workers’ Compensation Reform Act

More about Workers Comp Fraud in NC

If you have been injured at work — or hurt while on the way to or from a work function or while otherwise engaged in company business — you may be entitled to a wealth of North Carolina workers’ compensation benefits, including replacement for lost wages, vocational training and placement, help with medical bills, and compensation for pain and suffering. Unfortunately, if you mishandle your claim, you can miss out on these benefits.

So what are some of the common ways in which claimants ‘self-destruct’ their cases?

1. Ignoring the injury/accident.

Obviously, a claimant who falls off a ladder and breaks her leg is not likely to ignore her injury; however, not all job injuries are acute. Some are chronic. For instance, repetitive stress injuries — such as carpal tunnel syndrome, cubital tunnel syndrome, and thoracic outlet syndrome — can all significantly impair your quality of life, make job duties harder, and lead to thousands of dollars in medical bills and therapies. If you don’t report a claim in time, you may miss out on key workers’ comp benefits.

2. Failing to get appropriate treatment.

Not only can delaying your treatment lead to a worsening of your health problems or injuries, but neglecting to take proper care of yourself can provide insurance companies leverage to deny your claim. Delaying can also make it more difficult to demonstrate that the injury sustained was a direct result of your on the job accident.

3. Failing to realize that the insurance company will continue to investigate your situation even after your claim has been approved.

This shouldn’t be a problem as long as your claim is real (ongoing investigations are designed to probe for instances of North Carolina workers’ compensations fraud). But insurance companies generally do all they can to avoid paying long term claims. They may look for any loophole to deny your claim and/or reduce your coverage — even retroactively. Insurers have gone as far as to secretly videotape claimants to look for evidence to deny claims.

4. Trusting employers or insurance companies to ‘do right.’

As the old adage goes: trust, but verify. As we just discussed, insurers and employers may have sympathy for you. Some individuals may even go out of their way to help you figure out your rights and fill out paperwork. But make no mistake. These companies are in business to make money — and that means they have a strong motivation to deny claims and/or to limit them as much as possible. Thus, if you disclose too much information — or the wrong kind of information — to an insurance company investigating your claim, you could significantly impair your chances of collecting of a good settlement.

5. Settling for far too less.

Many claimants are desperate for any money to pay for medical bills, lost wages, and therapies. They thus will often quickly settle with insurance companies to get some active cash flow. However, usually an insurance company’s first offer is not the best offer. A reputable and time-proven North Carolina workers’ compensation attorney can likely help you get much more for your claim.

6. Waiting too long to consult/retain an attorney.

The longer you wait to speak with an experienced attorney about your injury/accident on the job, the greater the likelihood that you will make some error of omission that could damage your claim or cause it to be dismissed altogether. The laws governing workers’ comp benefits and payouts can be extremely complicated; thus, your case may require delicate finesse to get you the most compensation and in the fairest possible terms. Furthermore, a qualified and creditable workers’ compensation attorney can help you develop a plan of action that will reduce your anxiety and uncertainty.

More Web Resources

North Carolina Industrial Commission

North Carolina Office of Economic Opportunity

The Hartford Courant reports that a man named Steven Zaczynski has been charged with fraud and other counts in conjunction with a complex workers’ compensation scheme in CT. Although North Carolina workers’ compensation experts have yet to weigh in on the matter, the attention grabbing nature of this case may impact how authorities investigate and deal with similar North Carolina workers’ compensation fraud matters.

According to The Courant, Zaczynski had been working for the Department of Corrections at the Carl Robinson Correctional Institution, when he filed for workers’ comp benefits, citing an on-the-job injury. But according to an investigation ordered by Attorney General Richard Blumenthal, Zaczynski just took the money and continued to work full time for his own business, New England Pallet of Enfield. (Zaczynski allegedly stole $12,656 in benefits.)

But the case gets weirder and more complicated. Apparently, Zaczynski also fleeced customers of New England Pallet — he took money for pre-orders but never delivered products — AND he failed to provide workers’ comp coverage for his employees.

Given the nuances and layers of this case, it may be a while (if ever) before a similar North Carolina workers’ compensation case goes to trial. But the situation illustrates how fraud, insurance scams, larceny, and other labor rights violations can coincide. This is important because injury claimants who have been unfairly denied workers’ comp by their employers or insurance companies need to be aware — not just of their own situations — but also of the extended situations that may be preoccupying their employers/insurers.

Correction Officer Charged With Workers’ Compensation Fraud, Hartford Courant, Oct 7, 2009

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Carl Robinson Correctional Institution

Since the early 1900s, North Carolina workers’ compensation benefits have provided injured workers with money for missed wages, medical bills and retraining. Unfortunately, abuses of the workers’ comp system have reached epidemic proportions, according to the National Insurance Crime Bureau, which surveyed the industry and found that this crime costs America around five billion dollars a year.

Workers who feign injury to collect benefits pass the costs of these payouts onto insurance companies, employers, and the federal government, resulting in higher premiums for everyone and stealing focus from legitimate workers’ comp claims. Insurance company advocacy groups and federal and state regulators claim that perpetrators of North Carolina workers’ compensation fraud do systemic harm, in other words.

No doubt many people do take advantage of the system by intentionally misreporting or mischaracterizing aspects of their conditions, and so forth. At the same time, however, the insurance companies cannot fairly claim to be pure victims of this fraud. Companies are generally free to hike up rates. And by investigating — and in some cases harassing — legitimate North Carolina workers’ compensation policy claimants, insurers often exacerbate the stresses on these individuals, thus indirectly causing more health problems for them and thus straining healthcare resources further and hurting the economy.

It’s also debatable whether at least some of the fraud that’s been going on constitutes a “gray market” as opposed to a “black market.” Consider: many injured workers don’t get a fair shake when it comes to their benefits. Some then rebel against a system that they perceive to be (and objectively may be) biased against them by committing fraud. Thus some attempts to siphon money from insurance companies could theoretically be justified. (That said, the law is the law.)

The deeper issue that needs to be addressed may be more global in nature. In other words, perhaps neither the perpetrators of fraud, nor the insurance companies are at the root of this epidemic. Maybe the problem is that American workers do not get adequate safety training. Alternately, maybe some massive as-of-yet-fully-acknowledged problem (such as poor workstation ergonomics) is injuring a vast number of workers and thus draining the resources of insurance companies (who in turn must bully policyholders to survive financially; and in turn policyholders must
perpetrate small scale fraud to be able to pay their bills.)

The Cost of Fraud, NYSIF

The Myth of Workers Compensation Fraud, PBS, May 29, 2000

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National Insurance Crime Bureau

According to an El Paso, Texas news report from June 30, 2009, an El Paso man has been convicted and sentenced for trying to scam the US Postal Service via a fraudulent workers’ compensation scheme.

Attorneys, workers, employers, insurers and others interested in North Carolina workers’ compensation issues have closely followed the case of former postal worker, José Barraza, who accepted over $54,000 in workers’ comp payments before getting busted for his activities. After being clued into the possibility that Barraza had faked an injury to his arm, investigators videotaped him throwing a football, taking out trash, and otherwise using what turned out to be his perfectly healthy arm.

Although Barraza was arrested in Texas, his sentencing would likely have been similar had he been convicted of a North Carolina workers’ compensation scam. The US District Judge overseeing the case sentenced Barraza to pay back the $54,000+ he took from the US Postal Service and Department of Labor as well as a pay an assessment of $1,400. In addition, Barraza must serve out a 10 month prison sentence for committing fraud. Barraza was convicted by a jury of all 14 counts against him. But it is unknown at this time whether/how he will appeal the ruling. Following his jail sentence, Barraza will have to serve 3 years of supervised release.

Claims Journal.com, Former U.S. Postal Service Employee Sentenced for Work Comp Fraud, August 28, 2009

KVIA, Man sentenced for workers compensation fraud, August 26, 2009

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Workers’ Comp Fraud

El Paso, TX

On August 21, Reuter’s news agency reported that the American Insurance Group (AIG) won a significant battle against the National Council on Compensation Insurance (NCCI) regarding allegations that the insurer had defrauded workers’ compensation pools to the tune of over a billion dollars. The high stakes imbroglio between AIG and NCCI should ultimately have trickle down impacts on North Carolina workers’ compensation policy and process.

US District Court Judge Robert Gettleman ruled that the NCCI did not have standing to file the federal lawsuit against AIG. However, the judge did acknowledge that “there is no dispute that … the participating companies have standing to bring claim separately against AIG.”

The lawsuit alleged that AIG had deliberately understated its workers’ comp premiums so that it could keep costs down and that, as a result of doing this, the company could garner an unfair competitive advantage. AIG has been raked over the coals many times over the past months due to its widely criticized handling of $180 billion in federal bailout money. While Judge Gettleman’s ruling does not necessarily clear AIG of fallout from this workers’ compensation case – in North Carolina or elsewhere – it has bought AIG a bit of a temporary reprieve. And the ruling sent AIG’s stock price up by over 6%.

Reuters, AIG wins dismissal of $1 billion workers comp lawsuit, August 21, 2009

Bloomberg, AIG Wins Dismissal of Lawsuit Seeking $1 Billion, August 21, 2009

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AIG

NCCI

On August 20, the California Department of Insurance (CDI) reported that a Southern California resident named Joseph Baiden (56) had been arrested in conjunction with a massive workers’ compensation scam. Baiden, who surrendered to LA Superior Court, had an arrest warrant out on him stemming from allegations that he had deliberately underreported his workers’ compensation payroll numbers to reduce his insurance premiums. Over an eight year period, from 2001 to 2007, he allegedly cost his insurer, State Fund, around $1.4 million. North Carolina workers’ compensation insurers have taken notice of the case, and no doubt the outcome will dramatically influence local NC policies, procedures and safeguards.

The size and scope of the charges against Baiden have attracted attention from local and national media. The CA state insurance commissioner, Steve Poizner, broke the story personally. If the defendant is convicted of fraud, he could face up to 40 years in jail in addition to fines of well over $3.2 million. The California Department of Insurance has frozen Baiden’s bank accounts and seized five of his Southern California properties, including an exclusive estate in the posh Diamond Bar neighborhood.

One of the reasons why the CDI has come down so hard on the accused is that workers’ compensation fraud – whether it occur in North Carolina or elsewhere – pads costs across the employment spectrum. When insurers can’t collect premiums, they either raise rates or reduce service, thus creating a cascade of bad effects for employers and employees alike.

AP, Calif. man accused of cheating workers comp fund, August 21, 2009

Pasadena Star News, Diamond bar man suspected of fraud, properties seized, August 19, 2009

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Steve Poizner

California Department of Insurance

In October, 2006, employers who had bought into a self-insured North Carolina workers’ compensation group fund got some terrible news. The Phoenix Fund’s reinsurance broker, a man named Thomas Raitz, had been engaging in complicated illegal shenanigans to steal from the fund via a money laundering and mail-fraud operation. Investigators from North Carolina’s Department of Insurance concluded that Raitz’s scheme impacted more than $20 million worth of the fund’s money.

Although Raitz was convicted in 2007 after pleading guilty and was subsequently sentenced to nearly 6 years in jail, members of the Phoenix Fund have yet to collect money and damages. Finally, in 2008, Raitz was ordered by the court to pay $19 million to reimburse the Phoenix Fund. To date, Raitz has paid out $18 million, of which $11.5 million has gone to meet the obligations of the fund itself and has not gone to remunerate individual employers. Only $6.5 million collected will be distributed among the injured parties. That said, the North Carolina Insurance Commissioner, Wayne Goodwin, released a statement that sounded a note of optimism for these employers, assuring the victims that they would “get back every available penny” owed to them.

Triangle Business Journal, North Caroilna employers to get $6.5M from Phoenix Fund, August 10, 2009

Workforce Management, Workers’ Compensation Fund Members Hit by Fraud Get Distributions, August 14, 2009

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North Carolina Insurance Commission

North Carolina’s Department of Insurance

Is there a non-profit state agency that can provide unbiased information about North Carolina workers’ compensation benefits, eligibility and rights?

Yes. The North Carolina Industrial Commission (based out of Raleigh) is reachable at (919) 807-2500. You can also contact workers comp info specialists directly toll free at (800) 688-8349 or email someone for assistance at infospec@ic.nc.gov.

If your employer does not report your injury, for whatever reason (e.g. negligence, refusal to assist), is there anything you can do?

Yes. Collect a claim Form 18 or Form 18-B and file it with the NC Industrial Commission within two years of your on the job injury.

Can injured employees get benefits for using chiropractic services?

In some cases, yes. If your employer’s insurer allows, you can have up to twenty visits to a designated chiropractor paid for, provided that the services are “medically necessary.” If you require more chiropractic services, the chiropractor needs to contact the employer directly.

If you have been injured at work, what steps should you take immediately?

First of all, tell your employer — both verbally and in writing. It’s very important that you keep track of all of your correspondence and file it and date it. You should make sure to do this within thirty days of your injury, unless your recuperation has rendered you unable to make such a communication.

In the event that your employer lacks North Carolina workers’ compensation insurance, do you have any recourse to collect benefits?

Yes. First of all, the North Carolina Industrial Commission’s fraud hotline should be notified. You can call toll free at (888) 891-4895 or email a government representative at fraudcomplaint@ic.nc.gov. If you’ve been injured and then you discover that your employer lacks insurance, contact the Commission. You’ll likely have to fill out two forms — Form 33 and Form 18 — to attempt to collect benefits.

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North Carolina Industrial Commission

NC Workers Compensation Act