Department Of Insurance Busted $25-Million WC Fraud

Department of Insurance detectives have arrested nine people in connection with a serious case of workers’ compensation fraud, which caused financial damage to more than 200 insurance carriers and self-insured employers.

A company called G&G Interpreting Services, run by siblings Francisco Javier Gomez, Jr. and Angela Rehmann, issued fraudulent bills for non-existent services of translating Spanish. The total worth of the fraud has been estimated at $24.9 million.

G&G Interpreting worked with clinics and was supposed to mediate between injured workers of Latino origin seeking medical care and the healthcare professionals. However, the investigation revealed that the majority of staff in the clinics were Spanish speakers, while in others over 10 doctors spoke Spanish fluently. Needless to say, services of an interpreter weren’t necessary.

The medical institutions with which G&G Interpreting allegedly worked are located throughout Southern California and include the counties of LA and San Diego, Santa Barbara, Riverside, Orange, San Bernardino and Ventura.

The detectives have established that the alleged services were delivered on about 83,000 occasions. What is interesting is that it turns out the interpreters worked over 12 hours a day, which is more than the clinics were open. There is also the fact that services worth $400,000 were delivered by an interpreter who was ubiquitously in state prison doing a sentence.

Insurance Commissioner Dave Jones said that there is a wide-spread misconception that defrauding the workers’ compensation system is a crime without a victim, because in the end everyone has to pay.

In 1991 the Department of Insurance founded Fraud Assessment Commission that established how much was to be funded through employer assessment for enforcement and prosecution costs. It was in that year that workers’ compensation fraud was given the status of felony.

In October 2015 Jones was given grants in the amount of almost $35 million to fight insurance fraud. The funds were allocated to the district attorney offices in 42 California counties. In this case, the investigation was run by Dept. of Insurance detectives and supported by Riverside and San Bernardino district attorney offices, as well as California Highway Patrol. The suspects will be prosecuted by Los Angeles County district attorney office.

If you need a wc lawyer Orange County, feel free to turn to Workers’ Compensation Attorney Group in Orange County for a no-cost, no-pressure case review. Our team of exceptionally experienced and both aggressive and ethical attorneys will listen to you carefully and provide you accurate information regarding your case. If you choose to hire our services, you should know we work on a contingent fee basis, so you only pay if we win your case.

Can You Reopen Your Workers’ Compensation Claim?

An experienced workman’s comp attorney can very often help injured workers reopen claims after settlements. This possibility is especially beneficial for workers whose injury recurs or becomes worse and it is different from personal injury cases.

When can you reopen a workman’s compensation claim?

Certain circumstances and factors determine whether a worker is entitled to having a settled claim reopened. The first important question is how the claim was settled – was it through “Compromise and Release” or “Stipulation and Award”?

Compromise and Release is such a type of settlement that is final and resolves the worker’s case completely: in the past, present and future. Unless the settlement was reached by means of fraud, Compromise and Release makes it impossible for the injured worker to reopen the case.

Stipulation and Award, together with trial, permit the worker to reopen the claim in the future if the need arises. The Labor Code sanctions reopened claims when some specific circumstances take place. Typically, there are four conditions that allow reopening a worker’s compensation claim:

  • when the injury has become worse or come back
  • when new evidence has been discovered proving the settlement isn’t equitable and reopening the case would rectify an error of fact
  • when a fault in the law made the award unjust
  • when there was a clerical error

Injured workers with a settled claim who are thinking of reopening their cases should bear in mind that there is a time frame within which they can do this. This is called Statute of Limitations (SOL) and in workers’ compensation cases it is typically 5 years from the day of the injury.

Statute of Limitations in workers’ comp claims in Orange County

There are cases in which the old claim doesn’t have to be reopened, but the case can be filed. In the case of disability that has increased, the worker may have a cumulative claim, which is handled like a new claim. When this is so, the statute of limitations starts counting again from the “new” injury. Determining when SOL starts counting or recounting is quite complicated and can be handled only by an experienced workman’s comp attorney.

Because of the possibility to reopen the case in the future, workers are advised to think carefully before settling their claims through compromise and release. An experienced attorney can give you the best guidance on what you need to consider before accepting a settlement agreement, so that your interests and rights are best protected.

Workman’s comp attorney Orange County

If you or your close one are considering reopening your worker’s comp claim that has been settled, make sure you give Workers’ Compensation Attorney Group a call. Our attorneys have a vast knowledge and a huge experience in handling worker’s compensation cases. We are always ready to consult with you regarding your case free of charge and pressure to hire us. Remember that you only pay for our services when you recover your award, so feel free to call us right away!

What To Do After A Work-Related Injury

The best thing you can do if you happen to get hurt on the job is ask experienced compensation attorneys for guidance. We understand you will probably not seek the services of a wc lawyer prior to getting injured, so this article will outline the important steps to be taken right after a worker is injured in the workplace.

Report your injury to your manager

The most important thing you should do if and when you get hurt while performing job duties is let your manager know about your injury. If there were any witnesses, remember them and make sure you have their contact details. If there is any evidence it should be collected and if possible, record the accident site in photos. However, keep in mind there may be some security or confidentiality restrictions preventing you from taking them.

After your injury has been reported to your superiors, you should be provided with a form for making workers’ compensation claims in California, which is known as DWC-1. If your superior fails to give you the form, remember that it’s your right to ask for it.

The claim form is filled out by both parties, meaning you and your employer. When the form is fully filled out, request to be given one copy of it.

Filling out the workers’ compensation claim

When you are writing the claim, make a point of including all the body parts that were possibly injured in the claim. To illustrate this, we can use an example – if an object should fall on your shoulder, but it is your back that hurts, you should list both the shoulder and the back as injured body parts.

It will be possible to amend the claim later, but when you initially fill it out try not to leave out anything. That doesn’t mean you should lie or misstate anything, but it’s better to include more rather than less. Finally, you will be examined by a doctor to determine the scope and severity of your injuries.

Don’t be afraid to assert your rights

It’s disappointing how many workers decide to keep silent about getting hurt on the job because they are afraid of losing their employment. The reality is very few employees do get terminated after reporting a work-related injury. The workers’ compensation law protects employees from that and it’s illegal to terminate an employee because they sustained an injury in the workplace and reported it. Employers are aware of the law and don’t wish to get involved in a pricey lawsuit.

Do your best to report the injury in the shortest period possible, because that will drastically improve the chances of actually recovering the compensation you deserve.

Have an experienced workman’s comp lawyer fight for your rights

Having professional legal guidance is extremely valuable when you are asserting your employee rights in a compensation claim. If you are looking for wc attorneys in Orange County, make sure you give Workers’ Compensation Attorney Group a call. Our expert compensation attorneys are always ready and willing to review your case free of charge and pressure to hire us. Just bear in mind that our aggressive, experienced and ethical attorneys work for a contingency fee, which means you only pay for our services when you recover your compensation. Don’t hesitate to call us – we are always here for you!

Stipulation & Award Closure of Workman’s Compensation Claim in Orange County

There are a number of ways in which a workman’s compensation claim can close. The most common way is through Compromise and Release (C&R) in which the applicant gives up their rights for a lump-sum compensation. Once the judge approves the settlement by issuing an order, the claim is closed forever. This is a very popular way of ending claims because it avoids inherent risks of pursuing the claim in court (both parties risk an outcome of an unsatisfactory compensation).

Another way a claim can be ended is through Stipulation and Award.

The basics of Stipulation and Award in Orange County CA

This closure is less popular than Compromise and Release. There is no lump-sum compensation paid out to the applicant, but a level of disability is stipulated and future medical care provisions are secured for the hurt employee. The value of this compensation is usually smaller than with C&R because the medical part of the settlement is left open. Financial compensation is provided on a weekly basis until the set amount is exhausted. This compensation is called permanent disability money provided for injuries incurred in the workplace as a result of hazardous exposure. The disability, or physical impairment, is assessed through American Medical Association Guides of Permanent Impairment. Future medical care (FMC) is provided, but it must be reviewed and approved by the insurance provider.

Downsides of Stipulation and Award

When a workman’s compensation case is concluded in this way, it is unfavorable for the claimant that the compensation is nowhere near as high as with Compromise and Release and it’s stretched over a long period of time (usually years and less usually decades).

Moreover, it’s disadvantageous for the hurt employee that the medical treatment and care are and will be controlled by the insurance adjuster. Insurance providers commonly try to postpone or block medical procedures even when they’re doctor-recommended. California insurance carriers for workers’ compensation are infamous for turning down medical treatment procedures, and this is much more wide-spread than with the private health sector.

Upsides of Stipulation and Award

The fact that future medical care (FMC) is open is a good thing for the worker. This holds especially true in the case of chronic conditions, when FMC is the only financially feasible option within the system. Even though the care will remain in the control of the adjuster, it still beats nothing.

Another hidden advantage is the possibility of reopening the case if another related disability appears. The SOL (time limit) for this is 5 years since the date of the initial injury. If there are conditions or consequences that weren’t foreseen at the time of the settlement, there’s a chance to get a bigger amount of the permanent benefit and a wider medical coverage for the new or further impairments caused by the original injury.

A third upside is the opportunity to get a bigger amount of C&R if the claim is reopened due to further consequent impairments. This wouldn’t be possible if the case had been originally closed through C&R.

Get an Expert Attorney to Handle Your Workman’s Comp Claim In Orange County CA

If you or someone dear to you has incurred injuries on the job in Orange County, don’t hesitate to contact the experienced, aggressive and ethical attorneys at Workers’ Compensation Attorney Group in Orange County. Our lawyers are experts with an invaluable experience in leading workman’s compensation claims. Contact us right away to get a free case review with no pressure or obligation to retain our services. If you do choose to hire us, you don’t need to worry about exorbitant legal fees – you pay only if we win! You have nothing to lose, but valuable time and guidance in your case.

Termination After A Workers’ Compensation Claim

 

If your employer terminates you following your compensation claim, you should immediately seek help from an experienced attorney in your area. It is against the law to dismiss a worker after he or she sustained an injury in the workplace and filed a compensation claim thereafter. That is, an employer cannot terminate an employee on the grounds of worker’s work-related injury or because the employee asked for compensation. While the claim is being resolved or is pending the employee can be terminated or made redundant, but the termination cannot be due to the worker having sustained injury, filed the claim or because the injured worker needs lessened duties.

Being afraid of termination after filing a compensation claim

Many workers who sustain injuries or cumulative trauma in the workplace are afraid they are going to lose their employment if they file a claim or report it to the employer. This makes them apprehensive and anxious. It often happens that the injured worker tolerates the harmful injury and foregoes proper medical treatment, all the while performing their work duties as if nothing happened.

Unfortunately, when an injury is neglected and when the injured person is deprived of recovery, the detrimental effect of the injury usually worsens until it prevents the worker from doing their job as they should. The paradox is that these circumstances actually make losing their job more probable, which is exactly what the worker wanted to avoid by not reporting the injury. To make things worse, when the injury is not timely reported, the prospect of filing a claim and getting compensation is significantly diminished. It will be doubtful and difficult to prove whether the injury is related to work duties at all. It can appear that the employee was injured outside the workplace and is now trying to frame their employer for it.

What can be done after termination following a claim

The most important thing you should do is report your work-related injury to your employer in the shortest period possible, even when you are afraid you might be terminated. It is not at all common that an employee is terminated because of having filed a compensation claim as that can lead directly to a variety of lawsuits. If the worker reports the injury, files a compensation claim and asks for benefits and then experiences termination or discrimination in the workplace, the employer will face harsh penalties that can be demanded in court. It is also illegal to terminate a worker for having a disability, and remedies for that are provided in the Fair Employment Housing Act.

Have a workman compensation lawyer protect your rights

You shouldn’t be discouraged from claiming a compensation for benefits because you are afraid of termination or discrimination. You have the right to ask for benefits if you incurred an injury while doing your job. It’s extremely rare for employees to get fired because of the compensation claim, because employers know such a move would entail more lawsuits. The whole idea behind the workers’ compensation system is to benefit both sides – ensure the medical help and benefits for the employee are cost-effective and that the worker returns to the workplace in good health and ready to work.

If you live or work in Orange County and you sustained a work-related injury, don’t hesitate to contact Workers’ Compensation Attorney Group in Orange County. Our workman compensation lawyers are experienced, aggressive and ethical and they will only charge you if you recover the compensation. Feel free to call us right away and talk one on one with one of our expert lawyers and have a free case review with no pressure to hire us. You can only gain if you call us!

Workers Compensation Press Updates

Workers Compensation Press Updates

Workers Compensation Press Updates

Workers Compensation Press Updates

Workers Compensation Press Updates