Cecilia Watt Dec 21, 2017 03:53 AM
Employers lie! This is a HUGE problem for legitimately injured at work - workers. Insurance carriers no doubt appreciate the lies that employers tell so that they don't have to cover the medical treatment and compensation of the injured worker.
Juan Armenta Dec 21, 2017 01:10 PM
Mr. Kinsey and Mr. Don makes good points that merit clarification. There are many occasions in which the DA or Dept of Insurance has declined to assume primary prosecutorial responsibilities. In fact, that is the rule rather than the exception hence the many boutique firms that do nothing but qui tam cases. For instance in another recent case of ours the employer in his application for work comp insurance claimed only two employees with a total payroll of 70k. This went on for years, however his own books and deposition testimony from the general manager showed between six and ten employees with payroll over 450k. The Deputy AG explained that while her personally would advocate taking over the case the question is resource allocation. That is an understandable and reasonable position. That lack of prosecutorial resources is the gap in the system that allows bad actors to get away with fraud and which prompted the creation of qui tam statutes like the False Claims Act, PAGA and the IFPA. The “he said, she said” and risk of an explosion of dubious cases was the argument Sunline presented in its work comp exclusivity appeal which the DCA rejected given the clear legislative intent of the IFPA to combat fraud. We all know it is true, as Mr. Jon points out, that most applicant attorney’s do not file civil actions. Those of us that do realize that filing an IFPA case and proving it will be expensive. So, they are filed with a great degree of examination of the evidence. In this case, like almost all denial cases, the matter comes down to the boss denying that an injury occurred and the worker saying it did-classic “he said, she said”. But, the occurrence of the injury was corroborated by a courageous employee who witnessed the events unfold. Without that evidence it is unlikely we would have filed the case. The IFPA was enacted 17 years ago and a explosion of litigation has not occurred and I think that was one of the problems with Sunline’s explosion of litigation argument. The difficulty and expense of proving up a case is a natural limit. But, I do agree generally with Mr. Kinsey that the evidence should be carefully vetted whether the case be premium fraud, false injury denials, false payroll data, etc.
Beth Harville Dec 26, 2017 12:23 PM
I see 4 claims in EAMS for his (Mahmoud Alzayat) back, so probably a mix up because that is a lot of claims for one person with one employer.