Category Archives: Workers’ Compensation

Facebook Pictures’ Use Evolving in Workers’ Compensation Cases

Today’s post comes from guest author Brody Ockander, from Rehm, Bennett & Moore.

We routinely advise our clients to be aware of the possible discovery of Facebook and other social media sites. First step – check your privacy settings. If you do not control your privacy settings, your employer or the insurance carrier may easily access your posts. Also, do not post comments about your case, your employer, or your injury online.

In the past, I have warned about the possible pitfalls of social media on a workers’ compensation claim.

However, the Nebraska Workers’ Compensation Court has never really ruled on Facebook in the context of discovery matters in a work comp claim, meaning how much access can your employer have to your Facebook account if you file a workers’ compensation claim? 

Recently, however, the Nebraska Workers’ Compensation Court (at least one judge) has taken the position that in order for your employer to gain access to photographs from your Facebook profile, it must “make a showing of the necessary factual predicate underlying [the] broad request for access.” In other words, your employer must have a decent reason to suspect that a certain photograph or something from your Facebook account has the potential to be relevant to the work comp case before the court will simply grant full access to your Facebook account to your employer.

Therefore, depending on your situation, your Facebook may be safe from your employer to some degree. However, this is a cautionary tale to remind you that even though your employer cannot simply have blanket access to all of your Facebook photos – at least according to one Nebraska judge – it does not mean that your Facebook photos or posts are necessarily safe from your employer gaining access to them at some point during your work comp case. I think the judge in this case takes a step in right direction, but you still must be aware that anything you put on Facebook may be subject to discovery (i.e., your employer may still possibly get access to it) at some point in the future.

Is It Really WorkMAN’s Compensation or Workers’ Compensation?

Today’s post comes from guest author Brody Ockander, from Rehm, Bennett & Moore.

I often hear my clients refer to their work-injury claim by the antiquated term, “workman’s compensation.” This was formerly the common vernacular when referring to a work-injury claim. Now however, most – if not all – jurisdictions have adopted the more gender-neutral term “workers’ compensation.”

Why the change? While one would have a strong argument that the change reflects the new age of political correctness, an equally compelling case can be made that the change was merely to reflect the increasing numbers of work injuries suffered by women. When compared to the times when workers’ compensation laws were initially enacted, more and more women have moved into industrial jobs. Of course, it naturally follows that as women move into more dangerous and laborious jobs, more women are going to be injured on the job.

For example, in Nebraska 42.7% of all reported work injuries were to women, according to the Nebraska Workers’ Compensation Court Statistical Report For Injury Years 2003 – 2012.  So, while I certainly understand when my clients say “workman’s compensation,” once in a while I jokingly remind them that all injured workers are covered, regardless of their gender. 

$46 Million Stolen: 2013’s Top Ten Workers’ Compensation Fraud Cases

Professor Leonard T. Jernigan Jr. has compiled a list of 2013’s Top 10 Workers’ Compensation Fraud Cases

Today’s post comes from guest author Leonard Jernigan, from The Jernigan Law Firm.

Employer Fraud Cases (9):$44,064,492.00
Employee Fraud Cases (1): $1,500,000.00
Total: $45,564,492.00

Every year we hear about fraud in Workers’ Compensation cases and the public believes the fraud is employee driven. However, in 2009 I began tracking the Top Ten Fraud Cases and 100% of the Top Ten between 2009-2012 involved employers or shady characters posing as legitimate businesses. The amount of employer fraud is staggering. In 2013 one employee fraud case did crack the Top Ten, so the record is now 49-1 (employer fraud v. employee fraud) over the past five years.

  1. Florida: Owners of Diaz Supermarkets in Miami-Dade are Accused of $35 Million Fraud (4/16/13)

    John Diaz and his wife Mercedes Avila-Diaz owned and operated four supermarkets in the Miami-Dade area. They have been arrested and accused of workers’ compensation fraud and other fraudulent transactions totaling $35 million. One business they operated had no coverage for employees for ten years. They allegedly engaged in a scam to help subcontractors obtain false certificates of insurance that allowed the subs to work for general contractors who required the certificates.

  2. California: Hanford Farm Labor Contractor Convicted of Fraud in the Amount of $4,195,900 (12/6/2013)

    Richard Escamilla, Jr.

    Richard Escamilla, Jr. (47), owner of ROC Harvesting, misrepresented information to workers’ compensation insurance carriers by using new business names to obtain insurance and avoid providing a claim history. Escamilla pleaded guilty on October 29th and was sentenced to pay restitution of $4.1 million and serve six years in prison.

  3. Michigan: Insurance Executive Embezzled $2.6 Million from Workers’ Comp TPA (06/06/2013)

    Jerry Stage

    Jerry Stage (67), the former CEO of a non-profit workers’ compensation insurance company, and George Bauer (55), the bookkeeper, both pleaded guilty to embezzling from the Compensation Advisory Organization of Michigan (CAOM) for more than a decade. Mr. Stage embezzled $2.6 million from the company and conspired with Mr. Bauer to cover up the embezzlement.

  4. California: Employee Wasn’t Wheelchair Bound After All – Fraudulently Took $1.5 Million in Benefits (8/9/13)

    Yolandi Kohrumel

    Yolandi Kohrumel, 35, claimed for nine years that she was wheelchair bound after complications from toe surgery, but after she had collected $1.5 million in benefits it was revealed her claim was false. Her father, a South African native, was also engaged in the scam. Both pleaded guilty to insurance fraud, grand theft and perjury. Ms Kohrumel was sentenced to one year in jail, plus restitution.

  5. California: Father and Son Landscapers Accused of $1.45 Million in Insurance Fraud (5/7/13)

    Sunshine Landscaping

    Jesse Garcia Contreras (57) and Carlos Contreras (33), who operate a Thousand Palms landscaping business, are accused of committing $1.45 million in insurance fraud. They are accused of defrauding the California State Compensation Insurance Fund by misclassifying employees from January 2008 to March 2012. Mr. Jesse Contreras is the president and CEO of Sunshine Landscaping and his son is Director of Accounting. If convicted, they each face up to 19 years and 8 months in prison.

  6. Florida: Workers’ Compensation Check Cashing Operation Charged with $1 Million in Fraud (2/27/13)

    As a result of its investigation of I&T Financial Services, LLC, a company that was allegedly set up to execute a large scale check cashing scheme for the purpose of evading the cost of workers’ compensation coverage. Domenick Pucillo, the ringleader of the fraud scheme, was arrested and charged with filing a false and fraudulent document, forgery, uttering a forged instrument, and operating an unlicensed money service business. If convicted on all charges, he faces up to 45 years in prison. $1 million was seized during this investigation.

  7. West Virginia: Coal Company Contractor in Mingo County Caught in $405,000 Scam to Avoid Workers’ Comp Premiums (11/6/13)

    Bank of Mingo

    Jerame Russell (50), an executive with Aracoma Contracting, LLC, a company that provided labor to coal companies on a contract basis, entered a guilty plea to a scam that involved funneling over $2 million through a local bank to pay employees in cash, thus avoiding payroll taxes and $405,000 in workers’ compensation premiums. Aracoma also bribed an insurance auditor to cover up its true payroll.

  8. Ohio: Roofing Business Owners Guilty of $283,592 in Workers’ Comp Fraud (7/30/2013)

    Frederick Diebert

    The owners of Triple Star Roofing were found guilty of fraud on July 15 for failing to report payroll to the Ohio Bureau or Workers’ Compensation(BWC). The company failed to report to the BWC from 2004 to 2008, resulting in under-reported premiums of $283,592.

  9. Florida: Owner of Staffing Company arrested for $130,000 in Workers’ Comp Fraud

    Preferred Staffing of America, Inc.

    The owner of Preferred Staffing of America, Inc., a temporary staffing agency in Tampa, has been arrested for allegedly running an organized workers’ compensation fraud scheme. Preferred Staffing’s owner misled clients into believing that his company was a licensed professional employer organization (PEO) and could provide workers’ compensation insurance coverage. Employers were reportedly charged more than $130,000 for workers’ compensation insurance and other services that were never provided.

For more information, contact: Leonard T. Jernigan, Jr. Adjunct Professor of Workers’ Compensation N.C. Central School of Law The Jernigan Law Firm 2626 Glenwood Avenue, Suite 330 Raleigh, North Carolina 27608 (919) 833-0299 ltj@jernlaw.com www.jernlaw.com @jernlaw

A History of Workers’ Compensation – With a Washington State Slant

English Fire Insurance Laws Enacted in 1667

c2000, BC

Hammurabi, ruler of Babylon, was responsible for the Code of Hammurabi, part of which bears resemblance to today’s workers’ compensation laws.

c460-c377, BC

Hippocrates, the father of contemporary medicine, established .a link between the respiratory problems of Greek stonecutters and the rock dust surrounding them.

1667

The Great Fire of London (September 2-7, 1666) caused the first English fire insurance laws to be enacted.

1880

William Gladstone pushes Employers’ Liability Act in Britain

1864

The Pennsylvania Mine Safety Act (PMSA) was passed into law.

1871

Otto Eduard Leopold, Prince of Bismarck, Duke of Lauenburg, (known as Otto von Bismarck, a Prussian statesman) enacts the Employers’ Liability Act.

1877

The state of Massachusetts passed a law requiring guarding for dangerous machinery, and took authority for enforcement of factory inspection programs.

1878

The first recorded call by a labor organization for a federal occupational safety and health law is heard.

1884

Otto von Bismarck enacts Workers’ Accident Insurance

1902

The state of Maryland passed the first workers’ compensation law.

1911

Industrial Insurance laws enacted in Washington State.

1911 – 1915

During this period, 30 states passed workers’ compensation laws.

1968

President Lyndon Johnson called for a federal occupational safety and health law.

1970

President Richard Nixon signed into law the Occupational Safety and Health Act (OSHA), thus creating the OSH Administration and the National Institute for Occupational Safety and Health (NIOSH).

1972

Self-Insurance for Workers’ Compensation allowed for individual businesses in Washington State.

2012

Compromise and Release Structured Settlement Agreements allowed for certain Washington State workers’ compensation claims that meet basic criteria.

 

How Safe Is Healthcare for Workers?

Today’s post comes from guest author Rod Rehm, from Rehm, Bennett & Moore.

The issue raised by Mr. Rehm was investigated thoroughly in a book given to us by a client, an injured nurse who contributed her story to the effort under a pseudonym: Back Injury Among Healthcare Workers, published by Lewis Publishers. It is a great resource, providing case-studies, statistics and suggestions for improvements for workers in the healthcare field.

The article that today’s blog post is based upon is an in-depth look at how one state’s OSHA office interacts with a sector of the healthcare community: hospitals. Like Iowa, but unlike Nebraska, Oregon is one of 27 states or U.S. territories that has an OSHA office at the state level

The “Lund Report: Unlocking Oregon’s Healthcare System” article talks extensively about nuances within ways that OSHA offices, whether state or federal, can measure the safety of healthcare providers like hospitals and nursing homes. 

As evidenced in previous blog posts about senior-care workers and lifting injuries, I have continuing concerns for the safety of healthcare workers. 

According to the in-depth article, “A Lund Report review suggests that in Oregon, regulators are de-emphasizing attention to hospital employee safety, despite national data showing that healthcare workers are injured in the U.S. each year at rates similar to farmers and hunters. Most Oregon hospitals have not been inspected by the state Occupational Safety and Health Division in years. And when on-the-job hazards are detected, Oregon’s OSHA office levies the lowest average penalties in the country.”

Should workers get lost as the patients are the focus of these healthcare institutions? Should regulation and inspections or fines by such groups as OSHA be the driving force toward workplace safety for healthcare employees?

It seems to me that healthcare administrators’ emphasis on profit is more important than proper concern for their employees – the nation’s caregivers. And if you or your family member is the healthcare worker who gets hurt on the job, this lack of focus on the worker is more than just a philosophical argument.

Worker Privacy Concerns : Employers’ Access to Employees’ Prior Worker’s Compensation Claims

Today’s post comes from guest author Tom Domer, from The Domer Law Firm.

Washington similarly allows employers to access all prior claim records, even from other employers, when one of their employees files an injury claim. Workers’ compensation claims already had a lower privacy standard than other types of records – workers’ compensation is excluded from HIPPA protections – but this now allows easy access to all records, relevant or not, once a worker files an injury claim.

Republican legislators are feeling their oats these days. Throughout the Midwest, legislators are depriving workers of collective bargaining rights and trying to restrict workers’ rights in workers’ compensation claims.

In Missouri, workers’ compensation legislation was recently proposed that would have permitted an employer to provide a potential hire’s name and Social Security number so an employer could identify the potential employee’s prior workers’ compensation claims and the status of those claims. The Missouri Division of Workers’ Compensation estimated an online data base that would include over a half million claim records with over 10,000 records added each year.

To his credit, Democratic governor Jay Nixon vetoed this proposed online data base which would allow businesses to check a prospective employee’s workers’ compensation claims. He said it was “an affront to the privacy of our citizens and does not receive my approval.” As expected, supporters of the workers’ compensation data base (employers primarily) said the legislation would speed the hiring process and help bosses and workers. Regularly, information about workers’ compensation claims is available by written request and takes about two weeks to arrive.  Supporters of the legislation indicated the law was “preventing workers’ compensation abuses.”

Wisconsin’s workers’ compensation records are subject to Wisconsin public records law, except for records identifying an employee’s name, injury, medical condition, disability, or benefits – which are confidential.  Authorized requestors are limited to parties of the claim (the employee, the employer, and the insurance carrier), an authorized attorney or agent, a spouse or adult child of a deceased employee. Workers’ Compensation Division staff may provide limited confidential information regarding the status of claims to a legislator or government official on behalf of a party. In addition, workers’ compensation staff are not permitted by law to conduct a random search to determine if other injuries have been reported.

If the requestor is the same employer or insurance carrier involved in a prior injury, then access will be allowed. If the requestor is a different employer or insurance carrier but they make a reasonable argument that the prior injury and the current injury are related, access may be allowed. For example, the Department considers injuries “reasonably related” if the two injuries involve the same body areas.

Simply put, in Wisconsin, at least for the present, claimant information is confidential and not open to the public, other than to the parties to a current claim.

Texas Stories: Symptom of Bigger Workers’ Comp Debates

Today’s post comes from guest author Rod Rehm and Emily Wray Stander from Rehm, Bennett & Moore.

We have been listening with interest to a recent National Public Radio (NPR) series about construction workers and businesses in Texas. The series about this industry confronts many of the issues that are being debated by society these days, whether in the judicial, executive or legislative branches.

To add some context, these topics include employing immigrant workers; paying a living wage; calling an employee an independent contractor; and ensuring workplace safety, workers’ compensation, and payroll taxes are all done, practices that specifically are not happening in Texas, according to the stories. A notable quote from the first piece is “Texas is the only state in the nation without mandatory workers’ compensation, meaning hospitals and taxpayers usually end up shouldering the cost when uncovered construction workers are hurt.” And we think the information from the second piece is quite telling that the business owner “asked that NPR not use his last name because the IRS might take an interest in his business, designs and builds landscapes in the Dallas-Fort Worth area.” Because he treats his crew as “self-employed contractors,” meaning that the IRS would likely see his interpretations of tax law as illegal. From the story: “This is a key distinction. If Trent were to classify his workers as employees, he’d have to pay taxes, Social Security, unemployment and overtime. But by saying his workers are actually independent contractors – in essence, business owners – he’s off the hook.”

We think listening to these two pieces, at less than 15 minutes total, is a good opportunity to experience an applied illustration of what happens to the vulnerable when such protections as workers’ compensation are effectively dismantled for profit-taking and political reasons. Respected colleague Jon Gelman in New Jersey recently wrote a blog post that focuses on the first NPR report and “how bad it is for workers who get injured in Texas.”

Although things are allegedly always more extreme in Texas, attacks on the vulnerable aren’t limited to that state, unfortunately. Ms. Cathy Stanton, president of the Workers’ Injury Law and Advocacy Group (WILG), and a respected colleague from Pasternack Tilker Ziegler Walsh Stanton & Romano in New York, recently wrote an extremely useful article about “Emerging Trends in Legislative Attacks on Injured & Ill Workers.”

In Nebraska, the anti-worker, pro-business Nebraskans for Workers’ Compensation Equity and Fairness group is backing LB 584 that would dramatically limit protections that workers have when it comes to being injured through a concept called evidence-based medicine/utilization review. In addition to our firm writing numerous blog posts about this legislation, EBM/UR is #8 in Ms. Stanton’s list of “trends throughout the country which would negatively impact existing Workers’ Compensation benefits.” And according to this article, politicians in Tennessee are looking to gain some brownie points with business and insurance by overhauling the workers’ compensation courts to the detriment of injured workers. Iowa workers and attorneys have to contend with #6 on the list, restricting doctor choice, while a bill in Nebraska’s legislature is in the works to do the same if passed.

We agree with what Ms. Stanton writes: “All workers need to be aware of these trends because the likelihood of legislation being introduced in their state against their interests is strong. Employee immunity has remained untouched, but workers’ benefits are consistently under attack as a result of the collective lobbying efforts of the insurance industry and large corporations.   Unfortunately the great compromise is turning out to be one sided as workers are forced to endure multiple obstacles and hurdles to be entitled to fewer and more restricted benefits.”

So we would encourage you to join us in educating yourselves about how workers’ compensation “reform” can lead to stories like NPR’s cautionary tales about the construction industry in Texas and to explore what’s going on in your state legislature. Finally, get involved in your state’s political process to advocate for workers!

Structured Settlements – One Year Later

        As of January 1, 2012, a significant change in Washington’s workers’ compensation laws created Claims Resolution Structured Settlement Agreements, or CRSSAs.  The CRSSA provides an opportunity to resolve the claims of injured workers age 55 and over through structured settlements, an option intended to reduce overall claim costs for the Department of Labor and Industries, potentially leading to lower workers’ compensation premiums for both businesses and workers, while providing an alternative for injured workers who feel “stuck” in the Department’s system and wish to pursue retirement or alternative work goals outside their claims. – See more detail in our prior post on this subject here

        The Office of the Attorney General provides legal oversight to the Department and assists in the crafting of structured settlement agreements, including the agreement contracts.  The Board of Industrial Insurance Appeals, a separate State agency tasked with resolving disputed issues in workers’ compensation claims, among other things, has been given the responsibility to review CRSSAs and, thumbs-up or thumbs-down, approve or deny them.

        The CRSSA program is immense, involves three separate State agencies, and the laws that created the program were crafted as a concept with each agency left to determine their specific role and policies with the hopeful expectation that those roles and policies would efficiently mesh and result in a flushing out of the most expensive claims in the workers’ compensation system – total disability pension cases.   A claim that results in a disability pension is expensive for the Department of Labor and Industries not only because it has to fund a lifetime pension, often with survivor benefits for the injured worker’s spouse, but also because of the Herculean effort put into avoiding placement on the pension rolls in all but the most clear-cut cases.  

Since the inception of the CRSSA program, 60 cases have been through an approved structured settlement review by the Board of Industrial Insurance Appeals.  Of those, 31 have been rejected and 29 have been approved. 

        Vocational services provided to injured workers facing placement on the pension rolls if retraining services are not successful can be costly.  No stone is left unturned in the search for a retraining plan that will result in a finding of employability instead of total disability.  In one recent case, a vocational counselor put in a not-insignificant amount of time to try to document our client’s ability to return to work as a Disc Jockey – not because of the sweet tones in his voice, his love of radio, his prior work experience or an aptitude for performing the job, but because he had been the voice on the radio during a short time while in the military during the Vietnam War (and, because he had no education or work experience in light-duty work over the past 40+ years of his work life).  More common is a determination that an injured worker can return to work as a Parking Lot Attendant.  Our current discussions within the law firm lead us to believe that there have been more injured workers found employable as Parking Lot Attendants by the Department of Labor and Industries than there are positions at every parking lot across the state.  Although I do not have data to support that assertion, it is, by far, the most common outcome of vocational evaluations in our case load.  No stone unturned.

There is no blueprint for a standard approach – each claim is unique and each settlement agreement proposal is reviewed individually based on the facts in the claim and the circumstances of the injured worker. 

        Since the inception of the CRSSA program, 60 cases have been through an approved structured settlement review by the Board of Industrial Insurance Appeals.  Of those, 31 have been rejected and 29 have been approved.  I believe there are now 22 cases remaining in the pipeline that have not yet received a review determination.  A bottleneck effect has occurred with our cases since last fall, when the Office of the Attorney General put the brakes on the process while evaluating several agreements denied authorization to proceed by the Board of Industrial Insurance Appeals.  As each agreement is submitted for review, those approved and denied are thoroughly analyzed to determine which elements led to approval and which led to denials in an attempt to clarify the requirements of the Board.  Adjustments to pending contracts are made with each new item learned, refining the process each time.  Until recently, this analysis was done behind closed doors, with little to no discussion of the process with us.  The effect for the injured workers we represent who have been awaiting a settlement in their claim has been MONTHS of delay, initially with no details as to why.  After incessant phone calls and complaints, the lines of communication opened a bit and all parties are now working more collaboratively to craft contracts that will pass muster and, hopefully, be approved by the Board.

        The Attorneys General assigned to work on CRSSAs are making their best guesses to determine what the assigned Judges at the Board of Industrial Insurance Appeals want to see in a structured settlement.  There is no blueprint for a standard approach – each claim is unique and each settlement agreement proposal is reviewed individually based on the facts in the claim and the circumstances of the injured worker.  Because of the very short timeframe given to the Board by the statutes that created CRSSAs, which dictates an approval or denial within 14 days of filing, there is no time for any meaningful discussion between the parties and the Judge.  Thumbs-up or Thumbs-Down, that’s it.  If denied, the application can be altered and resubmitted to try to gain approval – not usually by changing the terms of the agreement but typically by updating the documentation of how that agreement will be implemented and how it will be in the “best interest of the worker” – the Board’s required role is to provide this oversight, this judgment of the overall agreement and whether or not it is in the worker’s best interest, usually without ever setting sight on the worker.

        The wrinkles have not yet been ironed out, yet already legislation has been introduced this year to amend last year’s statutes to open up the program to any worker over the age of 40.  House Bill 1097 and Senate Bill 5127, which initially would have removed the age restriction for CRSSAs entirely, have now been amended to lower the age limit from 55 to 40.  These bills have not yet passed but are a sign of how itchy the powers that be are to change the century-old system of workers’ compensation coverage in this State.  That said, I have a few clients that are not yet aged into the current CRSSA system that are watching this legislation carefully, hoping that they can take advantage of the option to cut their ties with the State in exchange for a cash payout.

A structured settlement is not right for everyone in every case.  If you are interested in exploring this option under your own claim, please feel free to contact Causey Law Firm for assistance.

$97 Million In Fraud: 2012’s Top 10 Workers’ Compensation Fraud Cases

CFO Jeff Atwater and Broward Sheriff Al Lamberti announced multiple arrests in Operation Dirty Money.

Today’s post comes from guest author Leonard Jernigan from The Jernigan Law Firm.

Over the past few years, many states have aggressively gone after workers’ compensation fraud (whether it’s the employee or the employer) and the amount of employer fraud being discovered continues to be staggering, notwithstanding these efforts. Legitimate business owners that pay for workers’ compensation, as required by law, are at a competitive disadvantage with those who cheat the system, and when people suffer a workplace disability and have no insurance local businesses that provide goods and services feel the pain along with health care providers who cannot get properly paid for their services. The cost of medical care and disability ends up being shifted to the taxpayer through Social Security, Medicare and Medicaid, and in states where compliance is not vigorously enforced a culture of cheating continues. The top ten cases for 2012 are listed below.

2012 TOP TEN WORKERS’ COMPENSATION FRAUD CASES Total Fraud: $97,466,500.00

1. ‘Operation Dirty Money,’ Stings Workers’ Comp Fraud Check Cashing Scheme

Florida: July 27, 2012

Multiple arrests were announced in Florida’s joint task force’s ‘Operation Dirty Money,’ which led to the arrest of alleged ringleader Hugo Rodriguez, owner of the Oto Group, Inc., and seven other individuals. Mr. Rodriguez was the facilitator of 10 known shell companies that funneled in excess of $70 million in undeclared and undetected payroll through different money service businesses. By using shell companies, Rodriguez was able to run a large construction operation and avoid paying the cost of workers’ compensation coverage, leaving employees at risk and scamming legitimate businesses.

 

2. Firms Face Charges for Skipping Workers’ Comp Payments

Ohio: May 13, 2012 Thousands of Ohio companies violated state law by not paying their most recent workers’ compensation premium, which can drive up insurance costs for businesses that follow the rules, a Dayton Daily News analysis found. The bureau identified about 41,247 private employers in the state that failed to report their payroll data and submit premium payments by the deadline. As of May, more than 12,200 accounts remain outstanding, and those companies owe an estimated $5.6 million in premiums.

3. Case Proves Employee Leasing too Good to be True

Texas: July 10, 2012

$4,466,500.00 was awarded in a Texas court against a staffing agency and its workers’ compensation insurance company. Jackson Brothers Hot Oil Service hired Business Staffing, Inc., (BSI) in 1999 and required BSI to have workers’ compensation insurance for its leased employees. BSI had 150 client companies with 2,000 employees. BSI bought a policy from Transglobal Indemnity for a total premium of $4,100.00 to cover all its employees. After failing to pay the medical bills of a 27-year-old oil field worker who was in an explosion and had 18 surgeries, the employee and Jackson Brothers sued BSI and Transglobal for fraud. Neither Transglobal (who had its corporate headquarters in the Turks and Caicos Islands) nor BSI had a license to conduct insurance business in Texas.

4. Business Owner Faces Insurance-fraud Charges

California: May 2, 2012


George Osumi was indicted on numerous felony counts.

Construction business owner George Osumi of Irvine, California was indicted on numerous felony counts of misrepresenting facts to the State Compensation Insurance Fund, among other charges. From December 2001 to March of 2006, Mr. Osumi committed workers’ compensation premium fraud by reporting his payroll to SCIF at just over $1 million, under-reporting over $3.5 million in payroll. This fraud resulted in a loss of over $814,000.00 in premium owed to the insurance fund.

5. Watertown Roofing Company and its Owners Plead Guilty and are Sentenced for Labor Violations

Massachusetts: January 11, 2012


Newton Contracting Company misclassified half of its workforce as subcontractors.

The Massachusetts Insurance Fraud Bureau discovered that the company, Newton Contracting Company, Inc., owned by Shaun Bryan and Antoinette Capurso-Bryan, misclassified half of its workforce as subcontractors, as well as failing to disclose to auditors more than $3.4 million of their company’s misclassified subcontractor payroll during its annual workers’ compensation audits.

6. 7-Year Sentence in $3.1 Million Fraud Case

California: November 30, 2012

Steven Morales, 65, of Wildomar, CA was convicted and sentenced to seven years in prison for his part in a $3.1 million workers’ compensation scheme. His son Brian was also convicted and sentenced to 4 years in prison. Morales and his son had set up a sophisticated system of shell companies to hide payroll and avoid paying workers’ compensation premiums.

7. Construction Company President Accused of Payroll Fraud

Florida: March 29, 2012

Randall Seltzer, president of Navarre Industries, Inc., was charged with multiple felony counts, including workers’ compensation fraud. An investigation by Florida’s Department of Financial Services’ Division of Insurance Fraud revealed that Seltzer systematically and intentionally under-reported his corporation’s true payroll to his insurance carrier. The department’s Division of Workers’ Compensation issued the company two stop-work orders within a five-year period. Seltzer allegedly established a shell corporation in 2011 to intentionally violate the stop-work orders and continue operating his construction business illegally. If convicted, Seltzer could face up to 30 years in prison and pay over $2.8 million in restitution.

8. CFO Jeff Atwater Announces Arrest of Owner of Fake Company for Creating Fraudulent Insurance Certificates and Avoiding Millions in Premiums

Florida: April 13, 2012


Yucet Batista allegedly used a shell company to commit large-scale fraud.

Yucet Batista was arrested for allegedly creating more than 250 fraudulent certificates of insurance to help uninsured contractors avoid $2.1 million in workers compensation premiums. Batista created the company and obtained the workers’ compensation insurance policy for the purpose of “renting” it, or making it available to dozens of uninsured subcontractors for a fee.

9. Audits Uncover Almost $1.2 million in Workers’ Compensation Violations at Boston Marriott Project

Massachusetts: September 4, 2012

In 12 audits conducted by the Joint Enforcement Task Force on the Underground Economy and Employee Misclassification and the Executive Office of Labor and Workforce Development, it was discovered that there were $584,249.00 in misclassified 1099 wages and $584,287 in unreported W-2 earnings, for a total of $1,171,536.00 in unreported wages by subcontractors on the Marriot renovation project. Six companies misclassified workers as contractors rather than employees, and seven companies failed to report wages. Among the worst of the offenders were one company that misclassified 28 workers and failed to report over $410,000.00 in wages; another failed to report $462,081 in W-2 wages.

10. Inn Owners Facing Workers’ Compensation and Insurance Fraud Charges

California: June 13, 2012


Owners of the historic Brookdale Inn and Spa are facing trial on charges of falsifying wage information to obtain lower insurance premiums.

The owners of historic Brookdale Inn and Spa, Sanjiv and Neelam Kakkar, are facing trial on charges that they falsified wage information to obtain lower insurance premiums. According to records, the couple paid approximately $800,000 less in insurance premiums than they should have over a period of several years.

Previously-Denied Claims for Some Hanford Workers to be Reviewed

Annette Cary of the Tri-City Herald reported on a change in the way that some claims will be handled for exposures at the Hanford Nuclear Site, including a review of more than 800 previously denied or pending claims for ill Hanford workers that are being reconsidered or put on a fast track for a decision after federal compensation rules were recently eased.

All those claims are for cancers covered by a newly designated special exposure cohort for workers at Hanford from July 1972 through 1983. Workers received that designation if inadequate information existed to estimate their radiation exposure.

The classification allows workers or their survivors to claim $150,000 in compensation plus medical coverage without an estimate showing they received enough radiation to likely cause the cancer. They also may be eligible for up to an additional $250,000 for impairment and wage loss.

Read Ms. Cary’s full story here for more details.