Local Workers’ Comp Fraudster Sentenced in Delaware

A woman who used an alias and a fake Social Security number to obtain disability payments from two employers will spend the next five to ten years in prison.

According to court documents, the 57-year-old woman claimed that in 2019 she was hurt from a fall while working at the Family Dollar store. She claimed she was totally disabled from the fall, so Family Dollar paid medical expenses, as well as workers’ compensation and wage-loss benefits for $1,500 every two weeks for about two years.

In August 2019, she took a job at a Delaware restaurant, using a different Social Security number and an alias, so her claims in Pennsylvania would not be discovered. Two months later, she reported she was hurt — claiming the same injuries sustained in Pennsylvania — from a fall at the restaurant. The restaurant’s insurer paid disability wage-loss benefits, and she received payments from both states until 2021.

According to the attorney general’s investigation, the woman received more than $97,000 in workers’ compensation and wage-loss benefits.

Workers’ Compensation Wage Replacement Benefits

Don’t overlook the fact that this woman received less than $100,000 in disability payments over a two-year period, even though she claimed total disability and was double dipping. That’s not very much money. Repeated insurance premiums reductions, including a 15 percent reduction for 2024, have drained much of the money from the system.

Since the current environment is so hostile, obtaining maximum wage replacement benefits in a job injury case is basically a three-step process for a Tampa workers’ compensation lawyer.

First, a competent doctor must fully and accurately diagnose the victim’s condition. This tent pole is easy to erect in many states. But it’s hard to establish in Florida. In most cases, job injury victims must see company doctors. These individuals serve two masters: the victims who come to them for help and the companies that pay their salaries.

Fortunately, Florida law allows job injury victims to get second opinions. Attorneys connect these individuals with doctors who not only focus on a particular kind of injury, like a fall-related injury, but also are highly qualified professionals. These two things usually give the second opinion report much greater weight than the initial report.

Additionally, a permanent partial or total disability is not just a medical issue. A disability in Florida is also an economic matter.

A bad fall-related injury that severely limits mobility is totally disabling for victims who are restaurant workers or other retail workers who spend almost all day on their feet. However, the same injury might only be partially disabling to a computer programmer or another individual who sits pretty much all day.

The extent of disability also depends on the victim’s educational background, vocational background, age, and even the unemployment rate. Restaurant workers cannot magically become computer programmers. And let’s face it. Disabled individuals don’t have the same economic opportunities as everyone else.

A Tampa workers’ compensation lawyer typically partners with a vocational expert in these areas. This partnership could make the difference between maximum benefits and settling for less.

Finally, lost wage replacement benefits are based on the victim’s AWW (average weekly wage). The AWW includes more than regular cash pay. It also includes irregular cash pay, like performance bonuses, and non-cash pay, like housing allowance. AWW undercalculation is one of the most common issues in workers’ compensation claims.

Workers’ Compensation Fraud

A few final words about workers’ compensation fraud. Episodes of employee fraud, like the one in the above story, mask the fact that employer fraud is a much bigger problem.

Lying on forms is a good example. To reduce their risk, and therefore their premium payments, many employers lie about payroll size. When insurance investigators uncover these lies, they normally cancel the policy and deny payment.

Injured victims still have legal options in these situations, mostly a claim for damages in civil court. To punish the lying employer, Florida law disallows key defenses, like comparative fault. So, it’s easier to prove negligence, or a lack of care, and obtain compensation.

 Count on a Hard-Working Hillsborough County Attorney

Injury victims are entitled to important financial benefits. For a free consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. We do not charge upfront legal fees in these matters.

Source:

insurancejournal.com/news/east/2024/03/01/762971.htm