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Location: San Luis Obispo and Santa Barbara Counties
6,390 posts, read 9,686,006 times
Reputation: 2622
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In CA it sure is. That is why you guys have fewer freedoms and pay the highest taxes.
I love you, there are very few posters here with your imagination.
A. I wonder what freedoms you are talking about, must wear a helmet on your dirt bike in town? Can't talk on your cellphone while driving?
B. California does not have "the highest taxes" and is only 3.6% more than the lowest taxed state in the nation.
I remember reading years ago that Red China had Neighborhood Watchers, people designated to watch the neighborhood and report any "anti state" behavior to the local version of the KGB. I found that repellant, and still do.
Jesus said in Matthew 7.3 "Why do you look at the speck of sawdust in your brother's eye and pay no attention to the plank in your own eye?
And, Matthew 7.1, Judge ye not lest ye be judged.
I find Christians in particular pay no attention to Jesus's advice if it conflicts with their prejudices.
Location: Central Bay Area, CA as of Jan 2010...but still a proud Texan from Houston!
7,484 posts, read 10,449,471 times
Reputation: 8955
Quote:
Originally Posted by .highnlite
I love you, there are very few posters here with your imagination.
A. I wonder what freedoms you are talking about, must wear a helmet on your dirt bike in town? Can't talk on your cellphone while driving?
B. California does not have "the highest taxes" and is only 3.6% more than the lowest taxed state in the nation.
I remember reading years ago that Red China had Neighborhood Watchers, people designated to watch the neighborhood and report any "anti state" behavior to the local version of the KGB. I found that repellant, and still do.
Jesus said in Matthew 7.3 "Why do you look at the speck of sawdust in your brother's eye and pay no attention to the plank in your own eye?
And, Matthew 7.1, Judge ye not lest ye be judged.
I find Christians in particular pay no attention to Jesus's advice if it conflicts with their prejudices.
Financial freedom is the most pressing freedom CA takes away from people.
You clearly show that you don't give a crap about our states future generation. Since it does not come out your paycheck then by golly let the people scam the system because Jesus says so Wow now I have heard it all from bible thumpers.
I am glad that not everyone see's turning in a disability scammer in the same light as you or this lady would still be stealing from the State. I am thankful that she has to pay back $79,000 in restitution.
Really shows more about who you are in choosing sides for people who scam a system which in turn hurts the very state you claim to live in.
It's a felony in CA to file a fraudulent workers' compensation claim. Believe me the insurance company will want to know since they are required to report suspected fraudulent claims to the Department of Insurance, and (allegedly) injured workers are prosecuted if the fraud can be proven.
Insurance companies generally have 90 days to investigate though, or a claim is presumed accepted.
I was an adjuster on one claim that was prosecuted for a $100.00 medical bill, with a conviction. The gentleman had to reimburse our costs and has a felony on his record now. I felt bad about the felony, thinking beforehand that he might be able to plead down to a misdemeanor, but no dice.
Workers' Comp fraud was rampant in the LA/Pasadena area in the early '90's. My caseload of 150 or so was 75% denied "psyche/cumulative trauma" claims with fraud highly suspected and actively investigated.
10 of my claims were employees of the same employer who were laid off on the same day. They all were picked up by a runner for an attorney and taken to the same ring of doctors. Most of the doctors reports were verbatim for each allegedly injured worker except for the name, dob, and other identifying info. We were working with the Long Beach DA on that one, with one hearing set for the 10 injured workers which was highly unusual.
The insurance premiums are pass through, with the customers paying for it in the end. Unless the premiums simply get to high to afford and the business goes out of business or leaves the state.
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Originally Posted by nightlysparrow
They are billion dollar companies and private detective work is cheap to them.
Not all workers compensation insurance companies in the state are billion dollar companies. While subrosa (private detective) work will be assigned out if necessary, it's an expense against the file. The loss ratio at the company I worked at was 86%. That means that 86 cents of every dollar taken in was spend on providing benefits to injured workers. The expenses (salary, real estate, taxes, and yes, investigations authorized on files, was a further 17 cents for a total loss ratio one year of over 100 percent. The only reason we made any profit that year was due to our treasury guy who invested and turned a couple million in the stock market. Yet we couldn't just raise premiums, or renewals would dry up. The workers comp market is expensive but very competitive. Companies have left the state due to the business conditions in CA...
Not big brother. But if you are scamming, it's probably an insurance company with a fiduciary duty to the insured to defend and/or indemnify against the fraudulent activity.
And it's perfectly legal in CA. I've had many doctors change their opinions after viewing subrosa tape.
Department of Insurance information on workers' compensation fraud:
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Fraud: Workers' Compensation Fraud and Convictions
WORKERS' COMPENSATION INSURANCE FRAUD PROGRAM
In California, workers' compensation insurance is a no-fault system. Injured employees need not prove an injury was someone else's fault in order to receive workers' compensation benefits for an on-the-job injury. In addition to medical expenses being covered for injured employees, some injured workers are entitled to a portion of their wages lost due to not being able to work. These benefits make fraudulent workers' compensation claims an enticing target for criminals.
Workers' compensation insurance fraud occurs in simple to complex schemes that often require difficult and lengthy investigations. For example, an employee either inflates the extent of his/her injuries, or simply fabricates injuries altogether. At the other end of the spectrum, white-collar criminals, including doctors and lawyers, entice, pay, and conspire with other individuals in cheating the system through fraudulent activity and insurance companies "pick up the tab," passing the cost onto policyholders, taxpayers and the general public.
The Workers' Compensation Fraud Program was established in 1991 through the passage of Senate Bill 1218 (Chapter 116). The law made workers' compensation fraud a felony, required insurers to report suspected fraud, and established a mechanism for funding enforcement and prosecution activities. Senate Bill 1218 also established the Fraud Assessment Commission to determine the level of assessments to fund investigation and prosecution of workers' compensation insurance fraud. The funding comes from California employers who are legally required to be insured or self-insured. The total aggregate assessment for Fiscal Year 2010-11 is $50,157,805.
During Fiscal Year 2010-11, the Fraud Division identified and reported 5,741 SFCs, assigned 501 new cases, made 254 arrests and referred 272 submissions to prosecuting authorities. Potential loss amounted to $276,894,742.
Underground Economy Task Force
Underground economy is a term that refers to those individuals and businesses that deal with cash and/or use other schemes to conceal their activities and their true tax liability from government licensing, regulatory, and taxing agencies. Underground economy is also referred to as tax evasion, tax fraud, cash pay, tax gap, payments under-the-table, and off the books.
When businesses operate in the underground economy, they illegally reduce the amount of money expensed for insurance, payroll taxes, licenses, employee benefits, safety equipment, and safety conditions. These types of employers then gain an unfair competitive advantage over businesses that comply with the various business laws. This causes unfair competition in the marketplace and forces law-abiding businesses to pay higher taxes and expenses.
On October 26, 1993, the Governor signed Executive Order W-66-93, which created the Joint Enforcement Strike Force (JESF) on the Underground Economy. The Governor subsequently signed Senate Bill 1490, which placed the provisions of the Executive Order into law as Section 329 of the California Unemployment Insurance Code, effective January 1, 1995.
The JESF is responsible for enhancing the development and sharing of information necessary to combat the underground economy, to improve the coordination of enforcement activities, and to develop methods to pool, focus, and target enforcement resources. The JESF is empowered and authorized to form joint enforcement teams when appropriate to utilize the collective investigative and enforcement capabilities of the JESF members.
In addition to the Employment Development Department, the other Strike Force members include Department of Consumer Affairs, Department of Industrial Relations, Department of Insurance, Franchise Tax Board, Board of Equalization, and Department of Justice.
The JESF obtains information through a number of sources, which indicate that a business may be operating illegally. These sources include hot line referrals, complaints from legitimate businesses, and information sharing through collaborating agencies' databases. The JESF conducts joint on-site business investigations to identify employers operating in the underground economy. The goal is to identify and bring into compliance those individual and businesses participating in the underground economy that are in violation of payroll tax, labor, licensing laws and workers' compensation insurance premium..
District Attorneys' Workers' Compensation Program
In Fiscal Year 2010-11, the district attorneys reported a total of 797 arrests, which also included the majority of Fraud Division arrests. During the same timeframe, district attorneys prosecuted 1,264 cases with 1,446 suspects, resulting in 666 convictions. Restitution of $58,365,532 was ordered in connection with these convictions and $8,484,998 was collected during Fiscal Year 2010-11. The total chargeable fraud was $248,118,899, representing only a small portion of actual fraud since many fraudulent activities had not been identified or investigated.
Note that potential losses were assessed by DOI at $276,894,742.
Now just imagine your roofer has his premium impacted by a fraudulent claim. That pro-rated cost is added right into your estimate for your roof. Workers comp fraud if not detected and reimbursed in passed straight through to the end consumer, no question about it. The difference in roof estimates can be dramatic if the roofer has a particularly high loss ratio and therefor, premium.
California requires that injured workers be advised of their rights. That includes a fraud warning:
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Insurance Code section 1871.4 provides that it is a felony to make or cause to be made a knowingly false or fraudulent material statement for the purpose of obtaining or denying compensation, as defined in Labor Code section 3207, or present or cause to be presented any knowingly false or fraudulent material statement in support of, or in opposition to, any claim for compensation for the purpose of obtaining or denying compensation, as defined in Labor Code section 3207. It is a crime to knowingly assist, conspire with, or solicit any person in an unlawful act of workers’ compensation insurance fraud. It is also a crime to make or cause to be made a knowingly false or fraudulent statement with regard to entitlement to benefits with the intent to discourage an injured worker from claiming benefits or pursuing a claim.
Please note that the fraud warning applies to the insurer and employer as well. It is the same felony to deny a workers' comp claim fraudulently.
The costs to the fraudulent party can be severe:
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Workers’ compensation fraud may be punished by imprisonment which can be in county jail for over one year, or in a state prison, for two to five years. A fine may also be imposed not exceeding $150,000, or double the amount of the fraud, whichever is greater. If someone is convicted of workers’ compensation fraud, the court is required to order restitution to be paid, including restitution for any medical evaluation or treatment services obtained and a convicted person may be charged the costs of the investigation at the discretion of the court. Insurance Code section 1871.5 provides that any person convicted of workers' compensation fraud pursuant to section 1871.4 or Penal Code section 550 shall be ineligible to receive or retain any compensation, as defined in Labor Code section 3207, where that compensation was owed or received as a result of a violation of section 1871.4 or section 550 of the Penal Code for which the recipient of the compensation was convicted. [/SIZE]
I'm afraid I don't see this as a liberal/conservative issue. The fraud legislation was passed in 1993 with a Democratic Senate and House and a moderate Pete Wilson as Governor. The insurance commissioner was democrat Pete Garamendi.
Much of the incentive for fraudulent Work Comp Claims in CA would go away IMO if the option to settle out medical claims were taken away. Insurance companies like this option because they pay only a fraction of the estimated cost. For a claimant that has a serious injury, while they in theory might be able to better economize their own care, the reality is it is essentially NEVER in their interest to settle their medical portion of their claim, and most get amounts that won't put in a dent in their cost of care. For a fraudulent claim, they won't spend a dime on medical after their case is closed, so it's all just a pay out for them. Attorney's also take a 15% cut on the medical settlement, but not if the claimant elects to keep their medical open...
I believe there has been a law for many years that you can't open a new WC claim in CA after you've been terminated-- this was done to reduce fraud--but an employer could abuse this by terminating an employee that they know plans to file a claim.
WC fraud is a problem, and I don't have any issue with using investigators to verify the validity of a claim. But the insurance companies waste massive amounts of money delaying and denying treatment for claims that they know are legitimate.
WC claimants are often villanized In the media and within the popular culture. The reality for those that have a serious legitimate WC injury, is that the system will never come close to making them "whole" again.
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Wow now I have heard it all from bible thumpers.
