Hello dear readers!
Your humble blogger is well aware that Valentine’s Day is over, and that we have put away all thoughts of chocolate and flowers, romance and love, and are now back to our hard-hearted ways of workers’ compensation. But, if you’ll allow me, I’d like to pull a little at your heart strings, and relate to you the love story of a man and woman inseparable in their outings and their dealings with the workers’ compensation industry alike.
Business Insurance reports that John Smiley and his wife, Cynthia Biasi-Smiley, have been convicted of workers’ compensation fraud. Mr. Smiley, a former correctional officer, was shot outside a club in San Francisco, and claimed he recognized the gunman as one of his former inmates.
Apparently, Mr. and Mrs. Smiley decided to visits a “swingers” club in San Francisco… one of those places where people go to “share and share alike”. After their “encounter”, an argument broken out and Mr. Smiley was shot by the “male companion” of one of the other club-goers.
He then filed an application for adjudication of claim, alleging that this was work-related because he had been shot by a former inmate, even though he knew full well this had nothing to do with his work. His wife filed a lien for in-home care taking care of her husband.
Now, as we know, acts of violence perpetrated against employees can be compensable. The issue is usually a factual inquiry: was the injury or death caused by a “personal risk” or by a risk likely to affect any worker on the job? So, for example, if a liquor store gets robbed, and the poor guy watching the counter is murdered as part of the robbery, the claim would be compensable. But, if the defendant can establish that, for example, the robbery was a cover for a personally motivated murder (unrelated to the victim’s job or job duties), then the claim would, in theory, be barred.
In this case, someone whispered into Mr. and Mrs. Smileys’ respective ears and they filed a workers’ compensation claim, changing the original story they gave the police, feigning ignorance for the reason for the shooting, only to claim that it actually was work related… so make with the money!
Look, the sentence here is pretty light – being shot is a bad enough punishment, as is losing a state job and retirement benefits, etc. But, we can all profit from this story: there are a lot of reports of injury that are fairly legitimate, but when you start getting into “hmmm… that’s odd…” or “what are the odds!?!?” territory on the mechanism of injury, it’s time to start investigating.
In this case, there was a shooting, and that kind of thing generates paper: police report, newspaper articles, etc. But there won’t always be a paper trail available – usually it will just be a co-worker mentioning a Christmas afternoon football game injury that quickly preceded a Monday morning back strain. It’s worth following up on and investigating, both to but the Kaibosh on the instant case and discouraging fraudulent claims in the future.
To quote my favorite swingers: “You’re so money and you don’t even know it!”
