Happy Wednesday dear readers!

Well, another week and another bit of news just to help us appreciate the various dangers facing employers in California. 

The Department of Insurance reports the sentencing of Karyl Lynn Reed for various fraud charges stemming from operating as an unlicensed insurance agent.  According to the press release, she collected premiums through Envoy Business Partners and Allenn Specialty Group.   She issued bogus Certificates of Insurance.  Her victims paid for the policies and operated thinking they were covered by a workers’ compensation policy when, in fact, they were uninsured.

Of course, aside from running a business and having to be on the lookout for fraudulent workers’ compensation claims made by employees (or alleged employees), California’s employers must also be on guard for the other side of the equation —  fraudulent insurance agents leaving employers exposed when on-the-job injuries occur.

If you’re considering engaging an insurance broker for a policy there are a few things you can do to verify that you are actually covered.  For one, ask to see the insurance agent’s license and run the credentials through the state’s license verification website.  Another step to take is, upon receiving a certificate of insurance and confirmation that the premium is paid, contact your insurance company directly and confirm that a valid policy exists for your business. 

Your humble blogger has represented parties alleged to have been illegally uninsured for workers’ compensation at the time of injury, and if you thought the deck was stacked against an insured employer, it is doubly so for an employer forced to unexpectedly adjust and defend a claim without the resources and expertise of a claims adjuster.  Exposure to severe penalties and costs await any employer so unfortunate as to find itself on the receiving end of an allegedly uninsured claim.

Your humble blogger tips his hat to justice being done – the sentence is four years in prison and a restitution order of more than $1.4 million – and hopes we can all profit from this news to remain vigilant from all sides.

A little-known fact about your humble blogger, dear readers, is that for a short part of my law school career, I studied how to grow rice.  I was the best, though no one knew it.  My rice was the riciest rice that ever riced.  However, when I submitted my rice for inspection in our law school rice growing class, the totally biased and unfair rice grader gave my rice an F.  Since the day of that totally true story that absolutely happened and is not just a ludicrous introduction to a blog post, I have always looked for justice being visited upon rice graders.  Well, at long last…

Brooke Gomez of Maxwell, California, a rice grader (see how I set that up?) has plead no contest to a misdemeanor fraud charge and was sentenced to 12 months of probation and ordered to pay restitution to her employer.

Convict-Gomez sustained an admitted injury, but co-workers reported her working as a bartender.  Meanwhile, she was collecting temporary disability benefits. 

The reports lead to eventual undercover investigators observing applicant serving drinks and counting money, as well as wiping down the bar.  In a twist worthy of a sit-com TV show, applicant discussed with patrons her pending workers’ compensation case and her hopes that she would not be discovered while working!

Fortunately, the other employees did the right thing and reported the fraud.  Fortunately, the case was picked up by the prosecution and brought to a plea of no contest.  Unfortunately, not all fraud is detected or even punished.

Although the criminal-defendant will have to make restitution, 12-month probation is hardly a deterrent for future similar activity.  At best, her next workers’ compensation claim will receive considerable scrutiny given her history.  Here’s hoping, at least!

Till next time, dear readers!

Happy Friday, dear readers!

Here we are again: another week is wrapping up, and another blog post about alleged workers’ compensation fraud by one of the community’s heroes.

Now, as always, your humble blogger must preface this by saying the fraud is only alleged.  No one has been convicted at this point, which is why your humble blogger declines to name names.  That being said, the allegations are illustrative for our own case-loads, and why we must be ever vigilant for fraud.

A firefighter for the City of Hollister has been charged with four felony counts including workers’ compensation fraud after he was caught, allegedly, working a second job while collecting temporary disability benefits.  As claimed by the prosecution, the firefighter had about nine months of collecting a second paycheck while still receiving temporary disability benefits.  He denied post-injury employment in a deposition.

Your humble blogger hopes the truth comes out and justice is served, of course, but bear with me a moment while we contemplate the implications if the prosecution is correct in all its charges and factual allegations.

In such a scenario, the firefighter has cheated the taxpayers by collecting money on TD to which he was not entitled.  He has cheated the taxpayers a second time by likely aggravating his condition through continued work, necessitating additional medical treatment.  He has cheated the taxpayers a third time by increasing the administrative costs of addressing his workers’ compensation claim, including investigation and prosecution.  And he has cheated the taxpayers a fourth time, by dishonoring his profession and poisoning the respect and admiration held for the firefighters all over California, who so regularly put themselves in harms way to the benefit of us all.

But the harm doesn’t stop there.  If this firefighter lied to his post-injury employer about the need for accommodations, the employer is likely exposed to a potential claim from the City of Hollister’s fire department for reimbursement or an application alleging a cumulative trauma for that period.  The subsequent employer is likely taken by surprise and now has increased workers’ compensation premiums to look forward to.

Let this be a reminder to us all – no human being, no matter how generously he or she is compensated, and no matter how otherwise noble or honorable his or her profession, is with certainty beyond the pull of greed and beyond the enticement of deceit.  While the injured worker’s occupation certainly matters when it comes to rating out permanent disability, it has no bearing on the level of vigilance that is called for in defending a claim.

Have a good weekend, dear readers.  Let those of us who can sleep the sleep of the just.