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Keyword: ‘hamster’

Dancing Hamster Fraudster Goes Down!

February 3rd, 2016 No comments

Although this blog is most certainly humble, it strives to be at least somewhat respectable as well.  To that effect, one would not expect a search of the blog to turn up many references to the word “hamster”, but it’s there!

In any case, dear readers, you may recall the curious case of the Kia car commercial’s dancing hamster – a dancer who tangoed his way from a workers’ comp claim to a Kia commercial, and then waltzed his way from the commercial to a no contest plea for insurance fraud.  Leroy Barnes will serve 90 days of electronic monitoring, 400 hours of community service, and pay $24,000 in restitution.

I guess you could say Mr. Barnes bit off more than he could chew…

hamster eating carrot

In any case, this story reminds us, on the defense side, of the importance of regular check-ups: social media, sub-rosa, etc. to make sure that we weed out the fraudsters and that there are enough benefits available for the legitimately injured workers.

Special thanks for JJB for the tip on this story!

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Dancing Hamster Arrested for Fraud

June 9th, 2014 No comments

You know the situation in California has really deteriorated, when even Hamsters are being charged with workers’ compensation fraud.

Your humble blogger will decline to name names at this point, but a certain dancer who performed in, among other things, a Kia car commercial, has been charged for workers’ compensation fraud.

Apparently, this intrepid dance collected more than $51,000 in disability benefits, yet continued working in various performance groups and the Kia commercials.

By the by – if you’re on disability, you’re not supposed to be working, because some misguided and unkind people mind consider that sort of thing “fraud” (you know, judges, juries, prosecutors, the tax-paying public and the workers’ comp premium funding consumers).

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Too Disabled for Police Work; Ok For Strongman Competitions?

July 11th, 2016 No comments

Work restrictions: the patient is prohibited from any law enforcement activity.  However, he is able to participate in strongman competitions.

Crazy, right? Well, welcome to California, my friend!

Happy Monday, dear readers.  We’ve all heard of Bogdan, the world’s strongest man:

But in our corner of the world, California has its own “strong man” competitions and recently, charges have been filed against a Santa Barbara police officer for competing in strongman competitions while receiving disability benefits.

Presently, this is just an allegation, but we’ve seen similar instances on this blog such as (1) firefighters competing in MMA; and (2) professional dancers performing in car commercials as hamsters while on disability.  Accordingly, this wouldn’t be the first time allegations have flown of an injured worker displaying disability for the worksite and super-human ability away from the eyes of the employer.

Until details emerge, of course, the office charged is entitled to the benefit of the doubt.  Not all injuries preclude all physical activities, and if the strong-man competitions were made under physician supervision, there’s an argument against a finding of Fraud.

The takeaway, for us in the workers’ comp world is that it makes sense to check up on people.  The longer the claimant is on TD, the more it makes sense to check up on him or her.

Most investigator offices will offer you services in the form of a social media or online check, but there are a few basic tricks you can do yourself:

  1. Have you done a basic search on Facebook or Twitter?
  2. Have you set up a google alert for your claimant’s name?
  3. Have you checked any professional updates on LinkedIn?

Just some ideas, dear readers.

See you on Wednesday!

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SB-563: Employers to Share UR Financial Arrangements

March 11th, 2015 No comments

Can you believe it, dear readers?  March is slipping away – just the other day I was admiring my beloved Mother’s Thanksgiving turkey and the relative restraint of blood-thirsty shoppers on “Black Friday.”  Now, in the blink of your humble blogger’s eye, here we are in mid-March.

Of course, not all things that greet us as time goes on include warmer weather.  In fact, Senate Bill 563, is just one cloud in what appears to be a veritable storm of anti-Business weather in California’s climate.

Introduced by Senator Richard Pan, SB 563 would force employers and insurers to disclose the financial arrangements around the UR process, specifically, “[e]ach employer, insurer, or other entity that is subject to Section 4610 shall disclose the payment methodology for each person who is involved in the process of reviewing, approving, modifying, delaying, or denying requests by physicians for authorization … for the provision of medical treatment services to injured workers…”

In other words, when employees, physicians, and the public request this information, it has to be made available to them.

The legislation does not provide for a timeline, or penalties for failure to comply, but, presumably, that can be fleshed out during the legislative process or through regulation.

Your humble blogger, however, is not a big fan of SB 563.  Forcing employers and insurers to reveal the arrangements made with their UR vendors is not going to do anyone much good.  What is the relevance of the information to determining necessity of medical treatment?  We used to have UR determinations go to panel QMEs or AMEs, and now, presumably, all disputes are resolved through IMR (at least for now – let’s watch the Courts on that one).

In some cases, the parties have even stipulated to skip IMR and have medical necessary disputes resolved by AME, in clear violation of Labor Code section 4062.2(f).

So, either the medical basis for denying the medical treatment is sound, or it isn’t – whether the physician who wrote the report was paid $10,000 or $10 for the report has no bearing on the medical reasoning.  The remedy is there as well: IMR for now, possibly something else once the Supreme Court weighs in.

What this does, instead, is increase the cost of doing business for the employers.  The cost of compliance in the form of providing information, upon “request” by anyone and everyone.  The cost of negotiating contracts with vendors who will now negotiate from the position of having their rates a subject for public knowledge.

Hopefully, this bill will face the same fate as your humble blogger’s proposed hamster-powered message delivery system (it was a really elaborate plan, actually – we would dress the hamsters up in little suits, and give them little briefcases to deliver messages, and would train them to quickly use a series of tubes to be installed throughout the city), and never be implemented.  Before you legislate, think of the hamsters!

hamster thumbs up

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