WCDefenseCA

Your humble blogger has heard that the limelight can be addictive.  Once one is in the spotlight, for better or for worse, it’s hard to return to the quiet life of everyday.

So, it should come as no surprise that a woman who graced the TVs of countless homes on the show Bridezillas has once again made her way into the forum of public discussion as she stands accused of various acts of insurance fraud.

It appears that this woman (seeing how this is an accusation rather than a conviction, her name will not grace the pages of this humblest of blogs) is accused by the California Department of Insurance of having lied to her treating physician regarding the existence of prior industrial injuries, and also stands accused of submit falls mileage tallies for reimbursement by her employer.

As the word goes, the alleged fraud was discovered when the defense investigation managed to find past awards and injuries which the injured worker either failed to mention or denied (as the facts come out in the criminal prosecution, we’ll know for certain).

Now, this is nothing new, dear readers.   Many people are inclined to wander from the truth, and it doesn’t take a humble blogger to realize that if you embellish your good health prior to injuries and maximize your poor health after the fact.  That being said, your humble blogger has these thoughts to offer which may be of some use to all employers, insurers, and the troops in the trenches:

1. The defense in this case needs to be credited with diligent investigation, discovery the existence of past injuries and the terms under which the relevant claims were resolved;

2. It’s the easiest thing in the world to simply process and pay a mileage reimbursement form – don’t. The attorney on the file, or your claims assistant, can run the destination through google maps and match the dates of the visits against medical appointments at no charge to the file.  Of course, the visits should be to authorized treatment, which passes both UR and MPN muster.

3. Odds are that before this case was presented to the Department of Insurance, all the leg work was properly done by the defense, including a proper outline and presentation of the claims made and the evidence contradicting the same. The law enforcement folks tend to be overworked to the point where limited resources necessitate taking the cases where it’s practically a “sure thing.”

Semper Vigilans, dear readers.