A $25-Million Work Comp Fraud Revealed

Nine individuals have recently been arrested for their involvement in a complex fraud that has damaged over 230 workers’ compensation carriers and self-insured employers. The Department of Insurance detectives conducted the investigation and the arrest in which it turned out that a company called G&G Interpreting Services fraudulently charged insurance companies almost $25 million for services rendered in cases of injured workers with Latino last names. The defrauding company was led by siblings Francisco Javier Gomez, Jr. and Angela Rehmann.

For more than 4 years, G&G Interpreting Services, who offered translation services for Spanish, have been billing for their services supposedly delivered in clinics where most personnel spoke Spanish and didn’t require help with interpreting. In other clinics in which the company allegedly provided their services 13 doctors were proficient in Spanish.

Insurance Commissioner Dave Jones has commented this case by pointing out that a lot of people mistakenly think there is no victim in an insurance fraud. Jones stated that fraudulent billing results in everyone paying up.

G&G Interpreting serviced injured workers who received medical care through the workers’ compensation system across Los Angeles County and Southern California. They issued fraudulent bills in San Diego, San Bernardino, Orange, Riverside, Los Angeles, Santa Barbara and Ventura.

The 83,411 occasions on which they delivered their supposed services total over 12 working hours a day, which exceeds the opening hours of the clinics. The company also charged $422,000 for services executed by a translator who was at that moment serving time in state prison.

The interpreting company changed their name in August 2012 from G&G Interpreting to American Liberty Interpreting.

The operation was aided by California Highway Patrol and two district attorney offices from the Riverside County and San Bernardino County. Los Angeles County District Attorney’s Office will be the prosecution in the case.

A few months back, in October 2015, Commissioner Jones received almost $35-million worth of grants that were funded through employer assessments and distributed to 37 district attorney offices in 42 California counties. Jones stated then that work comp frauds were draining the state economy. The grants were specifically aimed at medical provider fraud, employer defrauding employee, claimant fraud, employer premium fraud, insider fraud and the intentionally uninsured working in the underground economy.

To remind the reader, Department of Insurance established The Workers’ Compensation Fraud Program in 1991. The legislation proclaimed work comp fraud a felony and set up Fraud Assessment Commission to fund enforcement and prosecution activities.

Reopening Workers’ Compensation Claims

In a number of cases, a workman’s comp attorney can help workers reopen claims after they have been settled. This is particularly important for employees whose disability has recurred or increased. This is different from a personal injury case.

The factors for reopening a worker’s comp case

However, whether a worker is able to reopen a compensation claim depends on certain factors. Firstly, it’s important whether the claim was closed through the mechanism of “Compromise and Release” or through “Stipulation and Award”.

“Compromise and Release” is the type of settlement that addresses the employee’s claim in totality: in the past, present and future. If the settlement agreement wasn’t accomplished through fraud, C&R typically closes the case entirely and there is no possibility to reopen it.

“Stipulation and Award” and trial, on the other hand, allow the claim to be reopened. The Labor Code allows workers to reopen cases under certain conditions. Typically, there are four circumstances in which courts permit a worker to reopen a settled claim:

  • the recurrence or increase of the disability
  • the discovery of new evidence reveals that the award is unjust and reopening the case is necessary to remedy an error of fact
  • an error in the law rendered the award inequitable
  • a clerical error

It’s important to note that there is a time limit to reopening claims. Apart from occasional exceptions, if there are grounds to reopen a case, employees must do that within 5 years starting from the date of the injury. This time limitation is termed Statute of Limitation or SOL in the legal profession.

A cumulative claim

Reopening a settled claim isn’t the only course of action. When the disability has worsened, the employee may have a “cumulative claim” that is generally treated as a new one. In this situation the statute of limitations starts recounting from the “new injury” (the old one which has worsened). However, establishing when the statute of limitations starts counting or when it is reset is rather complicated and the injured worker would need the help of a workman’s comp attorney.

It is generally recommended to think carefully before accepting a compromise and release settlement, because of the possibility to reopen the claim in the future. The injured party should seriously consider whether there is a possibility that the injury will worsen with time and more medical treatment will be required. The assistance of an experienced attorney is very valuable at that point.

Workman’s comp attorney

If you or your loved one have been injured at work and you think the settled claim should be reopened, give our Workers’ Compensation Attorney Group a call. Our caring lawyers are experienced, aggressive and ethical and they are always available for a free review of your case. You only pay if you win and you have no obligation to retain our services if you consult with us regarding your case. You can only gain if you call us so don’t hesitate to do so!

What You Should Do After A Work-Related Injury

If you have suffered an injury while performing your work-related duties, it is best to seek help from experienced compensation attorneys as soon as possible. Of course, it is not likely you will have a legal professional hired before you sustain an injury, so this article will tell you about the very first steps you should take if you ever find yourself in this situation.

Let your manager know

The very first thing you should do right away is inform your employer or supervisor of your injury. You could also try to remember any witnesses that saw you getting injured, if applicable. If there is any evidence, collect it and take some photos of the injury site. However, you may be prevented from taking photos due to confidentiality or security restrictions.

Once you report the injury, your supervisor or employer should provide you with a form called DWC-1, which is a form for making a workers’ compensation claim in California. In the case you are not given this form, remember that you have the right to demand it.

One part of the form is filled by you and the other by your employer. Ask your employer to fill out their portion and ask to get one copy of the filled out claim.

Making the workers’ compensation claim

When you are completing the claim, be careful to list all the injured body parts. If something falls on your shoulder, but it actually causes an injury to your back, you should write both the shoulder and the back as injured body parts.

The claim can be amended later on, but when you do it initially it’s better to include as much as you can rather than leave stuff out. This is not to say you should make false statements in your claim, but it’s better to include all the body parts that were part of the injury. In the end, you will be examined by a doctor to establish the injuries and their severity.

Don’t be afraid to report the injury

A surprising number of workers choose not to report their injury because they fear termination. However, it is highly unlikely your employer will terminate you if you report your work-related injury, primarily because that’s against the law and such a move would risk them a lawsuit.

Make your compensation claim as soon as possible, so that you don’t jeopardize the whole process by reporting the injury (too) late.

Have an experienced WC lawyer protect your rights

The help of an experienced work compensation attorney is invaluable when it comes to asserting and protecting your rights as a worker. If you have experienced an injury in the workplace and you are now searching for compensation attorneys in San Diego, make sure you consider Workers’ Compensation Attorney Group. Our lawyers are not only experienced, but also aggressive and ethical and you only pay us if you win. We are always ready to have a free case review with you with no obligation to hire us. Call Workers’ Compensation Attorney Group now and ensure your rights are protected!

California Workers’ Compensation Law 101

The basics

Law has a set of rules that regulate workers’ compensation which helps employees cover medical expenses related to injuries incurred in the workplace. If a worker gets injured while doing job-related duties, the costs for medical treatment can and should be paid through workers’ compensation. Employers’ contributions finance workers’ comp. In a way, this system is a type of insurance. While the employer is covering the damages in this way, he or she cannot suffer liability, while the employee can obtain medical care without the necessity of suing for it.

A worker who gets harmed or injured in the workplace in California is generally eligible to get reimbursed for medical costs and receive benefits. Some benefits could be connected to lost wages while the employee was unable to work and others might be related to the insurance an employer is bound to have to insure his or her workers.

The guiding idea of the law is to protect workers from injury while doing job-related duties.

The time for filing a work injury claim

A worker must report a work-related injury or temporary disability to their employer within 30 days. What is also necessary is to file a workers’ compensation claim so that the injured worker could get cash benefits according to the policy. Failing to do these will probably prevent you from collecting due compensation. This is unless you have proof that your employer should have known or positively knew about your injury within the 30-day deadline. Even if you complain about back pain, that complaint qualifies if that pain is directly related to fulfilling your job duties.

Choosing a doctor

If you want to see the doctor you regularly visit when you have health problems, you should pre-designate that doctor as your primary care physician. Unless you do that, you’ll have to visit the doctor of your employer’s choosing or one who is a member of the medical network providing insurance for your employer.

If the case is that your employer didn’t notify you about the possibility of pre-designating your physician, or the employer didn’t give you a workers’ compensation claim to fill out or didn’t post notices of your rights, you can still go to a doctor outside your employer’s medical network.

Other concerns

If it happens that your employer isn’t insured for workers’ comp, you have the option of filing a lawsuit against them for medical cost compensation, lost wages and pain and suffering. This isn’t normally possible in a workers’ comp case. The fact that your employer isn’t insured allows you to file a claim against them and get benefits from the California’s Uninsured Employers Benefits Trust Fund. In order to do that you will need an attorney to lead your case.

Sometimes employers challenge workers’ injury claims, in which case an impartial doctor attends to the worker to assess the severity of the injury. To secure a fair settlement, it’s best to have an experienced attorney by your side.

Workers’ Compensation Attorney Group has experienced, aggressive and ethical attorneys ready to take your case and make sure you get the best possible outcome. We are always available for a free case review that doesn’t oblige you to retain our services. We would like to point out that our attorneys work for a contingent fee, meaning you only pay if you get financial recovery – that’s why we are confident we can bring you a successful result. Contact us today – you have nothing to lose but time.

The Deadline to File a Worker’s Compensation Lawsuit

Taking legal action against someone has a limited period of time during which it can be taken and that is called Statute of Limitations or SOL for short. The Statute specifies within how many years since an injury the wronged ones can file a lawsuit at the appropriate court. Every type of legal action has a certain SOL, which isn’t the same for all lawsuits. However, if the deadline for legal action expires, the opportunity to fight for one’s rights is lost forever. This policy serves to avoid cluttering the system. SOL is also called statute of repose.

In California, the time limit for pressing charges for someone’s negligence that caused a personal injury is 2 years in general. However, there are certain cases when it is possible to file a lawsuit even after the deadline. Exceptions to SOL usually involve specific circumstances or a higher public interest that a particular lawsuit could serve. When SOL is overridden, it is said SOL was tolled. This article will present general information about pressing charges for worker’s compensation and some usual tolling examples. No person who is not a legal professional should rely on this article for guidelines when to file their case. Only an attorney can assess personal injury cases and advise the plaintiff when to file the lawsuit. If you or someone dear to you live in San Diego County and have experienced a personal injury at work, don’t hesitate to contact Workers Compensation Attorney Group for a free consultation and case review.

 

SOL for workers compensation lawsuits in California

SOL for workers’ compensation claims seems to be simple enough, but it’s rife with exceptions. Basically, SOL for this type of claim is one year after the occurrence of the injury. In a lot of cases this is readily applicable. However, there are situations when the injured party sustains injuries over a period of time, which is called cumulative trauma. In that scenario, the SOL starts on the day of the last injury, or the last day the worker was exposed to an occupational hazard.

There are many more exceptions and complexities which will not be discussed here for want of space. Again, you should depend on a professional evaluation by an attorney to decide when to file your case.

SOL can be tolled

There are numerous situations when SOL can be extended, disregarded or tolled. A legal professional will be able to weigh all the circumstances of an individual case and establish whether there are grounds for having SOL tolled. These are some general rules which extend SOL:

  • The injured party is receiving medical treatment or care. The extension can be prolonged for maximum 5 years since the day of the injury.
  • When the worker is a minor, SOL runs from the date when the person turns 18.
  • When the worker reported the injury to the employer in timely manner and was not given a DWC-1 Claim Form to fill in NOR was the worker informed about the protocol for recovering compensation benefits.
  • When the worker is not aware of the injury, like in the case of toxic substance poisoning. In that situation, SOL starts to count since the day the worker discovered the injury and established it resulted from exposure at work. (Asbestos exposure and injuries are special and will not be discussed here.)

This is not an exhaustive list of exceptions, so you shouldn’t be put off if your case doesn’t fall in either of these categories. The best thing you can do is contact an experienced and knowledgeable lawyer right away to ensure your rights are protected.

Hire a professional to assist you with your personal injury case

Workers Compensation Attorney Group is here to help you with you work injury case if you live and/ or work in San Diego County. Feel free to contact us right now for a free review of your case without any pressure or obligation to retain our services. Don’t hesitate to consult with us and make sure you have your rights protected. And don’t worry about the financial side – we work on a contingent fee, meaning you only pay if and when we win and you get financial compensation. You have nothing to lose but precious time unless you call us right now and let us help you with your case.

Workers Compensation Press Updates

Workers Compensation Press Updates

Workers Compensation Press Updates

Workers Compensation Press Updates