National Organization of Injured Workers

What's Good For The Goose, Is Good For The Gander As Well.

8 Ball The most common question that we as lay advocates for America's injured workers are asked, is one that disturbs us greatly. Why the news media doesn't ask the same question of our legislators and those whose job it is to police these matters is as equally disturbing. Maybe we can answer that question in a simplistic manner that all can understand.

The question is a simple and straightforward one at that:

"Why aren't insurance companies, their defense attorneys and the medical-legal doctors that they employ, ever prosecuted for Workers' Compensation fraud, even though the testimony that they present to Workers Compensation judges is at best false and intended to mislead?"

Now that is certainly a mouthful!

But it is a question that deserves a legitimate response, especially to those who become victims of it's fallout!

The answer is simply twofold; First it's all about MONEY and all the LEGISLATIVE POWER that it can buy!

Sounds scary as hell to me, but if you've ever been caught behind the Workers' Compensation 8-Ball, you know first-hand of what I speak!

Why others who purport to advocate for injured workers can't even say those words is simply beyond me! And it's effects can even be found in the legislatures of our states by virtue of the passing of laws that are morally and ethically against good public policy!

Let us share with you an excerpt from the California Insurance Code section 1871.4, which is used on a daily basis statewide to prosecute injured workers, but almost never to hold the insurance companies, their defense attorneys or their medical-legal doctors to the same standard of accountability to the law!

1871.4. (a) It is unlawful to do any of the following:

Make or cause to be made a knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying any compensation, as defined in Section 3207 of the Labor Code.

Present or cause to be presented a knowingly false or fraudulent written or oral material statement in support of, or in opposition to, a claim for compensation for the purpose of obtaining or denying any compensation, as defined in Section 3207 of the Labor Code.

Knowingly assist, abet, conspire with, or solicit a person in an unlawful act under this section.

Make or cause to be made a knowingly false or fraudulent statement with regard to entitlement to benefits with the intent to discourage an injured worker from claiming benefits or pursuing a claim.

For the purposes of this subdivision, "statement" includes, but is not limited to, a notice, proof of injury, bill for services, payment for services, hospital or doctor records, X-ray, test results, medical-legal expense as defined in Section 4620 of the Labor Code, other evidence of loss, injury, or expense, or payment.

Make or cause to be made a knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying any of the benefits or reimbursement provided in the Return-to-Work Program established under Section 139.48 of the Labor Code.

Make or cause to be made a knowingly false or fraudulent material statement or material representation for the purpose of discouraging an employer from claiming any of the benefits or reimbursement provided in the Return-to-Work Program established under Section 139.48 of the Labor Code.

Now that is some pretty strong language that would appear to have been meant by the legislators who wrote and passed it to apply to injured workers and the insurance companies and their agents as well. But that is simply not the case and you have to ask yourself just precisely why?

Simply put, it's all about MONEY and POWER and the influence that it will buy! You don't have to be a nuclear physicist to figure that one out, but you do have to ask yourself why those whose job it is to make sure that those laws are enforced fairly, simply look the other way when complaints are filed against the insurers and their motley crew!

A classic example: California's newly elected insurance commissioner took office in 2005. Despite several prima facie complaints to the contrary, the Department of Insurance just can't seem to find the time to investigate them. Could it be that they don't want to rock the political boat that generates over 22 plus million dollars a year for their fraud fighting efforts and that of District Attorneys statewide?

Efforts that are used to selectively prosecute injured workers and employers who mis-classify their employees, but amazingly absent are any prosecutions against insurance companies or their lot for what amounts to textbook cases of fraud?

The lawbooks say that in order to successfully prosecute an individual or entity for fraud, there must be intent and a culpable state of mind.

In the case of an insurer, the intent is certainly there; to reduce or eliminate their financial liability and exposure by whatever means necessary, whether it's by hook or crook!

A culpable state of mind; try reading some of the reports that defense counsels submit as the gospel truth, when they know deep down in their bones that they are submitting some of the best fiction created by a narrow slice of physicians who have been so corrupted by the easy money that they use more of their creative writing skills that their medical skills! And some of these guys haven't treated a patient in years, yet they want you to believe their opinions?

Yes sir! That, should indeed bother you!

Why? Same reason why 2 Republican legislators won't represent the interests of the voters that believed what they promised over their loyalty to the party. That's why meaningful laws don't get passed and that's why we don't have a budget yet.

If you're tired of this rampant fraud and corruption, then you're just the person that we're looking for. You have to be able to admit that it exists and be able to say the words, before you can do something about it!