North Carolina Car Accident Lawyer Blog

North Carolina workers’ compensation fraud is a profound and seemingly indelible problem that saps much needed resources, degrades trust in the system, and leads to hardship and chaos for dependants. Why, then, do so many people continue to perpetrate this crime?

For example, let’s look just over the border to West Virginia, where last week, owners of an Apple Dumplin in Oak Glen, West VA, Keith McBride and Lois Ventura, got hit with three charges of workers’ comp fraud. Investigators with the workers’ compensation fraud prosecution unit tracked the couple since July. Here’s the scoop. The 51-year-old Ventura was hurt last August at her former job at Big Cheese Pizza. She collected workers’ comp benefits as a result of that claim. All good. But then, in violation of the benefits arrangement, she started running an Apple Dumplin with her boyfriend, Mr. McBride, and continued to “receive cash and medical benefits through the workers’ compensation program.”

When questioned about his girlfriend’s allegedly fraudulent activities, McBride “reportedly misrepresented the facts of the case by stating that he was the sole owner of the business and had no knowledge of the workers’ compensation benefits Ventura was receiving.” Not a good move. Now both Ventura and her boyfriend face counts. On November 3, at their arraignment, they both pled not guilty. A court date has been set for January 10.

Obviously, based simply on news reports, you should avoid leaping to judgment. Unless you probe the back story, evidence, and other relevant details, it’s probably wise to withhold “convicting people in your mind,” if only to hone your ability to see life objectively.

For the sake of a discussion, let’s assume the charges are correct. What lessons can we extract?

First of all, the story suggests that a significant number of North Carolina workers’ compensation fraud cases probably result from unplanned errors and inappropriate innovations. In other words, while some people plan workers’ comp fraud far in advance, many people simply “stumble into it” because fraud is easier and faster than operating ethically.

Often, people who are simply trying to “scrape by” come to believe that somehow they have been wronged by the system and that they “deserve” to break the rules.

The story also suggests that many workers’ comp beneficiaries do not receive enough training to understand the limits of what they can and cannot do. People might know that violating workers’ comp rules is somehow “wrong” in the abstract, but they may not know the specific punishments that are likely to meet them if they commit a crime.

For excellent guidance, no matter what your situation, connect immediately with a qualified and compassionate North Carolina workers’ compensation law firm.

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Apple Dumplin couple hit with workers’ comp fraud charges.

Often, North Carolina workers’ compensation cases discussed on the blogosphere and elsewhere revolve around relatively “dry” issues, such as the minute, discrete meanings of definitions or jurisdictions. A hot-button case out of Las Vegas, however, will almost definitely have you sitting up in your chair:

Here is the scoop, according to the Las Vegas Sun.

Last week, the Nevada Supreme Court ruled in the case of Gary Mogg, an employee for Fitzgeralds Casino Hotel assigned to monitor over three dozen television screens, acting in the capacity of “eye in the sky.” One day, in January 2008, Mogg made the seemingly innocuous decision to put his feet up on his desk. Lo and behold, he lost his balance and tipped over and severely hurt himself. Mogg claimed that the chair was defective and that he should be entitled to workers’ comp. The Casino, however, suggested that there was “implied prohibition” that prevented him from doing things like putting his feet up on his desk.

The courts have gone back and forth over whether this implied prohibition existed or not. Last week, the Nevada Supreme Court actually weighed in on the matter, ruling that “there was insufficient evidence for Gary Mogg…to qualify for industrial insurance payments.”

Reaction from the blogosphere was a bit sarcastic. One commenter, writing under the handle of BChap, wrote: “I am not of the opinion that this man should be compensated for this accident. However, if the resort is going to allow this individual to return to work, the employer should be sensitive to his medical needs and workplace safety. Maybe one of those apparatus’ that women utilize at the doctor’s office where the patient puts her feet up in the stirrups [should be installed for him.]”

If you or someone you care about has recently been hurt or made ill at work, you likely worry about having to endure this kind of sarcasm at your expense. To protect yourself and to ensure that you are treated justly not only by your employer and insurance companies but also by the system as a whole, connect immediately with a qualified North Carolina workers’ compensation law firm.

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Nevada Supreme Court rules in “feet up on the desk” case

Whether you’re a prospective North Carolina workers’ compensation beneficiary, or the relative or friend of someone who was recently hurt or injured at work (e.g. hurt while doing construction outside of Raleigh or sickened by repetitive stress syndrome contracted while working at a bank in the Research Triangle), you want help with getting fair compensation, holding wrongdoers accountable, and making sure insurers play fair.

Tackling all of these issues is of paramount importance. However, you may also want to analyze the broader context and think about why workplace accidents and injuries happen every year in North Carolina and beyond.

Are workers simply careless and negligent? Are employers careless or negligent? Is the system structured in a way that creates opportunities for injury/illness?

Perhaps. Perhaps. And perhaps.

However, there may be a “hidden cause” lurking underneath many workers’ comp cases. It’s a cause that doesn’t place blame employees or employers or even the system. The problem is a fundamentally human one. It’s the problem of creeping complacency.

Let’s analyze this.

When a new employee finds a job, he or she tends to enter the arena cautiously. New employees are more likely to listen to a supervisor’s instructions, handle complex machinery with care, and avoid overly ambitious or dangerous working conditions, such as working while fatigued, working without supervision, ignoring the company’s safety policies, etc. Likewise, employers tent to “dote on” new employees, putting them through rigorous reviews, following them through intra-company educational processes, and firing workers who violate company norms.

Dial forward several years (or, in some cases, several months), and that caution vanishes, or at least diminishes. Lassitude develops. Workers are allowed – or even encouraged – to push their limits, to “bend or break the rules” to get more done in less time and for less money. For instance, a construction worker, who in his first three months of working on a job would never use a sophisticated and dangerous piece of equipment without help, might, by month eight on the job, use that piece of equipment by himself, late at night, and without paying attention.

Which worker is going to be safer: The attentive rookie or the over-confident veteran?

Of course, “the complacency problem” is not the only fundamental cause of workplace injuries or illnesses, but it is one that is not discussed enough.

For specific help with a benefits question, connect with a time-tested and trusted North Carolina workers’ compensation law firm.

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The cost of complacency

How we become careless

In Part 1 of our series on how complacency at work impacts the North Carolina workers’ compensation system, we discussed how both workers and employers alike often act far more cautiously during the first few weeks and months of tenure.

After a certain amount of time, both the worker and the boss become comfortable with the processes and procedures, and a certain amount of slack sets in. This “slack” can be benign, neutral, or harmful. It can be benign when workers do their jobs in a more natural, fluid, resourceful way. It can be neutral when it has no impact. And it can be malignant when it creates the conditions for laziness, inaccuracy, and recklessness.

How can we prevent this third category – the malignant situations – from wreaking havoc and creating needless North Carolina workers’ compensation cases?

The “knee-jerk” response to this question might be: “The answer depends on the circumstances and specifics of the line of work.” And there is some truth to this response. An industrial worker who works with potentially dangerous equipment, like lathes or bulldozers, might require incremental training “refreshers” to stay sharp and focused and avoid malignant complacency. An office worker, on the other hand, at risk for developing carpal tunnel syndrome due to bad postural and typing habits, might require a very different kind of intervention. For instance, he or she might benefit from periodic massage or physical therapy, or even from changing around the office furniture every two months or so.

Businesses in general could do more to reduce worker/employer complacency. So could the government: state or even federal regulations could require certain businesses to retrain and resystematize their processes at regular intervals, for instance, to prevent malignant over-complacency. Of course, there are dangers with inherent over regulating, as well. So the policy problem is certainly a tough nut to crack. However, we should not give up on the dream of forging global-scale solutions to the complacency problem.

All this theory aside, however, you and your loved ones need help with a case. Connect with an experienced North Carolina workers’ compensation law firm to get insight into your problems right now.

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The dangers of complacency

Beating Complacency

After a serious workplace injury or illness, you worked extremely hard to obtain North Carolina workers’ compensation benefits and stabilize your medical condition.

Unfortunately, your quest to heal has been anything but linear. Perhaps you initially suffered some kind of insult to your musculoskeletal system – severe carpal tunnel syndrome, for instance, brought on by working a desk job somewhere in the Research Triangle – but your diagnosis got complicated, after you noticed that the numbness and tingling sensations extended beyond the afflicted area. Alternatively, perhaps you suffered spinal damage during a car crash while on a work delivery, and the extent of the nerve damage has only recently manifested, leaving both you and your doctors relatively depressed about your prognosis.

Setbacks with your North Carolina workers’ compensation recovery are not exclusively medical.

You might experience psychological setbacks, such as depression, anxiety, frustration, and loss of self-confidence. You might simultaneously feel financial setbacks, as you are compelled to pay for complicated, extensive treatment and rehab – all while making do with a reduced income stream. What’s worse, the various workers’ comp injury/illness-related stresses in your life can play off of one another, provoking a kind of a downward spiral. For instance, in your more agitated, anxious state, you may hold your body tighter and experience higher cortisol levels, which can in turn exacerbate the musculoskeletal damage you suffered at work.

Repairing physical, psychological, and financial damage is no small task, even for the well prepared. While hurt and injured workers can make significant progress by working with a reputable North Carolina workers’ compensation law firm, you still could face some pretty profound hurdles to long-term wellness.

It’s tempting to try to “deal with” all these setbacks at once, but this approach can also be discouraging. Instead, make an attempt to incorporate small, positive changes in your life, behaviors, and perspective. Just getting your e-mail under control, for instance, can restore a modicum of control and help you manage your setbacks in a more thoughtful, less reactive way.

Also, remember that even though your injury or illness might have taken just a second or even a fraction of a second to develop, doesn’t mean that you can solve the situation in a lightning-quick fashion. Instead, keep your eye on the “long road of recovery,” accept your reality for what it is, and begin to make progress, step-by-step, to move beyond the setbacks you encountered and rebuild your life, career, health, and future.

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Small Positive Changes Really Add Up

Setbacks are More Common than You Think

In a recent blog post, we discussed how many beneficiaries (or would-be beneficiaries) on North Carolina workers’ compensation struggle with setbacks in multiple arenas, including medical, financial, emotional, logistical, and social.

To manage these setbacks, you might find it helpful to adopt proven strategies and tactics to keep yourself better organized, more in control of your life, more relaxed, and more resilient.

This blog post cannot cover every positive behavior or beneficial scheduling strategy. However, it hopefully can encourage you to take the process of self improvement more seriously. Here are a few small but effective “good habits” to inculcate to relieve the stress of your North Carolina workers’ compensation journey.

• Get into the habit of keeping your e-mail inbox “at zero” – try out productivity guru David Allen’s GTD system for controlling e-mail (see link at the bottom of the page).

• Spend more time and energy thinking through your problems instead of acting impulsively to solve them. Do the mental work of clarifying an ideal outcome, assessing your “on the ground reality,” and brainstorming ideas to move from your present reality to your idealized future in an effective, sure-fire, cheap, and easy way. In other words, seek to break out of the habit of “acting before thinking.”

• Seek help and outside input. It’s often very difficult for victims of workplace injuries or accidents to ask for help, because victims already feel like their pride and autonomy have been compromised. Consciously break through that barrier and get help from friends, colleagues, family members, and outside resources, like a competent North Carolina workers’ compensation law firm.

• Test “catastrophic thinking.” When we get hurt or injured – when our welfare, health, social status, etc., are threatened by events or by other people – we have a tendency to imagine worst-case, catastrophic outcomes. This is a normal, human thinking, and it’s not necessarily deleterious. In fact, it can be helpful to be vigilant, depending on the situation. However, we always want to test the reality of our thoughts – especially thoughts that agitate us, keep us from sleeping, or scare us into spending hours on the Internet searching for a description and diagnosis of our symptoms.

• Thinking realistically is different from being a pollyanna. You don’t want to ignore dangerous symptoms, be they indicators of medical, financial, or psychological problems. On the other hand, we also want to detach our emotions and fears from our thoughts and seek to see them with a clear, objective lens.

• How do you cultivate this kind of clear-headed thinking? Some experts recommend engaging in daily meditative practice, such as mindful mediation, concentrated prayer, or some other exercise that enhances focus and helps you avoid getting sucked up into catastrophic thinking.

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The Perils of Catastrophic Thinking

David Allen’s System for Controlling E-mail