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

The Washington Times has reported on a relatively minor workers’ comp case in Virginia that may ultimately have bearing – perhaps substantial bearing – on North Carolina workers’ compensation law.

Why would a struggle over a mere $4,000 workers’ comp award have national implications?

Simply put, because the case pertains to whether professionals injured in cell phone related automobile accidents should be reimbursed by workers’ comp. The debate is controversial, emotionally charged, and interesting. Before we examine the broader implications, let’s take a look at the specifics of this case.

Donna Turpin was a hospice nurse on call late one night in November 2009, when she received a call on her cell phone, which was tucked into her uniform. Distracted by the call, Ms. Turpin drove off the road and hit an embankment. She suffered some injuries and damage to her vehicle, but it was otherwise a minor incident.

Should Ms. Turpin be entitled to workers’ comp, since her employer knew to contact her via her cell phone if the employer-provided pager did not work? According to testimony, she had responded to 12 pages or calls earlier that same day. Ms. Turpin testified that she was “programmed” to tune into her beeper and cell phone to answer medical or hospice emergencies. Did it matter whether the message was work related or not? The judge decided that, in this case, it did not.


However, the judge’s ruling had some nuance: “the mere possibility that a call on a cell phone might originate from an employer does not make any injury that occurs while the employee attempts to respond to the call, or received call, one that arises out of employment.”

So what are the broader implications? The Washington Times report suggests that the unpublished opinion “could contribute to debates in cases involving doctors, reporters, food delivery drivers, and others whose work is tied to urgent cell phone calls.”

No doubt, in the following years, we will see a spate of circumstances similar to Ms. Turpin’s. In this case, the costs were low. Ms. Turpin only asked for $4,000 to treat her whiplash and pay for an ambulance and an emergency room visit. Fortunately, she returned to work that very weekend. But what might happen if and when a worker stops to answer a cell phone or pager and causes a catastrophic accident – perhaps one with fatalities – and seeks damages on the order of six or seven figures? We will likely see bigger headlines then, and the implications could stir up even more debate in the blogosphere.

The takeaway is that hurt workers need to examine and understand their legal rights. A North Carolina workers’ compensation law firm can help you make sense of what happened to you and determine how and whether to pursue a case against an insurer or other entity.

More Web Resources:

Workers’ Comp Case Upheld in Cell Phone Related Crash

Nurse Injured While Glancing at Cell Phone Due Workers’ Comp

A workers’ comp case way out in Aurora, Colorado has caught the attention of the North Carolina workers’ compensation community because of the heart breaking realities at the center of it all.

Martin Lobatos and his wife Belen Lobatos were indicted on 18-counts last Friday, after Colorado investigators alleged that the couple collected $140,000 worth of workers’ comp claims from Pinnacol Assurance. Lobatos worked as a roofer until September 8, 2008, when he sustained a terrible fall off of a ladder. He went back to work a month later but started complaining of ongoing vertigo and dizziness from his accident. Six months later, in April 2009, Lobatos’ doctors maintained that he had fully recovered.

Lobatos was fired and later collected a $20,000 settlement from Pinnacol Assurance. In the fall of 2009, however, Lobatos began experiencing more symptoms, such as memory loss, having trouble recognizing his children, dizziness, and a host of other frustrating problems. His doctors agreed. In March 2010, Lobatos claimed to be “fully catatonic.” And he allegedly acted catatonic in medical exams. But witnesses later saw him driving around, shopping, engaging in activities in a decidedly non-catatonic state. This evidence allegedly led to the investigation and ultimately to the allegations and 18 count indictment against Lobatos and his wife. If convicted of the crime, the Lobatoses could face fines of $750,000 each and a dozen years in prison.

Obviously, North Carolina workers’ compensation fraud (and such fraud elsewhere in the country) is an enormous problem, and perpetrators should be held to account. But is it really fair to slap these people with $1.5 million in fines and over 10 years in prison? Many homicide cases don’t get punished that severely. Again, this is not to say fraud shouldn’t be punished appropriately. But the punishment must fit the crime, and the context of the crime should also deeply inform the legal remedies.

What’s frustrating here is that many injuries that ultimately send people to seek the services of a North Carolina workers’ compensation firm don’t manifest immediately after an accident. A fall off of a ladder, for instance, may lead to a temporary concussion that seems to resolve after few weeks or months…only to give way to longer term, chronic, and confusing injuries months or even years after the fact.

Again, it’s impossible to weigh in on the Lobatos’ case without far more information. But victims of workplace accidents or illnesses should understand that they may go through a similar kind of rollercoaster – feeling bad after the accident, then feeling better again for a while, then feeling suddenly worse for no apparent reason. This is why it’s so important to contact professionals, like experienced law firms and good doctors, to build evidence, stay within the bounds of the law, and maximize your chances for getting the money and support you need to get back to work and support your family.

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Pinnacol Assurance

Martin Lobatos fraud

Ohio Governor John Kasich is seeking to lower that state’s workers’ comp rates – if the Governor succeeds, what will that mean for Ohio, and what will it mean in general for the programs of other states, like North Carolina workers’ compensation?

First, the basics, courtesy an April 29 story from the AP: “Ohio’s Governor wants to lower premiums employers pay for workers’ compensation by 4% for a total cut of about $65 million a year.”

Governor Kasich submitted his proposal last Thursday to the Ohio Bureau of Workers Compensation – his goal is to encourage businesses to work in Ohio and “make the state more competitive.” If the BWC adopts his plan this month, employers would not see changes in their premiums until February 2012. Steve Beuhrer, the CEO of the BWC’s Board of Directors had the following comments regarding the proposal (courtesy www.business-journal.com) “our goal is to increase premium stability and lower costs for all Ohio employers… rates are a critical part of job growth decisions made by Ohio employers, but will also continue to focus on other aspects, such as containing medical costs and helping injured workers return to leading healthy productive lives sooner.”

Beuhrer’s comments here are germane to discussions about how to renovate and streamline the North Carolina workers’ compensation system. It’s NOT just about slashing rates and limiting benefits. Our solutions must also focus on “continuing medical costs” – and perhaps even more importantly “helping injured workers return to leading healthy productive life sooner.” After all, this is the raison d’etre of workers’ comp – it’s to help return us to productivity ASAP.

Unfortunately, the political discussion about workers’ comp reform often revolves around costs: whether to spend or not; on what; and for how long. This inevitably leads to political calculations.

But what if the most relevant parts of the equation are those two factors that Beuhrer named – containing costs and helping people recover?

Perhaps we are giving short shrift to these questions. Maybe we’re not thinking “out of the box” enough. For instance, cost control measures tend to focus on measurable, direct contributing factors. We aim to reduce the severity and number of workplace injuries, for instance. But we don’t take time to look at long-term exacerbating factors. For instance, are workers getting enough rest? Are workers too distracted by things like the internet and social media to concentrate effectively on their tasks? These indirect factors – such as how much sleep we get, how distracted we are, how much sugar we eat, et cetera – must be addressed if we want to lower injury rates and reduce hospital bills.

Backing away from the philosophical discussion… you may have more practical concerns about how to collect benefits and how to deal with insurance companies and employers. A North Carolina workers’ compensation law firm can answer your questions and put you on a good track.

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Ohio Governor John Kasich

Steve Beuhrer, the CEO of the BWC’s Board of Directors

While most North Carolina workers’ compensation analysts probe the local news for instructive stories, sometimes blogs look to international sources to find the most compelling news. And a case out of Toronto – reported by the Vancouver Sun – has many in the North Carolina workers’ compensation community talking. An Alberta tribunal has ordered workers’ comp payments for a convenient store worker who suffered serious shoulder injuries from scooping hard ice cream. According to the Sun’s report, the woman had to serve up an enormous quantity of orders in a short period of time during a heat spell in April 2009. The Appeal Board noted that “the activity required considerable force with her right hand and arm in a twisting motion because the ice cream was frozen hard…the total sale of ice cream cones [for a 2 day period] was $1,500.”

The woman had been treated for a shoulder injury prior to working at the ice cream store and had rectified that injury through the use of cortisone shots. But the ice cream scooping reinjured her shoulder so badly that she needed surgery on her rotator cuff to deal with the flare up. The Sun’s article quoted an orthopedic surgeon, Dr. Stephen Reed, who argued that ice cream scooping is indeed a dangerous activity. Dr. Reed said “they are forced to do this basically at arm’s length, reaching into a large cabinet…it’s basically poor ergonomics, and they are doing it repetitively.”

Repetitive strain injuries due to manual labor, such as ice cream scooping, typing, or repetitive lifting, can cause lasting damage to muscles, fascia, ligaments, and other soft tissue. More frustratingly, the full extent of the damage may take weeks or months to reveal itself. By the time an injured employee notices what’s been happening, it may be too late to reverse the problems easily.

If you or someone you love or work with has been sidelined with a repetitive stress injury or other workplace injury, either chronic or acute, you can benefit tremendously from consulting with a qualified North Carolina workers’ compensation firm. By exploring your rights as a potential claimant, you can collect compensation for things like your lost wages and medical bills. Moreover, you can simplify the process, focus your limited resources on healing from your injuries and getting back to work (or finding new work), and holding reluctant employers or insurance companies fully accountable.

More Web Resources:

Scooping hard ice cream can be hazardous to your health

RSI resources

Gabe Reid, a former tight end for the Chicago Bears, got an award of $325,000 for a knee injury from the Illinois Workers’ Compensation Commission this week. North Carolina workers’ compensation experts have been closely following NFL related workers’ comp cases like Reid’s – this blog reported last month about California’s dilemma over how and whether to compensate injured athletes who played for teams outside of California but who got hurt in games played in the Golden State.

Reid played for the Bears from 2003 to 2006. The team released him in 2006 to be an unrestricted free agent. His settlement was the biggest settlement for a pro athlete in Illinois history; although another ex-Bear, Mike Brown, recently collected $140,000 for injuries he suffered to his foot and leg while he played for the Bears. More ex-Bears may be eligible to collect additional funds, according to state sports reporters.

How will Reid’s settlement impact similar North Carolina workers’ compensation cases, if at all? Will ex-Panthers be eligible for similarly large payouts? Truth be told, the states individually are in the process of working out how to compensate NFL athletes (and athletes in other sports). And it will likely be several years before policy analysts have enough data to draw any clear conclusions. However, with all the financial pressure on state workers’ compensation agencies to tighten their budgets – and the new POWER initiative launched by the Obama administration, which this blog reported on earlier in the week – it may be more difficult for claimants to win relevant arguments.

Irrespective of what happens to ex-NFLers like Reid and Brown, what can you personally do to improve the likelihood of collecting fair and flexible benefits for your injury or workplace illness?

If you suffered a chronic, debilitating injury at work such as a knee problem or typing injury – or if you got hurt in some kind of acute accident – such as a slip and fall or work-related car accident – you must simultaneously struggle under a number of burdens. First, you must deal with the medical recuperation, which can be exhausting and emotionally draining in and of itself. Then, you need to figure out how to rehabilitate yourself and get back to work in some fashion ASAP – and/or how to deal with your financial situation. And lastly, under certain circumstances, you might have to fight back against unwilling employers, recalcitrant insurance companies, and bureaucratic red tape to get benefits paid out in a timely fashion.

With all these stresses on your shoulders, it may behoove you to discuss your problems with a qualified North Carolina workers’ compensation attorney. A good lawyer can simplify your strategy, relieve you of logistical and emotional stresses, and help you collect appropriate payments without hassle or frustration.

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Gabe Reid case

Mike Brown case

Initiative 1082 — way up in Washington State — has sparked a firestorm of debate and controversy among North Carolina workers’ compensation analysts. Ordinarily, a statewide initiative in a far off part of the country would not rile up insurers, business owners, injured workers, and state bureaucrats. But the vocal debate out of Washington has served as a touchtone for a number of issues hotly being discussed right here in NC.

Facts about the Initiative, and Implications for North Carolina Workers’ Compensation Politics

The Building Industry Association of Washington – regarded as a politically conservative group – sponsored I-1082 to crack the state monopoly on workers’ comp. To qualify for the ballot, the measure needed 241,000 signatures – allegedly, it got nearly 100,000 signatures above that mark. Clearly, many Washingtonians are fired up. Sponsors argue that the current system sticks business owners with high insurance premiums and allows injured workers to enjoy overly-plump benefits. Opponents of I-1082 say that introducing a for-profit component into the workers’ comp system could degrade benefits and lead to claims being delayed or denied.

Both opponents and proponents of the initiative claim that the implications of I-1082’s passage for the state could be profound. Currently, Washington is one of only four states that does not allow companies to privately compete with a state-run workers’ comp system.

The North Carolina workers’ compensation system allows private insurers to compete – so the WA debate can be relevant only indirectly. However, the growing frustration among business owners regarding workers’ comp costs – and the simultaneous growing health problems among workers, including chronic occupational diseases and medical conditions like obesity and diabetes – may well portend a sea-change in the next few years, economically speaking.

Can small businesses survive a clunky economy and potentially a double dip recession? Can hurt employees – many of whom may soon start to lose their unemployment benefits – survive if their benefits get curtailed or restricted?

If you or a coworker or a family member has been experiencing difficulties collecting your benefits, connect ASAP with an attorney to advise you. A free and confidential consultation with a North Carolina workers’ compensation lawyer can help protect your rights and ensure your family’s financial stability.

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Initiative 1082

Workers comp initiative steps closer to ballot

On June 15th, regulators announced that South Carolina workers’ compensation rates would fall to 9.8% — news that has sent ripples of interest and concern across the North Carolina workers’ compensation community. According to SC Insurance Director, Scott Richardson, 2009 marked the second year in a row in which regulators approved a decrease. He argued that “this trend [implies] an improved economic climate, and [we] hope to see this continue into next year.”

SC insurers will be able to use the new 9.8% rate in just 30 days. Richardson cited multiple reasons for the decline in rates, including enhanced employee safety programs, a reduction in the frequency of claims, and changes to the nature of claims themselves. In South Carolina, more than 40% of benefit costs can be directly attributed to payments for medical services. Most SC workers’ comp costs go to indemnity payments – that is, benefits to replace wages lost. As Richardson and others have noted, the extent to which the rate change will impact policy regarding medical costs in the state remains to be seen. Richardson noted that the state “will continue to monitor and assess the impact these reforms have on workers’ compensation rates…as it will take several years to realize the full impact.”

Meanwhile, north of the border, North Carolina workers’ compensation experts have been feverishly debating whether and how these rate changes might influence the playing field up here. So many unbalancing factors are at play – both at the state level (see our earlier blog entry about the ongoing devastation at the last year’s Slim Jim plant in the town of Garner, for instance) and at the national level (see our past blog entries on the local implications of the Gulf oil spill, for instance).

It’s important to recognize the limits of our collective power to influence the interactions of the dynamic elements that comprise the ecology of the North Carolina workers’ compensation system. Even among key players — who include but are not limited to insurance adjusters, attorneys, judges, economists, employers, employees, and their families — debate about how to set rates rages.

Getting away from generalities and down to brass tacks… if you or a loved one has a clear and present concern about North Carolina workers’ compensation benefits, insurance, or coverage, consider connecting today with a top caliber attorney to discuss your needs and responsibilities.

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South Carolina Workers’ Compensation Rates to Drop 9.8%

South Carolina Regulators Approve 9.8% Cut in Workers’ Comp Rates

Although her saga does not technically pertain directly to North Carolina workers’ compensation matters, Octomom Nadya Suleman quest for workers’ comp has riveted the attention of the nation. According to breaking reports, the Southern California mom of 8 has finally settled a long standing lawsuit for workers comp for just a little over $23,000.

Background

In 1999, Suleman sustained an injury at the Metropolitan State Hospital while working as a psychiatric technician (hurt her back). For this, she subsequently received around $170,000, which she used in part to fund the in vitro fertilization that led to her becoming the mother of octuplets last January. The California Division of Workers’ Compensation reported that her original settlement of $40,000 was diminished by nearly half because of attorney’s fees and advance payments.

Suleman has been roasted widely in the press for feeding her children with food stamps, selling pictures of herself clad in a bikini to the tabloids, and taking $5,000 from People for the Ethical Treatment of Animals in exchange for putting a sign in her window that reads “don’t let your dog or cat become an Octomom – Always spay or neuter.”

The workers’ comp drama may not be over for Ms. Suleman, given that some of her medical providers have a lien against her, claiming that she owes them around $800.

Are there lessons here for would be North Carolina workers’ compensation claimants? Likely not. Ms. Suleman’s case is fairly unique, and not just because she has octuplets and has behaved in fairly idiosyncratic manner. California has special laws in place that may not be applicable to North Carolina workers’ compensation cases.

For instance as this blog recently reported, an NFL player who hurts himself in a game in California can theoretically claim workers’ comp benefits from the state for the rest of his life – CA is unique in the nation regarding this kind of liberal policy.

If you or a family member faces difficulties collecting benefits, wrangling with insurance companies, or even processing paperwork to meet critical deadlines, it may behoove you to speak with a reputable and battle proven North Carolina workers’ compensation attorney. As the case of Octomom illustrates, workers’ comp – whether you succeed in getting appropriate payments or not – may not be a complete solution for your financial woes.

Speak with a financial planner to draw up a battle plan for you and your family to get on a more even financial keel.

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Octuplets mom Nadya Suleman settles her workers’ comp case

Octuplet mom settles disability claim for $23,000

Last Wednesday, the multinational bank Wells Fargo was ordered to pay out $30 million to four non-profit entities, pursuant to a jury’s verdict that the bank participated in fraud. North Carolina workers’ compensation policy analysts have been reviewing the case to see whether it may have interstate implications.

The four non-profit entities — the Minnesota Workers’ Compensation Reinsurance Association, the Robins, Kaplan, Miller and Ciresi Foundation for Children, the Minnesota Medical Foundation, and the Minneapolis Foundation — all alleged that Wells Fargo essentially tricked them into believing that they were investing in low risk options, when in actuality the bank had been funneling their money into risky investments which blew up during the recent credit collapse. The jury found that the bank violated the Minnesota Consumer Fraud Act (and other laws). Punitive damages have yet to be assessed against Wells Fargo.

Representatives for the bank expressed disappointment about the decision, although it could have been worse for Wells Fargo. The non-profits asked for $400 million — more than ten times what the jury returned.

The litigation over punitive damages (and the potential Wells Fargo appeal) could stretch on for years – a not uncommon phenomenon in North Carolina workers’ compensation cases in which millions of dollars hang in the balance.

Most individual workers’ comp cases involving occupational diseases, injuries at work, and conflicts with insurers do not take as long to resolve and do not get nearly as complicated as the Wells Fargo case. Nevertheless, if you or a loved one faces friction getting benefits, dealing with an insurer, or managing the deadlines associated with your claim, connect at once with a reputable and experienced North Carolina workers’ compensation attorney to review your strategic options and make sure that you’ve dotted all your I’s and crossed all your T’s.

More Web Resources

Wells Fargo vs the non-profits

Minnesota Workers’ Compensation Reinsurance Association

Many North Carolina workers’ compensation cases wind up being dry and technical, requiring attorneys to develop nuanced arguments based on subtle interpretations of the law. But a new case out of Montana has engendered lots of laughs and some raised eyebrows. Below are the deets.

On June 7, a judge found in favor of a 23-year old plaintiff, Brock Hopkins, who was mauled by a bear he had been feeding while high on marijuana. Brock had been volunteering at Great Bear Adventures in Montana. One day, he smoked a pipe of marijuana and came in to do his job when the bear attacked him, dislocating his knee cap, and leading to $70,000 in medical expenses.

The park’s owner, Russell Kilpatrick, argued that Hopkins’ marijuana use was the major cause of the attack – had he not been high, the bear would not have attacked. But although the judge found Hopkins behavior to be “ill advised to say the least and mind bogglingly stupid to say the most,” he also found that Kilpatrick’s testimony that he paid Hopkins “out of my heart” to be laughably disingenuous. Since Hopkins should have been considered an employee of the park, he deserved workers comp benefits.

We have to throw in this pretty amazing quote from Kilpatrick about the event: “Brock could not resist one last time of harassing the bear with his habit of blowing smoke in their faces for God only knows what reason in direct defiance of my telling him not to disturb them!!!”

Hopkins is clearly lucky to have survived the encounter and hopefully has learned his lesson. If you or another family member has been hurt at work (even if you don’t work at a Grizzly Park), your employer or the state could be liable for your medical bills, time off work and other costs. Filing out a North Carolina workers’ compensation claim is not easy. You can find more information about how to do so at the official North Carolina Industrial Commission website.

If you encounter any problems with your insurer, employer, or any other party, it may make sense to connect ASAP with a top caliber North Carolina workers’ compensation attorney to review your rights and make sure the legal system treats you fairly.

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Bear Attack Victim Eligible for Workers’ Comp Despite Marijuana Use

Pot not to blame for bear mauling, judge rules

A sad and disturbing fraud case out of Pennsylvania has North Carolina workers’ compensation policy makers and analysts furiously debating a number of moral and ethical quandaries.

Background

On April 29, authorities arrested 43-year-old Christina Gamble for workers’ comp and insurance fraud stemming from a claim she made in November 2007 that she allegedly made under false pretences.

The PA Attorney General’s office alleges the following:

Gamble had been working for the restaurant Red Robin, when she fell on November 9, 2007 and hurt her back. The restaurant alerted its insurance carrier. In November 2008, a judge awarded her benefits for workers’ compensation. She collected over $22,700 in disability benefits and $4,100 in medical expenses before being caught working in a new capacity – as an exotic dancer for C.R. Fanny’s Gentlemen’s Club and Sports Bar. A private investigator tipped off an agent of Highmark Insurance, which had been representing Red Robin. Since Gamble made her claim on the basis that she could barely move her back, her work as a dancer for hire obviously completely undermined her claim.

Gamble is due in court on May 7. If she is convicted of both accounts of insurance fraud and theft, she could face 14 years in jail and $30,000 in fines.

Workers’ comp and insurance fraud are obviously reprehensible. Enforcement of North Carolina workers’ compensation laws must be strict to ensure that people who do play by the rules get treated fairly and that system-wide costs don’t get out of control. Nevertheless, this case illustrates – or at least implies – how difficult it can be for some people to recover from bad injuries or occupational diseases. Here is a story of a waitress who presumably hurt herself and then did a wrong thing by stealing from her employer’s insurance carrier. But (likely) the news story does not give us the full human dimensions of Gamble’s struggle. As anyone who has personally dealt with North Carolina workers’ compensation issues can tell you, it’s not easy to handle insurance companies or to figure out how to correctly and efficiently get your life back on financially solid ground.

To that end, before you or a family member does something dumb like try to defraud an insurance company or misreport numbers on your workers’ compensation form, connect with an ethical, reliable, and results-proven North Carolina workers’ compensation attorney to discuss your situation in confidence. A free consultation can give you the strategic guidance you need to make wise and ethical decisions about how to move forward and recover from an injury, both medically and financially.

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Christina Gamble fraud saga

Strip club no cure for her bad back

Most North Carolina workers’ compensation matters that this blog covers are local or national. But today we turn our attention to a fascinating case out of Australia involving a pilot for the airline Qantas. This story’s applicability to North Carolina workers’ compensation concerns may be somewhat indirect, but it’s a gripping one, so we had to include it!

Background

A pilot named Bryan Arthur Griffin flew for Qantas in the late ‘70s and early ‘80s. During that time, he developed a mental illness related to obsessive compulsion and anxiety. Mr. Griffin felt a tremendous urge to crash the airplanes he was flying. He heard a voice inside of him telling him to turn off the engines, to cry and scream, to intentionally ignore crew instructions, and so forth. On one flight to Singapore, he developed an urge to crash the plane that was so strong that he had to physically immobilize his arm to avoid killing a whole plane full of people.

Throughout his ordeal, Mr. Griffin was repeatedly looked at by doctors and evaluated by Qantas. Amazingly, the doctors and the airline allowed him to continue to fly for over three years. Not only did allowing Mr. Griffin to fly potentially endanger passengers and crew, but doing so also caused health problems for Mr. Griffin, who became more anxious, depressed, and compulsive as his stint as a pilot wore on.

Eventually, an Australian Commissioner in charge of adjudicating workers’ compensation matters won a judgment for Mr. Griffin for $160,000 for all of his pain, anxiety, and compulsive problems. Qantas also had to pay for his legal and medical fees.

Have you or a family member ever been forced to work at a job that’s caused you anxiety, depression, or compulsion? Your on-the-job injuries and occupational diseases may be covered by North Carolina workers’ compensation.

Take the first step to filing a claim today by connecting with a reputable North Carolina workers’ compensation attorney for a confidential and free consultation. Understand your rights – and your employer’s responsibilities – so you don’t endanger yourself or others at work.

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Qantas

Bryan Arthur Griffin