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  1. #1
    Join Date
    Nov 2012

    Default Worker's Comp Insurance Company is Alleging Fraud

    My workers compensation claim was made in the State of: Hawaii
    DOI 2/2010
    My husband was injured in a motor vehicle accident while on the job. The other driver was at fault. Back in 11/12 the WC carrier submitted an alleged fraud claim as a result of surveillance. The video never showed anything out of his limits set by his doctors and in fact confirmed his injury in many instances. There were a total of 159 video edits and it also included commentary that had no supporting video (things they claim happened and didn't and places they claim he was and he wasn't). Their IME was in his favor and then the doctor rescinded his initial report saying that my husband must have lied. But he also said in the commentary "the claimant is seen pounding his legs which could be an indicator of radiculopathy." After the fraud claim, (which they claim 41 instances = $410,000 in fines + all amounts paid out and are seeking repayment) they terminated his TTD payments without approval from the state and have denied further treatment plans, medicines, but continue to pay the doctors).

    Because of the MVA, there is a 3rd party liability. The girl that hit him, her insurance is paying out on her policy. Our attorney drafted a letter to the WC regarding the $20,000 3rd party claim (because of subrogation) informing them that 80% would go to my husband, 20% to me, less attorney and court fees. The WC sent a letter back accepting and also proposed that if he stops further claim, they will drop all charges! It makes me sick to think that this has been their intention from the get-go. They have wanted to scare him into submission. And now they have him right where they want him.

    He also has 2 other potential recovery claims from our underinsured motorists coverage (as well as the company vehicle). His doctors have unofficially rated him at near 100% disability.

    What should we do? I HATE the fact that they are gonna get away with committing their own fraud. It's not about the money. WC is limited anyway and with the other bodily injury, etc. insurances, he/we should be okay. It's about the principle. He doesn't want to give in. But even if the hearing officer rules in his favor (attorney thinks there's a 90%+ chance they will) the WC will file an appeal and can appeal all the way to the district courts, which could draw this out for years to come. And the fact that there is a slim chance that he loses because we all know there are "not so smart" people everywhere and leaving it to our legal system is certainly a gamble. We are struggling with what to do.

    Losing sleep.....

  2. #2
    Join Date
    Nov 2013

    Default Re: Against a Wall

    Wow!!! I wish i had an answer for you, you certainly are stuck between a rock and a hard place. The only thing i can suggest is go off your attorneys advice, at the very least this will keep you out of any potential legal troubel.

    IDK sorry and good luck

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