Would you report workmans comp fraud?

[BlueTaelon]

So, guy supposedly injured his shoulder a year ago and can't work. You just saw him and his friend pick up a 1000+ lb piano and put it in the bed of a truck. There is no possible way an injured guy unable to work could pick that thing up. If you would report it, how would you even do that?

[chickenpatty]

I would not report it. Lifting a heavy item once in months(?) is different than using the same motions daily in a job - like turning wrenches or things like that.

 

I'm not saying it very well, but there are things I know I physically could not do regularly, but every once in a while, I could.

 

That's my 2 cents. :)

[PIE!]

I would not report it. Lifting a heavy item once in months(?) is different than using the same motions daily in a job - like turning wrenches or things like that.

 

I'm not saying it very well, but there are things I know I physically could not do regularly, but every once in a while, I could.

 

That's my 2 cents. :)

 

this

[BlueTaelon]

I would not report it. Lifting a heavy item once in months(?) is different than using the same motions daily in a job - like turning wrenches or things like that.

 

I'm not saying it very well, but there are things I know I physically could not do regularly, but every once in a while, I could.

 

That's my 2 cents. :)

 

 

He's been getting big stuff like the piano for free and turning around and selling it.

[Crimson Wife]

Most states have a hotline where you can report suspected fraud anonymously. Here is the one for CA, you can Google the one for your state.

 

When people rip off the system, the state has to raise fees on employers, which hurts the ability of those employers to hire or maintain workers. It's not a "victimless" crime. :glare:

[Flowing Brook]

Not saying it is right but a lot of people on workman's comp do not get enough to pay their bills. So they do things that will injure themselves further just to be able to make it financially. We can't see some injuries from the out side. Is it possible that his shoulder is really bothering him but he has to sell stuff just to make ends meet, despite the pain?

[sparrow]

No, I probably wouldn't.

[Hockey Mom]

Most states have a hotline where you can report suspected fraud anonymously. Here is the one for CA, you can Google the one for your state.

 

When people rip off the system, the state has to raise fees on employers, which hurts the ability of those employers to hire or maintain workers. It's not a "victimless" crime. :glare:

:iagree:

[Mrs Mungo]

I would not report it. Lifting a heavy item once in months(?) is different than using the same motions daily in a job - like turning wrenches or things like that.

 

I'm not saying it very well, but there are things I know I physically could not do regularly, but every once in a while, I could.

 

That's my 2 cents. :)

 

I tend to agree with this.

[Jean in Newcastle]

Most states have a hotline where you can report suspected fraud anonymously. Here is the one for CA, you can Google the one for your state.

 

When people rip off the system, the state has to raise fees on employers, which hurts the ability of those employers to hire or maintain workers. It's not a "victimless" crime. :glare:

 

Reporting what you saw does not convict him. It just gives them a heads-up so that they can investigate.

[KidsHappen]

Nope. I am a chronic pain patient. Just getting up and down the stairs daily is a challange for me but occassionally I will push myself to accomplish something that I need done when no one is available to help me. I always regret it later so I try not to do anything to strenuous very often. For instance, I ususally don't drive. I can drive but generally don't unless I really have to. However, about ever two months I drive to my dd's house in GA. It takes me at least a week to recover from a round trip ticket. IMO a single act or even an occassional one that is supposed to be beyond a person's capability does not mean that they are not still having trouble on a daily basis.

[Joanne]

He's been getting big stuff like the piano for free and turning around and selling it.

 

No, I would not report it.

[Samiam]

I guess if I was feeling the need to be so involved in this person's life to go as far as reporting it (and I reported it because I am FULLY informed of all issues and reasons as to why this person is on workmen's comp to begin with), then I would also feel comfortable being so involved that I would be willing support this person, feed them, provide a home etc if they are no longer able to afford it, when their workmen's comp is cancelled.

 

Karma would usually come around to someone who is fraudently, without me taking over Karma's job. Cuz I wouldn't want Karma coming back to my door to give thanks.

[Impish]

I would, in a freaking heartbeat.

 

It's guys like that that have made my dealings w/WCB a4 y(and still going!) misery.

 

I'm disabled. And NO, I couldn't 'once in a while' do extraordinary things w/my arm. Just instinctively moving it to catch a falling child causes me to shriek. That wasn't actually CATCHING the kid, just the arm jerking partway in an instinctive reaction.

 

So yeah, I'd report his heinie. :glare:

[Jennifer3141]

I would not report it. Lifting a heavy item once in months(?) is different than using the same motions daily in a job - like turning wrenches or things like that.

 

I'm not saying it very well, but there are things I know I physically could not do regularly, but every once in a while, I could.

 

That's my 2 cents. :)

 

:iagree::iagree:

 

And as someone with a chronic back problem, there are days I can do something easily and days I cannot. That's just the breaks of the game.

 

I would also question my own motives in this as the observer. Do you have a grudge against this person? Did you call him/her out on it when you saw the piano get lifted?

[Impish]

Guys, he's lifting 500 lbs. It's something a completely healthy person would struggle w/.

 

We're not talking a longer walk. Lifting 1,000 lb piano w/1 person assisting.

 

That's not something someone on disability w/a bad back would be realistically able to do. Seriously. W/all the hoops WCB makes someone go through, there's no way they'd agree someone capable of that is disabled. My Dad hooped his back @ work. He can barely move out of bed some days. Still took them a yr or 2 to decide, yeah, you're done.

 

1,000 lb piano...no.

[Jennifer3141]

Guys, he's lifting 500 lbs. It's something a completely healthy person would struggle w/.

 

We're not talking a longer walk. Lifting 1,000 lb piano w/1 person assisting.

 

That's not something someone on disability w/a bad back would be realistically able to do. Seriously. W/all the hoops WCB makes someone go through, there's no way they'd agree someone capable of that is disabled. My Dad hooped his back @ work. He can barely move out of bed some days. Still took them a yr or 2 to decide, yeah, you're done.

 

1,000 lb piano...no.

 

Actually, my disc problem qualifies me for permanent disability. Technically, I shouldn't do stuff like this either. However, I do it almost weekly - usually with someone in my family yelling, "Your back! Your back!" at me.

 

I am the kind of person that wants stuff DONE and if I want to move my darn piano, I am going to move my darn piano. I will bend at the knees. I will use my arms. I will do my best to mitigate and baby my back but I'm moving the dang piano. And if it's something my kids NEED - like an emergency situation and you stand there and scream, "Your back!" at me - then not only will I move the piano but I'll come over and punch you in the face afterwards.

 

I may spend the next day in bed with a ton of anti-inflammatories but Meh. There's always something new to watch on TV. :D

 

And I would rather be shot in the head than have the government consider me permanently disabled - for NOW.

[Nestof3]

I'm only going to say that worker's compensation costs we employers a lot of money. It's so much that my husband declines to have it on himself.

 

But, again, I only think this insurance should pay when an employee is injured from negligence at the company, not just because he/she got injured there. Blameless injuries happen all over the place. I think this sort of insurance should be something a person has on a personal policy like health or car insurance.

[Impish]

I'm only going to say that worker's compensation costs we employers a lot of money. It's so much that my husband declines to have it on himself.

 

But, again, I only think this insurance should pay when an employee is injured from negligence at the company, not just because he/she got injured there. Blameless injuries happen all over the place. I think this sort of insurance should be something a person has on a personal policy like health or car insurance.

Determine what is negligence though.

 

I was injured b/c I was assaulted by a resident. This resident had injured others before me, and others after me. Is that negligence on the part of the co, for not having some sort of restraint (chemical or physical) in place, or just the breaks of working in health care?

 

My Dad fell down a flight of stairs, grabbing a rail on the way down. Stairs were wet from snow. Negligence, or just happens?

 

There'd be a WHOLE lotta fighting over what negligence actually is. Ppl would be starving, families suffering, waiting for the ins cos to finish duking it out over who is supposed to be paying. Co A would say, negligence, YOUR responsibility, co B would say, it's the worker's fault!

 

It would be a gong show. WCB is bad enough as it is. I can't imagine what would happened to an injured worker if there were TWO ins cos involved. :001_huh:

[Nestof3]

Yes, I am sure in some instances it would be difficult to determine fault.

 

My dad drove a tractor trailer (for deliveries), and he backed out of the trailer part, thinking he still had enough flooring. He didn't, fell and ended up with a concussion. He did not file a claim because he said it was his fault he wasn't more careful. I thought that was honorable.

 

So, perhaps I wish that if people injure themselves in a way they could injure themselves anywhere, that they would consider it a non-worker's comp event. I know people who have special insurance in case someone slips on their walkway to the house -- so they don't get sued. Why would anyone sue for slipping on a sidewalk anywhere? Sidewalks can be slippery.

 

You have a bad back and you lift something heavy at home, your back goes out. Same thing in the workplace. I just don't see how the employer is to blame for that.

 

I just know how I would handle it. If I injured myself in a way I could injure myself at my own home or because of something I didn't consider negligence on the part of the employer, I would not seek compensation. I guess what others choose to do is up to them.

 

 

 

Determine what is negligence though.

 

I was injured b/c I was assaulted by a resident. This resident had injured others before me, and others after me. Is that negligence on the part of the co, for not having some sort of restraint (chemical or physical) in place, or just the breaks of working in health care?

 

My Dad fell down a flight of stairs, grabbing a rail on the way down. Stairs were wet from snow. Negligence, or just happens?

 

There'd be a WHOLE lotta fighting over what negligence actually is. Ppl would be starving, families suffering, waiting for the ins cos to finish duking it out over who is supposed to be paying. Co A would say, negligence, YOUR responsibility, co B would say, it's the worker's fault!

 

It would be a gong show. WCB is bad enough as it is. I can't imagine what would happened to an injured worker if there were TWO ins cos involved. :001_huh:

[Impish]

Yes, I am sure in some instances it would be difficult to determine fault.

 

My dad drove a tractor trailer (for deliveries), and he backed out of the trailer part, thinking he still had enough flooring. He didn't, fell and ended up with a concussion. He did not file a claim because he said it was his fault he wasn't more careful. I thought that was honorable.

 

So, perhaps I wish that if people injure themselves in a way they could injure themselves anywhere, that they would consider it a non-worker's comp event. I know people who have special insurance in case someone slips on their walkway to the house -- so they don't get sued. Why would anyone sue for slipping on a sidewalk anywhere? Sidewalks can be slippery.

 

You have a bad back and you lift something heavy at home, your back goes out. Same thing in the workplace. I just don't see how the employer is to blame for that.

 

I just know how I would handle it. If I injured myself in a way I could injure myself at my own home or because of something I didn't consider negligence on the part of the employer, I would not seek compensation. I guess what others choose to do is up to them.

It's tricky.

 

I mean, I *could* have had an accident, strain/sprained my hand/arm, partially torn a tendon at home. Could've. That could've resulted in RSD, leaving me disabled the rest of my life.

 

But, it didn't. There's never been a doubt how the injury happened, and what the results have been.

 

And, reality is, I'll never work again (even though WCB argues that an employer would be DELIGHTED to have someone that can only use their non dominant hand, severe chronic pain that would have me leaving/not showing up, etc w/little notice) and my quality of life is severely diminished.

 

The meds I get are hundreds of dollars a mth.

 

Realistically, pretty much *any* injury that happens at work *could* happen anywhere.

 

Frankly, I count myself lucky that there were 2 witnesses that had to intervene in the assault, so there was no question of what happened.

[Unicorn.]

Actually, my disc problem qualifies me for permanent disability. Technically, I shouldn't do stuff like this either. However, I do it almost weekly - usually with someone in my family yelling, "Your back! Your back!" at me.

 

I am the kind of person that wants stuff DONE and if I want to move my darn piano, I am going to move my darn piano. I will bend at the knees. I will use my arms. I will do my best to mitigate and baby my back but I'm moving the dang piano. And if it's something my kids NEED - like an emergency situation and you stand there and scream, "Your back!" at me - then not only will I move the piano but I'll come over and punch you in the face afterwards.

 

I may spend the next day in bed with a ton of anti-inflammatories but Meh. There's always something new to watch on TV. :D

 

And I would rather be shot in the head than have the government consider me permanently disabled - for NOW.[/QUOTE]

 

And that's the difference between an honest person, and someone who abuses the system.

 

I personally agree w/ Imp. I would report it. I worked w/ a guy who supposedly injured his back at work, and couldn't come to work because he was in too much pain. I was in college at the time, and this was a gas/convience store. He was in his late 40's early 50's. Mr. "too much pain" was seen dancing the night away every. single. weekend! I did hurt my back working there, but it was my own dang fault for not lifting properly. I didn't file w/c. I didn't skip work. I paid for my own doc visits, I went to work in pain, and I still have problems, but I deal with it. I can't stand people who abuse the system. I'm tired of paying for other people's laziness, and I'm tired of people like Imp, who really need the help, not getting it because of other's abuse. So, Yes, by all means report it and let them investigate.

[Nestof3]

I did not say your case is not a worker's comp case. No worries because my thoughts are not the reality in the workforce.

 

People complain about wages being so low, but this insurance is one of the reasons. A company pays worker's comp based on the wages, thus the potential risk the company would have to pay out over the years in case of injury. A person making $20,000 a year would result in the company paying for less in worker's comp than a person making $60,000.

 

My husband opted out of having coverage because he is so low-risk. Though he does operate potentially dangerous equipment, he knows he isn't going to stick his hand down to pull out leaves from a turning blade on a mower. He knows how to operate on a bank riding a zero-turn radius. He wears eye protection when he is supposed to. He knows not to hold the trimmer close to his body.

 

But manual labor is going to put a strain on his body, and he knows that going into it. He knows he may injure his back because lifting heavy equipment can do that. I injured my back helping my husband to move the sofa bed so we could put up a Christmas tree. It just happens. I have a bulging disc that flares up every now and then (that was the actual cause of the injury -- partly because I had a desk job and say so much). But, I don't blame the company for having a desk job that makes me more prone to back injury. I don't blame the company that working and helping care for my boyfriend's son made me so busy I hardly had time to exercise anymore (one more reason for the bulging disc).

 

I sit at my desk a lot at home. I type a lot at home. I use a mouse a lot at home. I know the risks. I may get carpal tunnel syndrome. My eyes may go bad from the strain. I would know them just the same if I worked for a company doing what I am doing.

 

I broke my arm playing kickball in my back yard. I sprained my ankle walking down my stairs. I sprained my ankle playing hockey at school when I was young. It wouldn't be any different if I sprained my ankle walking down the steps at work unless the steps were broken. If it's snowing outside, yes, I can assume that when I walk into the library the floor may be slippery. I wouldn't sue if I fell and injured myself there.

 

It's tricky.

 

I mean, I *could* have had an accident, strain/sprained my hand/arm, partially torn a tendon at home. Could've. That could've resulted in RSD, leaving me disabled the rest of my life.

 

But, it didn't. There's never been a doubt how the injury happened, and what the results have been.

 

And, reality is, I'll never work again (even though WCB argues that an employer would be DELIGHTED to have someone that can only use their non dominant hand, severe chronic pain that would have me leaving/not showing up, etc w/little notice) and my quality of life is severely diminished.

 

The meds I get are hundreds of dollars a mth.

 

Realistically, pretty much *any* injury that happens at work *could* happen anywhere.

 

Frankly, I count myself lucky that there were 2 witnesses that had to intervene in the assault, so there was no question of what happened.

Edited October 1, 2012 by nestof3

[SailorMom]

I get the thought behind considering reporting it, but I think this is a "stay out of it" kinda situation. He has to have a doctor backing him up - let it stay his problem.

[mommymilkies]

Not saying it is right but a lot of people on workman's comp do not get enough to pay their bills. So they do things that will injure themselves further just to be able to make it financially. We can't see some injuries from the out side. Is it possible that his shoulder is really bothering him but he has to sell stuff just to make ends meet, despite the pain?

 

:iagree: my mom was injured in a terrible wreck at work (she's on a road crew). Workers comp has been putting her through hoops for almost 2 years when all she needs is a MRI and surgery. She lifts my kids even though she has a horrible back injury because she doesn't want to waste time with "her babies", it doesn't mean she's not hurt. She's just stubborn. That's a lot different than working a road crew every day for 16-18 hours. She doesn't get monetary compensation, but they're finally paying for her knee surgery. She's still waiting for back surgery approval. :glare:

[Jean in Newcastle]

This man is receiving money from Workman's Comp for his injury but is still working (selling things like this piano) doing things that he says that he can't do for pay. That is fraud. That is not pushing himself a bit too hard to help out his family. You could say that working to sell the piano is helping his family financially. Great. Then he should do that legally and upfront, without taking money because he "can't work otherwise".

[LMA]

Yes, I am sure in some instances it would be difficult to determine fault.

 

My dad drove a tractor trailer (for deliveries), and he backed out of the trailer part, thinking he still had enough flooring. He didn't, fell and ended up with a concussion. He did not file a claim because he said it was his fault he wasn't more careful. I thought that was honorable.

 

So, perhaps I wish that if people injure themselves in a way they could injure themselves anywhere, that they would consider it a non-worker's comp event. I know people who have special insurance in case someone slips on their walkway to the house -- so they don't get sued. Why would anyone sue for slipping on a sidewalk anywhere? Sidewalks can be slippery.

 

You have a bad back and you lift something heavy at home, your back goes out. Same thing in the workplace. I just don't see how the employer is to blame for that.

 

I just know how I would handle it. If I injured myself in a way I could injure myself at my own home or because of something I didn't consider negligence on the part of the employer, I would not seek compensation. I guess what others choose to do is up to them.

 

Actually, if you injure yourself at work, most companies require it to be reported regardless of fault. My husband tripped over something at work (his fault) and he hurt his knee. His manager told him it has to be reported and OSHA had to be called in. They told him to take a sick day for the knee and go see the orthopedic surgeon. All covered by workmen's comp.

 

Workmen's comp covers all accidents, including those caused by the employee. The key is that the accident happened on the premises of the employer. There can be compensation for medical bills or income. It is designed for everyone and most claims are just a medical visit to be checked out.

 

We have extra coverage for slippage on the sidewalk/driveway at our home. The insurance company told me that if someone is injured on our property, we are responsible for the claim.

[mandymom]

I'm only going to say that worker's compensation costs we employers a lot of money. It's so much that my husband declines to have it on himself.

 

 

:iagree:

[elegantlion]

Actually, if you injure yourself at work, most companies require it to be reported regardless of fault. My husband tripped over something at work (his fault) and he hurt his knee. His manager told him it has to be reported and OSHA had to be called in. They told him to take a sick day for the knee and go see the orthopedic surgeon. All covered by workmen's comp.

 

 

Yes, my dh cut himself at work the other day. It was nothing (he would come home with worse when he was self-employed), but they had to make a formal report.

[LMA]

One more thing: My husband went to the doctor for a minor injury (from home) last year and the doctor's office asked if the injury occurred at work. They told us if it occurred at work, he would have to file a workmen's comp with his company. Also, they said the insurance company would go after the workmen's comp insurance company anyway.

[Soror]

This man is receiving money from Workman's Comp for his injury but is still working (selling things like this piano) doing things that he says that he can't do for pay. That is fraud. That is not pushing himself a bit too hard to help out his family. You could say that working to sell the piano is helping his family financially. Great. Then he should do that legally and upfront, without taking money because he "can't work otherwise".

:iagree:

My dh works with way too many people that constantly look for various ways to abuse the system. Then complain about it. Yes, there are innocent people trying to get by but not everyone is, there is fraud.

[Jennifer3141]

This man is receiving money from Workman's Comp for his injury but is still working (selling things like this piano) doing things that he says that he can't do for pay. That is fraud. That is not pushing himself a bit too hard to help out his family. You could say that working to sell the piano is helping his family financially. Great. Then he should do that legally and upfront, without taking money because he "can't work otherwise".

 

 

However, unless the OP has intimate knowledge of this person's medical records we do not know the actual final diagnosis. Did workman's comp cover PT for a year or more? Is the patient on long term pain medication? Did the company not want the guy back because he could no longer do the work?

 

At my family's business, we ran into that a bit. We did commercial truck tires. Now once you're too handicapped to drive a forklift, we had nothing left for you unless you wanted to do things like manage our 401k and handle accounts receivable, etc. and honestly, people who barely graduated from high school are too stupid do to things like that. And that was MY job. :lol:

 

So we had more than one employee leave under permanant disability and go on and do other things in their lives that may or may not have involved moving pianos. We never cared to follow people after they left. If you can go through the hoops to get those benefits, as far as my family was concerned - you deserved them.

[Dina in Oklahoma]

Most states have a hotline where you can report suspected fraud anonymously. Here is the one for CA, you can Google the one for your state.

 

When people rip off the system, the state has to raise fees on employers, which hurts the ability of those employers to hire or maintain workers. It's not a "victimless" crime. :glare:

:iagree:Exactly!:iagree::iagree:

Edited October 1, 2012 by Dina in Oklahoma

[KungFuPanda]

Guys, he's lifting 500 lbs. It's something a completely healthy person would struggle w/.

 

We're not talking a longer walk. Lifting 1,000 lb piano w/1 person assisting.

 

That's not something someone on disability w/a bad back would be realistically able to do. Seriously. W/all the hoops WCB makes someone go through, there's no way they'd agree someone capable of that is disabled. My Dad hooped his back @ work. He can barely move out of bed some days. Still took them a yr or 2 to decide, yeah, you're done.

 

1,000 lb piano...no.

 

I disagree. I get that your point of reference is your own disability, but every disability is different. My husband broke his back in the military. He couldn't do a physical job every day for a living, but he can do occasional heavy lifting at home. Also, pianos generally have wheels. We could be talking about a few seconds of actual heavy lifting surrounded by lots of balancing and shifting and what not. I'd never interfere with someone else's livelihood because I 'think' I know something based upon my own experience.

 

Now, if the guy is running an under-the-table moving company next door and I witness him moving pianos daily, over a long period of time, that might be different. However, this could be the case of someone further injuring themselves just to make ends meet. Would you report someone you LIKED over an incident like this? Or give them the benefit of the doubt?

[Nestof3]

Yes, I understand the law on it. The law for reporting is to protect the employer -- to make sure the employer isn't covering it up. My dad, however, did not want the company's insurance to increase because of something he did on his own. He also knew he would be leaving the company soon to retire completely (this was just a part-time job). He purposely refused to work more so that it did not interfere with his social security paycheck (not even going there).

 

I know exactly how worker's comp works.

 

I understand that we can be sued by someone slipping on our walkway, so I guess it's a good thing we don't have visitors often. I am not arguing what is the law, I am saying I disagree with it. I would never sue a friend for slipping on her porch. I guess it's one more reason to be thankful I have so very few friends. With friends like that, who needs them?

 

 

 

Actually, if you injure yourself at work, most companies require it to be reported regardless of fault. My husband tripped over something at work (his fault) and he hurt his knee. His manager told him it has to be reported and OSHA had to be called in. They told him to take a sick day for the knee and go see the orthopedic surgeon. All covered by workmen's comp.

 

Workmen's comp covers all accidents, including those caused by the employee. The key is that the accident happened on the premises of the employer. There can be compensation for medical bills or income. It is designed for everyone and most claims are just a medical visit to be checked out.

 

We have extra coverage for slippage on the sidewalk/driveway at our home. The insurance company told me that if someone is injured on our property, we are responsible for the claim.

[In the Rain]

I wouldn't report it, for most of the reasons mentioned above. It is a shame (and a crime) if he is committing fraud, but it is also possible he is working within the limits of his injury or disability. Many injuries relate to repetitive use rather than strength.

[Acorn]

Guys, he's lifting 500 lbs. It's something a completely healthy person would struggle w/.

 

We're not talking a longer walk. Lifting 1,000 lb piano w/1 person assisting.

 

That's not something someone on disability w/a bad back would be realistically able to do. Seriously. W/all the hoops WCB makes someone go through, there's no way they'd agree someone capable of that is disabled. My Dad hooped his back @ work. He can barely move out of bed some days. Still took them a yr or 2 to decide, yeah, you're done.

 

1,000 lb piano...no.

 

Why didn't he use a ramp? I had a rotor cuff injury that still allowed forward pushing or some lifting but not doing part of my job that required lifting things arms above my head.

[elfgivas]

can you say more about why you would report it? about why you wouldn't?

 

what relationship do you have with this person?

 

questions, no answers.....

ann

 

ps. you did ask what we would do. if it were someone i know, i'd say something to them. if it were someone i didn't know, i'd say something to the person we knew in common. if someone were being injured, i would report in a heartbeat. if someone is being less than honest, then i take that to be more of a soul/personal issue. flip side, it is my taxes that he is "stealing", if indeed he is being dishonest. but honestly, unless you had asked me, it wouldn't have dawned on me to report him. it would have dawned on me to question him or our mutual friend. fwiw.

[Nestof3]

We have extra coverage for slippage on the sidewalk/driveway at our home. The insurance company told me that if someone is injured on our property, we are responsible for the claim.

 

When we were growing up, we played at friends' houses -- on swing sets, backyards, etc., and kids played at our house -- on our swing set. We swam at friends' pools. My parents never would have dreamed of asking the neighbor to pay our medical bill if I broke my arm from jumping off their swing.

 

Now, we limit what kids are allowed to do because we realize we live in a litigious society. Neighbor kids are not allowed in our fort. They were not allowed on the trampoline when we had it. They are not allowed to use the rope swing. In fact, no one is allowed to do these things when friends are over. I think it is ridiculous to have to be so afraid today. Perhaps kids shouldn't even come over. I mean, they might trip on a tree root. No fake swords because someone might get hurt. A ten-year old might decide to be dumb one day and swallow a Lego.

 

Yeah, it should just be up to us to add yet one more bill on top of our monthly bills to protect us from this craziness.

[Anne in CA]

I didn't read all the replies but I used to work for a private investigator who worked worker's comp cases. There is nothing that will happen to him over a report. What will happen is that he will be referred to a private investigator who will use methods that are illegal but effective to catch him. The investigator will monitor his cell phone conversations until he makes plans to do something strenuous and then he will get it on film.

[LMA]

Yes, I understand the law on it. The law for reporting is to protect the employer -- to make sure the employer isn't covering it up. My dad, however, did not want the company's insurance to increase because of something he did on his own. He also knew he would be leaving the company soon to retire completely (this was just a part-time job). He purposely refused to work more so that it did not interfere with his social security paycheck (not even going there).

 

I know exactly how worker's comp works.

 

I understand that we can be sued by someone slipping on our walkway, so I guess it's a good thing we don't have visitors often. I am not arguing what is the law, I am saying I disagree with it. I would never sue a friend for slipping on her porch. I guess it's one more reason to be thankful I have so very few friends. With friends like that, who needs them?

 

Workmen's comp protects the employee also. It is a no-fault program and has to pay claims for both types of accidents at fault and not at fault. The HR dept. at my husband's company has a policy saying that not reporting an injury is the same offense as over-exaggerating an injury.

 

You don't have to be sued for someone's injury on your property. They only have to make a claim with your insurance company. My friend's aunt fell at my friend's house and the aunt's insurance company went after my friend's insurance company and my friend's company had to pay for her medical bills. She was not sued but she was still responsible.

 

Unfortunately, that's how the system works. I agree with you there!

[Nestof3]

You don't have to be sued for someone's injury on your property. They only have to make a claim with your insurance company. My friend's aunt fell at my friend's house and the aunt's insurance company went after my friend's insurance company and my friend's company had to pay for her medical bills. She was not sued but she was still responsible.

 

Unfortunately, that's how the system works. I agree with you there!

 

I understand that's how it works for many people. My son ran into a tree earlier this year at my eldest son's house. It never occurred to me that my eldest son's insurance company or the owner's insurance company (since my son is renting) should pay his medical bill.

 

It just seems hard for people to understand that there are people who want to take responsibility for themselves and their own children. There are people who don't see a difference between running into a tree while playing tag in the dark at your own house vs. someone else's house. The doctor never asked whose house this occurred at in order to find out whose insurance company should pay. I'm pretty sure your aunt had to have brought this information up.

 

I just don't see a difference between falling in my kitchen or your kitchen -- unless you booby-trapped me. :tongue_smilie:

 

Thinking more about it, though we have insurance, we still had to pay the bill. Perhaps I should have tried to get someone else to pay. In fact, maybe I should have my kids play at others' houses since my kids are so accident-prone. :)

 

I plan to keep on living by these standards.

Edited October 1, 2012 by nestof3

[brehon]

I understand that's how it works for many people. My son ran into a tree earlier this year at my eldest son's house. It never occurred to me that my eldest son's insurance company or the owner's insurance company (since my son is renting) should pay his medical bill.

 

It just seems hard for people to understand that there are people who want to take responsibility for themselves and their own children. There are people who don't see a difference between running into a tree while playing tag in the dark at your own house vs. someone else's house. The doctor never asked whose house this occurred at in order to find out whose insurance company should pay. I'm pretty sure your aunt had to have brought this information up.

 

I just don't see a difference between falling in my kitchen or your kitchen -- unless you booby-trapped me. :tongue_smilie:

 

I plan to keep on living with my standards.

 

Dawn, it's not a matter of taking responsibility for yourself. Insurance companies send out forms asking how an injury occurred - regardless if someone reports it or not. The insurance companies usually get this information from the medical records related to the accident. No one (except the doctor or hospital filing a medical bill) has to tell the insurance companies anything. This happens whether you want it to or not. The form sent out will ask questions about where the injury occurred; who was involved; were there any witnesses; etc. The doctors don't have to ask which property the injury occurred on; the insurance company will. Then one needs to decide whether one will lie on an accident report to "take responsibility" or tell the truth and risk one's insurance company going after a friend or family (or their insurance, more than likely) for payment.

 

The only way an insurance company won't find out about an injury is if there are no medical records related to the accident. Records, not bills. In other words, no one goes to the doctor/hospital which may not be possible for a more serious injury.

 

I don't agree with this, by the by. It just is.

[elegantlion]

Dh was self-employed for many years. He's worked with two broken wrists before, not pretty in construction, but the onus was on him. Now, at his job (not self-employed) there is a situation he has told his boss about. It needs to be addressed, it is a safety issue. He can fix it, but must have materials and approval and someone order the materials. It's been a month of his superiors ignoring the situation. If he were injured because of their delay in addressing the situation, you bet your butt we would be filing workman's comp. They would need to take responsibility for it. We are not sue-happy for sure, but if it impacted his ability to work in the future we'd take action.

 

Unless the OP is well aware of this person's claim and all the reasoning behind it, I would not file a complaint.

[Nestof3]

That did not happen in our case. We told the doctors where the injury occurred, but for some reason our insurance company did not inquire about it. So, it seems they only ask about certain injuries?

 

It seems that falls, especially with elderly, are so common that I'm surprised it would even be investigated.

 

We are talking about medical insurance here right? Not home owners.

 

Dawn, it's not a matter of taking responsibility for yourself. Insurance companies send out forms asking how an injury occurred - regardless if someone reports it or not. The insurance companies usually get this information from the medical records related to the accident. No one (except the doctor or hospital filing a medical bill) has to tell the insurance companies anything. This happens whether you want it to or not. The form sent out will ask questions about where the injury occurred; who was involved; were there any witnesses; etc. The doctors don't have to ask which property the injury occurred on; the insurance company will. Then one needs to decide whether one will lie on an accident report to "take responsibility" or tell the truth and risk one's insurance company going after a friend or family (or their insurance, more than likely) for payment.

 

The only way an insurance company won't find out about an injury is if there are no medical records related to the accident. Records, not bills. In other words, no one goes to the doctor/hospital which may not be possible for a more serious injury.

 

I don't agree with this, by the by. It just is.

Edited October 1, 2012 by nestof3

[Nestof3]

Dh was self-employed for many years. He's worked with two broken wrists before, not pretty in construction, but the onus was on him. Now, at his job (not self-employed) there is a situation he has told his boss about. It needs to be addressed, it is a safety issue. He can fix it, but must have materials and approval and someone order the materials. It's been a month of his superiors ignoring the situation. If he were injured because of their delay in addressing the situation, you bet your butt we would be filing workman's comp. They would need to take responsibility for it. We are not sue-happy for sure, but if it impacted his ability to work in the future we'd take action.

 

Unless the OP is well aware of this person's claim and all the reasoning behind it, I would not file a complaint.

 

You are very right. I hope it is fixed as its horribly irresponsible of them.

[Lang Syne Boardie]

I would not report it.

 

I don't want to live in a society where it is common to report our friends and neighbors on the basis of our own assumptions.

[beaners]

That did not happen in our case. We told the doctors where the injury occurred, but for some reason our insurance company did not inquire about it. So, it seems they only ask about certain injuries?

 

Well, just last week my husband had to go to Urgent Care to get staples in his head from an incident at work. Either the doctor or front desk specifically asked him if it happened at work. Maybe they assumed that it had based on the fact that he was wearing a dress-shirt and tie? About a year ago his ankle was broken in a different work incident, and again he was asked specifically if it happened at work. (His job is really not that dangerous!)

[brehon]

That did not happen in our case. We told the doctors where the injury occurred, but for some reason our insurance company did not inquire about it. So, it seems they only ask about certain injuries?

 

It seems that falls, especially with elderly, are so common that I'm surprised it would even be investigated.

 

We are talking about medical insurance here right? Not home owners.

 

Well, it could be injury specific, state specific, and/or insurance company specific. Last summer my dd(then 6) hurt her arm while playing with her cousins who were visiting from out of town. She ended up needing a 3/4 arm cast and an MRI to rule out tendon damage. Of course, we used our medical insurance and never dreamed about having my BIL & SIL pay for anything. Kids play, kids get hurt. Nobody was at fault.

 

A couple of weeks later we received a letter from our insurance company (medical) asking just the sorts of questions I listed before. Basically, our insurance company was looking for someone else's ins co to pay the medical bills. My dh and I gave a bare bones account of what happened. Although we didn't mention my BIL/SIL (well, their child) in the report, we called to give them a heads-up. We most certainly didn't want them to pay for anything. The point is that we couldn't order our insurance company to just pay the bills and not bother anyone else. Although this example involves only medical insurance, homeowner's insurance works the same (at least here). That's why the PP mentioned a specific rider on her policy.

 

As far as elderly falls I imagine the same types of questionnaires are sent out unless, perhaps, the person lives in a nursing home, assisted living facility, etc. Also, I don't know how or if having Medicare plays into these types of issues.

 

Oh, I wanted to say that I actually threw the first letter from my insurance company away. They sent a second letter to me asking for the information. This is the one weanswered. Persistent litte buggers.

[sbgrace]

That did not happen in our case. We told the doctors where the injury occurred, but for some reason our insurance company did not inquire about it. So, it seems they only ask about certain injuries?

 

It seems that falls, especially with elderly, are so common that I'm surprised it would even be investigated.

 

We are talking about medical insurance here right? Not home owners.

 

Most of time when I'm filling out the paperwork, or the nurse is, there is a question about whether the injury occured at work. In my experience a person would have to lie to keep a claim from going to worker's comp.

 

OP, I personally wouldn't interfere unless you are privy to the details of his disability/injury and so why he can no longer work. I don't think all disabilities affect people on every single day for example. We had a neighbor who has good and bad days with his disability.