Would you report workmans comp fraud?

[Jean in Newcastle]

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!)

 

Whenever there is an accident, the doctors will ask if it happened at work. I am a SAHM who has no employer listed on my paperwork but they will still ask me if an accident occurred at work.

[Nestof3]

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!)

 

No, I was talking about situations where a person falls in a friend's back yard. Someone said the insurance company of the other lady was involved.

[*Michelle*]

Whenever there is an accident, the doctors will ask if it happened at work. I am a SAHM who has no employer listed on my paperwork but they will still ask me if an accident occurred at work.

 

Yes, and they also ask if your visit is related to a car accident, presumably for insurance purposes also.

[SitLongTalkMuch]

No, I was talking about situations where a person falls in a friend's back yard. Someone said the insurance company of the other lady was involved.

 

Our health insurance always sends out a questionaire after we receive medical treatment asking very pointed questions about where the accident happened.

 

Last year I needed stitches in my foot (pyrex pan exploded in my kitchen) and dd needed stitches (fell off bike in our driveway). Both times we received the questionaire to fill out and return. The insurance companies don't want to pay.

[Flowing Brook]

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".

 

Here is a scenario that I have seen a lot of. Joe got injured at work. He went from making 2000 a month to getting 1000 a month. His bills come to 1500 a month. He is only allowed to make an extra 200 on the side and still get his disability. He really cannot work he is in too much pain his injuries are too severe to hold a steady job. He can work a little from time to time. If he gets a regular job he will lose his disability. He can't hold a regular job because of the pain. However, he is capable of holding a job under the table job from time to time. It is the only way to make ends meet despite the pain and further injuring himself. What is "Joe" to do?

Edited October 1, 2012 by puddles

[elegantlion]

Here is a scenario that I have seen a lot of. Joe got injured at work. He went from making 2000 a month to getting 1000 a month. His bills come to 1500 a month. He is only allowed to make an extra 200 on the side and still get his disability. He really cannot work he is in too much pain his injuries are too severe to hold a steady job. He can work a little from time to time. If he gets a regular job he will lose his disability. He can't hold a regular job because of the pain. However, he is capable of holding a job under the table job from time to time. It is the only way to make ends meet despite the pain and further injuring himself. What is "Joe" to do?

 

This scenario is part of my thoughts as well. Before reporting I would have to know the particulars and feel 99.9% confident that fraud was happening and not just an earnest attempt at survival. I want to live so that my actions don't make life harder for people who are seriously trying to simply stay afloat.

[Nestof3]

Our health insurance always sends out a questionaire after we receive medical treatment asking very pointed questions about where the accident happened.

 

Last year I needed stitches in my foot (pyrex pan exploded in my kitchen) and dd needed stitches (fell off bike in our driveway). Both times we received the questionaire to fill out and return. The insurance companies don't want to pay.

 

Wow! I am really learning stuff here. I wonder if it's the provider. We've had Anthem (a personal policy), and had several injuries.

 

Aaron's hand severely cut by knife

 

Nathan's face injured from running into a tree

 

Ben's head scanned when he hit it after jumping out of a tree

 

My husband injured himself with hedge clippers

 

I am confused why one would take out a rider for unjuries at one's house if the other person will end up going through our undurance anyway.

 

I still don't really understand these household injuries. So, my health insurance policy only covers injuries we incur on our own property?

 

We did mention the car accident when taking Ben in because we wanted to make sure the at-fault driver's insurance paid.

[Acorn]

We had Anthem when my son needed stitches. I ignored the first injury inquiry from anthem. It was addressed to my 2 year old son and marked "confidential". It was standard questionnaire asking for more details on the injury and who else could be billed (workmans comp, homeowners or auto ins.). I thought it was crazy and ignored it. Then, we got the second letter, still addressed "confidential" to a 2 year old and a very explicitly said that if we didn't return the form that he would be in limbo with our health coverage until the matter was resolved.

[Acorn]

No, I was talking about situations where a person falls in a friend's back yard. Someone said the insurance company of the other lady was involved.

 

Yeah sometimes it is unfortunate, but the law is that homeowners are responsible for some accidents on their property. It isn't a matter of "suing" but getting proper insurance coverage. To claim it to your own health ins. when it happened elsewhere (work or another's house) could be committing ins. fraud.

[twinmami01]

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 dad is not on workman's comp, but he is on disability. He barely makes enough to get by. He can barely manage but he sometimes does pick up heavy items to turn around and sell just so he can survive. Yes, it makes his injuries worse, but he does what he can. You don't know the whole story, so I wouldn't get involved.

[twinmami01]

Here is a scenario that I have seen a lot of. Joe got injured at work. He went from making 2000 a month to getting 1000 a month. His bills come to 1500 a month. He is only allowed to make an extra 200 on the side and still get his disability. He really cannot work he is in too much pain his injuries are too severe to hold a steady job. He can work a little from time to time. If he gets a regular job he will lose his disability. He can't hold a regular job because of the pain. However, he is capable of holding a job under the table job from time to time. It is the only way to make ends meet despite the pain and further injuring himself. What is "Joe" to do?

 

:iagree: This sounds like my dad.

[NanceXToo]

No, I would not. It's not the type of thing I consider my business, nor would I claim to know what he's really going through or feeling on a regular basis just because he might have good days or push himself on things now and then. I have back problems sometimes. There are days I feel like I just can't move, and I don't. There are days I feel great and I get tons done. There are days that are iffy and I do things that maybe I shouldn't and I tell myself I'm gonna regret it later, but if something needs to get done, it needs to get done. I don't get benefits for it or anything but if I did if hate to think some neighbor was watching me, judging me, and deciding whether to "report" me based on how I was feeling or what I was doing on one given day. Live your life and let him live his. He's not bothering you, I assume.

[Jpoy85]

Here is a scenario that I have seen a lot of. Joe got injured at work. He went from making 2000 a month to getting 1000 a month. His bills come to 1500 a month. He is only allowed to make an extra 200 on the side and still get his disability. He really cannot work he is in too much pain his injuries are too severe to hold a steady job. He can work a little from time to time. If he gets a regular job he will lose his disability. He can't hold a regular job because of the pain. However, he is capable of holding a job under the table job from time to time. It is the only way to make ends meet despite the pain and further injuring himself. What is "Joe" to do?

 

:iagree:

What good would come of involving yourself in HIS business and he loses all help he currently has? I say stay out unless it directly involves you and it doesnt sound like it does.

[NittanyJen]

As somebody who was badly injured in a car accident, and who had plenty of time to get thoroughly sick of all kinds of people telling me they knew what I could and could not do, I would stay out of it. I had people amazingly annointing themselves with MD's left and right, announcing my neck and other spinal cord injuries had healed and that I was "really fine now" and that I should "just get over it" because "enough time had passed."

 

I was working very intensively with my physical therapists, and we were using certain elements of my martial arts in my healing attempts. Someone from work who observed me performing some (highly altered, but they would not have known that) martial arts, announced that they "saw me doing kuhrahtee" and therefore I was faking my injuries and no longer needed time off from work for physical therapy or my modified work schedule or any accommodations at work.

 

Another person at work announced that her husband "had the same injuries I did" (doubtful; he is a different human being, and I don't recall disclosing a full medical report to her in any event) and that after four months he was able to "just suck it up and get over it." Yet another person "saw me turn my head freely just fine one day" and was sure I must be faking it.

 

My, the world was certainly full of knowledgable people! I wish they were around when I woke up in the morning and couldn't turn my head! Or when I was trying to climb a flight of stairs and would suddenly collapse for no apparent reason! Or any of a number of problems I had at the time. Fortunately I am doing better now. But then? No, i was not. It was just a bunch of people who didn't know nearly as much as they thought they did making a lot of self-righteous noise because having somebody in pain around working as hard as she could and not complaining must have made them very uncomfortable, and they had to be some kind of self-styled expert in order to deal with it.

 

I would never presume to assume I knew what was going on internally with another individual unless I had really, really strong knowledge of what was going on, and the standard for having that knowledge is pretty high. Even my own immediate family got it wrong nearly 100% of the time, not because I refused to communicate, but because the dynamics of pain are difficult to understand for anyone not currently experiencing it.

 

The idea of fraud is very aggravating and frustrating-- it cheats us all! But people who are in the system are often treated with suspicion and distrust, just for being in the system in the first place, as if they got injured on purpose, adding insult to injury. You are not only injured, but also suspected of fraud simply by virtue of being injured. Instead of compassion, no matter what you do-- sit home and don't do anything, or get out and do the most you can-- somebody is out there, judging you for your actions for one reason or the other, because you have been injured, and demanding that you prove yourself all over again, that you justify yourself to someone, be it insurance company, trial jury, workman's comp board inquiry, or something.

 

Maybe sometimes we can err on the side of compassion, instead of making those who fight pain on a daily basis feel as if they are no better than criminals, always held up to every single neighbor, relative, and other layperson for judgement.

[elizabeth]

Normally I would never use Wikipedia to explain that which I do not have time to explain myself. That said, there is a trade off that most do not understand in play . Here is a quick version of the law and how it was developed to respond to the conflicting interests of insurance companies and the rights of workers to a safe, healthy environment and they need not prove fault to be made whole from the injury. It saves all of us money in the long run but you have to see how and why it was developed as an alternative to pure tort law where one party is guilty and the other not or at least not as contributorily negligent to the point that there is no liability. It is not legal in our state to refuse to carry Workers Compensation for certain professions. It was not designed for small business. And I do see where that is problematic. Here is a succinct history that might prove interesting . http://en.wikipedia.org/wiki/Workers'_compensation

Fraud does happen unfortunately but usually they are caught by being flagrant in displaying abilities way beyond their self reported pain levels. That being said it is relatively rare. You would not believe the poor souls who are denied disability by the Fed. I can only generalize but out of our 275 current live cases, there is not one woman who claims PTSD and agoraphobia who was not molested repeatedly by family members or close family friends.There are abundant medical and psych records to back up the claims. For years usually. They are plagued with self hatred, physical trauma, PTSD, substance abuse, suicidal ideations, the list is endless. They are so often so dysfunctional that they have NO ONE, their family is not trustworthy as they let the abuse go on, they are terrified of people, they live in absolute seclusion. Many are found able to work. As the saying goes, walk a mile in the other's shoes...We do both SSDisability and Work Comp. I cannot even describe the majority of cases due to respect for the sensitive people who read these boards. Degloving. Google it. I have seen the injury and the rehab, I would rather die than face what those clients have to go through. God love them. On the other side of the spectrum are the rare frauds who we spot along with the MD's and they are given the boot quickly. It is tragic that so many are injured so horribly and one fraud case or two casts a pall over the pool of those who are truly injured and the system is there to protect them AND their employers from tort cases where the employee can sue for negligence . Because heaven knows the employers are all responsible and swell with nifty protective gear etc. A guard not in place on a chicken meat extractor will eat your arm in under 2 minutes. Not mangle it but literally crush and consume it. Think it does not happen every day? You are fortunate...we live in meat packing country and see hideous short cuts taken every day to speed up production or save a few bucks that maim workers in that industry. Then we have a negligence situation and no punitive damages for the employer just a fine that means nothing to the industry. No one cares until it is their hiney in the sling. Then we want OSHA, the state legislatures, FDA the whole megillah when it is one of our own hurt. There are no easy answers but you must understand a trade off was made, no negligence by the employer need be proven,they fear no punitive damages or large injury awards.The employee is covered as long as it was in the course of and arising out of employment. The two questions as to in the ourse of and arising out of are where the litigation occurs. It is all crafted by statute in each state. I love discussing Work Comp and could do so all night but must now go forth and compile college application packets. Great discussion though. Many thoughts and issues at hand and they are life and death questions.

[QueenCat]

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

 

nm

Edited October 2, 2012 by CathieC

[QueenCat]

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.

 

NEVER, in 22 years of having kids, have I received a questionnaire from the insurance company about where the accident happened. They've happened in our home, in friend's homes, at the airport... but that wasn't a part of getting covered. EVER. I'm wondering which companies do this. Only in one workman's comp situation were those questions asked.

[LMA]

NEVER, in 22 years of having kids, have I received a questionnaire from the insurance company about where the accident happened. They've happened in our home, in friend's homes, at the airport... but that wasn't a part of getting covered. EVER. I'm wondering which companies do this. Only in one workman's comp situation were those questions asked.

 

We've gotten plenty for various claims from all of our insurance companies (these are all company insurance plans) - BCBS, United Health, BC Anthem, and now BC - Federal Employees. I've gotten them for all of my surgeries, including my c-sections. They even sent one for the baby in the NICU, just checking to see if his birth was a result of an injury from someone else's fault.

[QueenCat]

We've gotten plenty for various claims from all of our insurance companies (these are all company insurance plans) - BCBS, United Health, BC Anthem, and now BC - Federal Employees. I've gotten them for all of my surgeries, including my c-sections. They even sent one for the baby in the NICU, just checking to see if his birth was a result of an injury from someone else's fault.

 

Wow! We have BCBS now, and have had United Health, Aetna, Kaiser in the past. Never something like that. I've heard of plenty of people having crazy issues with Anthem but nothing like these questionnaires. I've had a few claims where I've had to deal with "stuff" to get things covered as they should be when we had United (or maybe it was Aetna, only one was a little difficult, but it was a long time ago). The birth thing is super nuts.

[GailV]

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

 

:iagree:

[Nestof3]

We've gotten plenty for various claims from all of our insurance companies (these are all company insurance plans) - BCBS, United Health, BC Anthem, and now BC - Federal Employees. I've gotten them for all of my surgeries, including my c-sections. They even sent one for the baby in the NICU, just checking to see if his birth was a result of an injury from someone else's fault.

 

Wow. This hasn't happened in my 13 years of marriage. Just seems so bizarre to me that where on your street you get injured has anything to do with coverage.

 

So, I'm assuming if the other person has no insurance, your company pays? Does the premiums go up for the other person if a claim is filed?

 

Again, why have home owner riders if health insurance will cover it?

[brehon]

NEVER, in 22 years of having kids, have I received a questionnaire from the insurance company about where the accident happened. They've happened in our home, in friend's homes, at the airport... but that wasn't a part of getting covered. EVER. I'm wondering which companies do this. Only in one workman's comp situation were those questions asked.

 

These days most of the privates follow this practice. And every workman's comp investigation does this. As I said I don't like this practice; but, lil ol' me isn't going to change the practice.

[QueenCat]

Wow. This hasn't happened in my 13 years of marriage. Just seems so bizarre to me that where on your street you get injured has anything to do with coverage.

 

So, I'm assuming if the other person has no insurance, your company pays? Does the premiums go up for the other person if a claim is filed?

 

Again, why have home owner riders if health insurance will cover it?

 

I'm still trying to wrap my head around the idea of these questionnaire's. The discussion of "where" has only occurred during "chatter" with the medical provider while they're working with us. With the exception of the one workman's comp situation.

[QueenCat]

These days most of the privates follow this practice. And every workman's comp investigation does this. As I said I don't like this practice; but, lil ol' me isn't going to change the practice.

 

I expect it for workman's comp. I've just never seen or heard of it, regarding personal injuries, before tonight. We've always been with privates. I can't imagine having to deal with my homeowners if a friend's child got hurt playing here, doing normal childhood things (if I was truly negligent, I would, of course, offer to pay).... our $3000 deductible is meant to be there for MAJOR claims.

Edited October 2, 2012 by CathieC

[LMA]

Wow. This hasn't happened in my 13 years of marriage. Just seems so bizarre to me that where on your street you get injured has anything to do with coverage.

 

So, I'm assuming if the other person has no insurance, your company pays? Does the premiums go up for the other person if a claim is filed?

 

Again, why have home owner riders if health insurance will cover it?

 

The reason for the questionnaire is not for me to file a claim but for the insurance company to go after the other person or their insurance company. None of my surgeries were the result of someone else's fault though.

 

For example, my daughter was hit behind her ear by a hockey puck at a pro game last spring. She went by ambulance to the nearest hospital. She was fine. My husband gave his insurance information to pay for the ambulance and ER visit. However, my husband followed up with the team's insurance company and they paid our out of pocket expenses and the rep expected our own insurance company to contact him about the expenses already paid.We did not have to file a claim with the company.

[LucyStoner]

If I had direct knowledge of fraud? Sure. If I had a suspicion? No. I think the OP describes a suspicion and not confirmed knowledge.

[QueenCat]

The reason for the questionnaire is not for me to file a claim but for the insurance company to go after the other person or their insurance company. None of my surgeries were the result of someone else's fault though.

 

For example, my daughter was hit behind her ear by a hockey puck at a pro game last spring. She went by ambulance to the nearest hospital. She was fine. My husband gave his insurance information to pay for the ambulance and ER visit. However, my husband followed up with the team's insurance company and they paid our out of pocket expenses and the rep expected our own insurance company to contact him about the expenses already paid.We did not have to file a claim with the company.

 

In car accidents, which I hadn't thought about in my previous post, it is expected for the other party to pay via insurance. I can see it in your situation at the hockey game, as that is a business. Going after people when a kid falls out of tree, or whatever, when playing, is absurd. That is what health insurance is for!

[QueenCat]

I'm trying to figure out how to word a spin off message about these questionnaire's and going after people's homeowners insurance for medical issues. I'd like to know how widespread this practice is, as it is new to me. Any suggestions? Start a new thread if you can think of a good way to say it before I do....

Edited October 2, 2012 by CathieC

[LMA]

In car accidents, which I hadn't thought about in my previous post, it is expected for the other party to pay via insurance. I can see it in your situation at the hockey game, as that is a business. Going after people when a kid falls out of tree, or whatever, when playing, is absurd. That is what health insurance is for!

 

Another example. My 75-year old friend fell on her friend's driveway going to her car and she hurt her knee. This was in April. She had all kinds of test and now has to have a partial knee replacement done as a result of the fall. She did not have a problem with the knee before the fall. Her health insurance company (Medicare supplement policy) is going after the homeowner's insurance of the friend to pay for the operation. My friend told the doctor that she fell in a friend's driveway and they put that in the medical records and the insurance company followed up from there. She did not ask the insurance company to make a claim nor did she plan to make a claim or to make a lawsuit or any other thing. She is horrified that the insurance company is doing this, but there is nothing she can do about it now.

 

I think with the healthcare issues and cost, you will see more of this practice. Not agreeing with it, just stating my own experiences.

[QueenCat]

Another example. My 75-year old friend fell on her friend's driveway going to her car and she hurt her knee. This was in April. She had all kinds of test and now has to have a partial knee replacement done as a result of the fall. She did not have a problem with the knee before the fall. Her health insurance company (Medicare supplement policy) is going after the homeowner's insurance of the friend to pay for the operation. My friend told the doctor that she fell in a friend's driveway and they put that in the medical records and the insurance company followed up from there. She did not ask the insurance company to make a claim nor did she plan to make a claim or to make a lawsuit or any other thing. She is horrified that the insurance company is doing this, but there is nothing she can do about it now.

 

I think with the healthcare issues and cost, you will see more of this practice. Not agreeing with it, just stating my own experiences.

 

The big question is whether or not the homeowners insurance will actually pay out... I would think they would have to find that the homeowner was negligent (i.e. cracked, broken concrete, uncleared snow/ice) in the upkeep of her driveway for this type of situation. At least I would hope so!

[cdrumm4448]

These days most of the privates follow this practice. And every workman's comp investigation does this. As I said I don't like this practice; but, lil ol' me isn't going to change the practice.

 

In over 20 years of coverage we also have never seen these questionnaires. I wouldn't answer them if I did.

[Crimson Wife]

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.

 

And I don't want to live in a society where good, hardworking folks are unemployed because dirtbags are scamming the system and the rest of us are too chicken to do anything about it. :glare:

[Jpoy85]

And I don't want to live in a society where good, hardworking folks are unemployed because dirtbags are scamming the system and the rest of us are too chicken to do anything about it. :glare:

 

Its not about being chicken, its about not knowing every in and out of the other persons life. If the OP doesnt live with the person in question how could she possibly know what he is or isnt capable of? Thats not being a chicken, thats called minding your own business. There are too many people who dont know when to stay out these days- from this topic to discipline and everything in between. :auto:

Edited October 2, 2012 by Jpoy85

[Crimson Wife]

Its not about being chicken, its about not knowing every in and out of the other persons life. If the OP does live with the person in question how could she possibly know what he is or isnt capable of?

 

That's what the fraud investigators are for- to determine whether the guy is legit or a dirtbag. Calling the tipline doesn't lead to an immediate cutoff of benefits but gives a red flag that the investigators can decide whether there is reason to pursue an investigation or not.

 

Again, this kind of fraud is not a "victimless" crime and it is ALL of our business because abuse of the system causes higher unemployment, and that in turn hurts the broader economy. :thumbdown:

[Pink Fairy]

In over 20 years of coverage we also have never seen these questionnaires. I wouldn't answer them if I did.

 

I got one of those forms two years ago when I sprained my ankle (fell down my own garage steps). Blue Shield said on the form that they wouldn't pay out until they got the form back.

[Lang Syne Boardie]

Its not about being chicken, its about not knowing every in and out of the other persons life. If the OP does live with the person in question how could she possibly know what he is or isnt capable of? Thats not being a chicken, thats called minding your own business. There are too many people who dont know when to stay out these days- from this topic to discipline and everything in between. :auto:

 

I agree.

 

If someone told me he was cheating, or I had access to his medical records and I knew fraud was happening, I would tell him to either turn himself in or I would have to.

 

I don't diagnose people and judge their disabilities from afar, and then take it upon myself to inform on them based on nothing more than my ill-informed assumptions. That's ridiculous.

[Joanne]

That's what the fraud investigators are for- to determine whether the guy is legit or a dirtbag. Calling the tipline doesn't lead to an immediate cutoff of benefits but gives a red flag that the investigators can decide whether there is reason to pursue an investigation or not.

 

Again, this kind of fraud is not a "victimless" crime and it is ALL of our business because abuse of the system causes higher unemployment, and that in turn hurts the broader economy. :thumbdown:

 

Yea, but people who hold and operate on this view frequently don't think it is ALL of our business when a single mom can't make it on 2 jobs, a family doesn't have health insurance, or the next door neighbor's electricity is going to be cut off.

[Crimson Wife]

Yea, but people who hold and operate on this view frequently don't think it is ALL of our business when a single mom can't make it on 2 jobs, a family doesn't have health insurance, or the next door neighbor's electricity is going to be cut off.

 

Maybe they do but feel that assistance should be done through private charity rather than the government. Small government conservatives are frequently very generous in donating their time and income to charity. Research has shown that conservatives donate about 30% more to charity than liberals even though liberals average 6% higher income (source is here).

[IsabelC]

It's hard to say. I think, on balance, that you probably ought to report it and let the relevant authority investigate if warranted. But personally, I probably wouldn't report it, not for any ethical reasons but because I grew up with a pretty strong "don't dob on people" culture.

[IsabelC]

Maybe they do but feel that assistance should be done through private charity rather than the government. Small government conservatives are frequently very generous in donating their time and income to charity. Research has shown that conservatives donate about 30% more to charity than liberals even though liberals average 6% higher income (source is here).

 

Your theory is certainly possible. However, the article you linked is only based on one book, and the research presented in that book is unreliable for quite a few reasons.

[Melissa in Australia]

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.

:iagree:

[Nestof3]

That's what the fraud investigators are for- to determine whether the guy is legit or a dirtbag. Calling the tipline doesn't lead to an immediate cutoff of benefits but gives a red flag that the investigators can decide whether there is reason to pursue an investigation or not.

 

Again, this kind of fraud is not a "victimless" crime and it is ALL of our business because abuse of the system causes higher unemployment, and that in turn hurts the broader economy. :thumbdown:

 

:iagree: with you here. Companies have to pay more for every worker's comp claim, every rise in unemployment, etc. The fraud investigation is there for a reason. If the person is innocent in it, then there is nothing to worry about.

 

In the end, everyone pays on these things in some way. And, yes, there are people who intentionally abuse the system. There are people who intentionally break the law on both sides -- employer and employee. I think few people would be concerned about squealing on the employer side.

 

We have no qualms reporting companies we feel are in violation of pesticide certification laws here. It costs our business time and money to be certified to spray herbicides and pesticides. These things, like required liability insurance to do so, cost us money. Too many companies like ours are refusing to be legal so they can charge less/make more profit.

[Nestof3]

Yea, but people who hold and operate on this view frequently don't think it is ALL of our business when a single mom can't make it on 2 jobs, a family doesn't have health insurance, or the next door neighbor's electricity is going to be cut off.

 

Again, in many situations, we do know these people, and we know what they do with their money, and we do not want to give our money directly to them. We would rather give it to people we know have legitimate need.

 

And despite your feelings about helping the poor, reporting a potential crime really has nothing to do with it.

[Acorn]

In over 20 years of coverage we also have never seen these questionnaires. I wouldn't answer them if I did.

is

 

That is what I thought the first time. The second letter made it clear that we had to return it or coverage would be denied.

[PiCO]

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.

 

I have a business, and I pay worker's comp. I like that WC is no-fault in my area. I have many part-time employees, and I don't cover them with health insurance... most of these part-time employees are students, so they are covered under their parents. But some are not, so I'm glad that they are covered if they get hurt at work.

 

WC also pays disability while the employee can't work due to their injury. I have an employee who has been unable to work since May, and won't be released back to work until probably January. It was a freak accident, she wasn't even going to report it. Then she was going to see her chiropractor, which would have made it so she couldn't use the WC. Now she's covered until the end of December, and she can heal properly.

 

WC can be a really good thing.

[brehon]

In over 20 years of coverage we also have never seen these questionnaires. I wouldn't answer them if I did.

 

Good luck with that. As I wrote previously I threw the first letter away. I received a second letter a few weeks later stating that if I chose not to answer the insurance company's questions, they would not pay for any claims related to my dd's accident.

 

I've heard from some people (IRL) that their insurance companies may even deny coverage completely (i.e., drop them) for refusing to answer these types of questionnaires. My company's letter did not say that nor do I have enough money to cover all the interventions and tests my dd needed. We chose to answer very vaguely and my BIL & SIL have not been bothered.

[NittanyJen]

Think of it ths way: what if your neighbor saw your kids out playing in the yard every day, and you driving them places. He thought, "We'll, they are supposed to be homeschooling, but how could they be getting any school done? I better call the authorities. It is their job to see that these kids are really in school."

 

How would you feel?

[I.Dup.]

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.

 

I agree. I think people need to attend to their own business and stop worrying about everyone else's, unless they're wanting to pitch and help, provide, encourage, support. Not nark.

[GailV]

I agree.

 

If someone told me he was cheating, or I had access to his medical records and I knew fraud was happening, I would tell him to either turn himself in or I would have to.

 

I don't diagnose people and judge their disabilities from afar, and then take it upon myself to inform on them based on nothing more than my ill-informed assumptions. That's ridiculous.

 

And no one is saying that calling a tip line accomplishes that. The tip line alerts those who ARE up close. They (the people on the other end of the tip line) are NOT judging from afar, and making an ill-informed judgment.

 

Sheesh, let's all remember this discussion next time a thread is posted wherein someone SHOULD have gotten involved. Right now everyone's in a we-all-should-mind-our-own-business panic.

Edited October 2, 2012 by GailV

[ktgrok]

Good luck with that. As I wrote previously I threw the first letter away. I received a second letter a few weeks later stating that if I chose not to answer the insurance company's questions, they would not pay for any claims related to my dd's accident.

 

I've heard from some people (IRL) that their insurance companies may even deny coverage completely (i.e., drop them) for refusing to answer these types of questionnaires. My company's letter did not say that nor do I have enough money to cover all the interventions and tests my dd needed. We chose to answer very vaguely and my BIL & SIL have not been bothered.

 

yup, I have one I have to reply to right now, actually.

 

As for turning them in, only if I knew more details. My husband is currently getting physical therapy for back/neck/head injuries from an auto accident. He was told not to do anything strenuous, but he powered through and finished up most of our remodeling so that there wouldn't be exposed drywall/wires/etc when the new baby came. He shouldn't have...it definitely caused him more pain, but he felt he had to. And he worried someone would see him carrying/lifting stuff (in great pain) and would somehow inform on him and he wouldn't get insurance to pay for the physical therapy.