Sometimes work comp claims just aren’t what they seem

| Nov 15, 2018 | workers compensation insurance defense

The legal realm of workers’ compensation is both singular and complex, as well as involving more than an occasional dispute. We prominently note that on our website at the proven Louisiana insurance defense law firm of Caffery, Oubre, Campbell & Garrison. We note therein that the workers’ comp universe encompasses a “complicated maze of deadlines and regulations imposed by state and federal laws.”

And not only that. Outsized risks often challenge business principals in workers’ comp matters. We duly stress that, “From the moment a worker is injured, employers are faced with decisions that can affect their potential liability.”

It is certainly reasonable for employers and their insurance companies to assume honesty and good faith concerning the work-related injury claims they must deal with.

Unfortunately, though, it is not always realistic. Fraud and related misrepresentations sometimes mark workers’ comp-linked matters, which can result in unjustified liability and payouts.

Recent news concerning a doctor centrally involved in claim matters strongly bears that out. That physician was sentenced last week to a five-year felony probationary term and additional exactions for his sustained efforts to extract payments from multiple insurers relevant to workers’ comp claims.

There was a problem with that: The claims — that is, the official reports written by the doctor in his falsely stated capacity as a qualified medical evaluator – were bogus. A media report on the matter notes that the doctor disingenuously created reports “to resolve nonexistent disputes,” coupled with billing demands to insurers totaling scores of thousands of dollars.

Those companies include notable entities ranging from The Hartford and Zurich Insurance to Liberty Mutual and other insurers. The physician’s license was suspended prior to his criminal sentencing.