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A complex work comp fraud has recently been discovered, resulting in the arrests of nine suspects. The investigation carried out by Department of Insurance has determined that the fraud involved 230 wc insurance companies and self-insured employers. G&G Interpreting Services, the company providing Spanish translations, fraudulently billed insurance carriers in the amount of nearly $25 million for translation services provided to claimants of Central and South American origin. The company was helmed by a siblings couple, Francisco Javier Gomez, Jr. and Angela Rehmann.
The company rendered their services from 2012 until this December. They issued bogus bills for services in clinics where the majority of employees spoke Spanish and didn’t need a mediator. G&G Interpreting also delivered their supposed services in clinics where over 10 physicians spoke Spanish fluently.
The area in which G&G provided services was a wide one and encompassed a large portion of Southern California, including Los Angeles and San Diego Counties, San Bernardino, Santa Barbara, Ventura, Orange and Riverside.
The investigation has unearthed that they extended their fictitious services around 83,000 times. Those working hours top 12 hours a day, which is longer than the clinics were open. A number of services, charged in the excess of $400,000, were performed by a translator who was physically prevented from visiting the clinics due to the fact she was at that time incarcerated in state prison.
Department of Insurance detectives led the investigation and Los Angeles County District Attorney’s Office will handle prosecution. The operation was supported by California Highway Patrol and Riverside and San Bernardino district attorneys’ offices.
Insurance Commissioner David Jones of Department of Insurance has emphasized that a lot of people are mistaken when they think such a crime of an insurance fraud is victimless. He stated that when companies decide to take advantage of the system through overbilling or billing shams, everyone picks up the tab in the aftermath.
Department of Insurance founded The Workers’ Compensation Fraud Program in in 1991, when the legislation gave the crime a felony status. That’s also when Fraud Assessment Commission was started to finance the enforcement and prosecution in the cases.
In October 2015, Jones was granted nearly $35 million to support insurance fraud investigations. The collected grants were given to district attorney offices across California counties. The finances will be used toward discovering workers’ comp insurance frauds of various kinds in order to prevent them from draining California’s economy, as Jones said.
If you need a Southern California workers’ compensation attorney, make sure you contact Workers’ Compensation Attorney Group in Los Angeles. You can get a no-cost and no-obligation case review from the most aggressive, ethical and experienced wc lawyers in the County if you call right away.
If you got hurt on the job, absolutely the best thing you could do is get help from a Southern California workers’ compensation lawyer. It’s highly unlikely that you will have retained the services of a wc lawyer before you sustain an injury at work, so this article will tell you what’s important for you to do right after the injury takes place.
Inform your manager
Report the injury to your supervisor as soon as possible. Try to remember any eyewitnesses who possibly saw you getting hurt. You should collect any evidence if there is any and if applicable, make photo records of the site of the injury. However, taking photos could be prohibited because of security or confidentiality limitations.
When you inform your supervisor of your injury, you should be given a form called DWC-1, which is a claim form for workers’ compensation in California. Should your supervisor fail to give you this form, keep in mind you have the right to request it.
The claim form is filled out partly by you and partly by your supervisor. After you have completed your portion, your manager should fill out the rest. Remember to demand one copy of the fully completed claim for your reference.
Completing the workers’ compensation claim
When you are filling out the form, make sure you list all the body parts involved in the injury. For the sake of example, let’s say a heavy object falls on your shoulder, but your back suffers the majority of the injury. You should be careful to list both your shoulder and your back as injured body parts in the claim form.
Bear in mind that the form can be changed later, but when you are filling it out for the first time, it’s best to include as many details as possible. We are not saying you should lie in the claim, but it’s more advisable to overinclude rather than underinclude. Remember that your injuries and their severity will be checked and established by a doctor.
Report the injury despite the fear
It is always surprising how many hurt workers decide not to make a compensation claim for their work-related injuries because they are afraid of losing their jobs. In reality, chances are very low a worker would be terminated if they reported an injury. Employers know such a termination is against the law and could easily get them into an expensive lawsuit.
It’s very important to make your compensation claim in the shortest possible period. If you act timely, you will maximize the chances of recovering due compensation.
An experienced workman’s comp lawyer protect should represent you
A Southern California workers’ compensation lawyer is your best ally in following through your compensation claim. If you have gotten hurt on the job and you are looking for an attorney, make sure you give Workers’ Compensation Attorney Group a call. We are always prepared to have a no-cost and pressure-free case review with you. Our experienced, aggressive and ethical lawyers work for a contingency fee, so you only pay when you recover the compensation. Don’t hesitate to call us today – there’s nothing to lose!
If your employer terminates you following your compensation claim, you should immediately seek help from an experienced attorney in your area. It is against the law to dismiss a worker after he or she sustained an injury in the workplace and filed a compensation claim thereafter. That is, an employer cannot terminate an employee on the grounds of worker’s work-related injury or because the employee asked for compensation. While the claim is being resolved or is pending the employee can be terminated or made redundant, but the termination cannot be due to the worker having sustained injury, filed the claim or because the injured worker needs lessened duties.
Being afraid of termination after filing a compensation claim
Many workers who sustain injuries or cumulative trauma in the workplace are afraid they are going to lose their employment if they file a claim or report it to the employer. This makes them apprehensive and anxious. It often happens that the injured worker tolerates the harmful injury and foregoes proper medical treatment, all the while performing their work duties as if nothing happened.
Unfortunately, when an injury is neglected and when the injured person is deprived of recovery, the detrimental effect of the injury usually worsens until it prevents the worker from doing their job as they should. The paradox is that these circumstances actually make losing their job more probable, which is exactly what the worker wanted to avoid by not reporting the injury. To make things worse, when the injury is not timely reported, the prospect of filing a claim and getting compensation is significantly diminished. It will be doubtful and difficult to prove whether the injury is related to work duties at all. It can appear that the employee was injured outside the workplace and is now trying to frame their employer for it.
What can be done after termination following a claim
The most important thing you should do is report your work-related injury to your employer in the shortest period possible, even when you are afraid you might be terminated. It is not at all common that an employee is terminated because of having filed a compensation claim as that can lead directly to a variety of lawsuits. If the worker reports the injury, files a compensation claim and asks for benefits and then experiences termination or discrimination in the workplace, the employer will face harsh penalties that can be demanded in court. It is also illegal to terminate a worker for having a disability, and remedies for that are provided in the Fair Employment Housing Act.
Have a workman compensation lawyer in Orange County protect your rights
You shouldn’t be discouraged from claiming a compensation for benefits because you are afraid of termination or discrimination. You have the right to ask for benefits if you incurred an injury while doing your job. It’s extremely rare for employees to get fired because of the compensation claim, because employers know such a move would entail more lawsuits. The whole idea behind the workers’ compensation system is to benefit both sides – ensure the medical help and benefits for the employee are cost-effective and that the worker returns to the workplace in good health and ready to work.
If you live or work in Orange County and you sustained a work-related injury, don’t hesitate to contact Workers’ Compensation Attorney Group in Orange County. Our workman compensation lawyers are experienced, aggressive and ethical and they will only charge you if you recover the compensation. Feel free to call us right away and talk one on one with one of our expert lawyers and have a free case review with no pressure to hire us. You can only gain if you call us!
A worker who wants to file a workers’ compensation claim in court in California can do so through their legal representative or they can do it themselves (in pro per). In most cases, injured employees choose to have professional representation before the Workers’ Compensation Appeal Board (WCAB). This is common because the employer’s insurance company is certain to retain the services of an attorney and the employees get one as well just to level the playing field.
Moreover, the process itself can be complicated and disorienting to a non-professional. A skillful and experienced lawyer at the worker’s side will maximize the chances of a successful outcome. A lawyer is able to confidently navigate the court procedures and processes.
Most employees who file the lawsuit in pro per end up hiring an attorney before the case is resolved because issues that are too complex for them emerge.
Filing a California workers’ compensation claim with your lawyer
After you have chosen your legal representative and signed an agreement about representation, the attorney will decide when to file your claim. This is done by filing an Application for Adjudication of Claim at the local WCAB district office in the county where the claimant resides or where the law office is located. Sometimes a new Primary Treating Physician (PTP) is chosen after filing the claim. However, the order of these actions isn’t fixed and the claimant’s attorney decides which strategy to employ.
Another benefit of having professional legal representative is that they will take care of all the administrative work – meaning, you don’t have to worry about having improperly filled out a form or having missed a deadline.
Filing a California workers’ compensation claim without a lawyer
There are claimants who choose to represent themselves in a court of law. In the beginning, many see this as a good idea. They think they will save money that way, which would compensate for the lack of skills and knowledge. However, they oversee the fact that the chances of achieving a positive outcome in their claim are significantly higher when they are represented by a professional at law. Bear in mind that some law firms work on a contingent fee, which means that the claimant only pays if the case is won to their advantage. Another thing is that an injured worker with a representative attorney can focus on getting better and doesn’t have to expose themselves to the strain of leading their case.
Consult Workers’ Compensation Attorney Group in Los Angeles
If you or someone close to you has been injured while performing job-related duties, don’t hesitate to contact the expert attorneys at Workers’ Compensation Attorney Group in LA. We are always available for a free consultation without any pressure or obligation for you to choose us to represent you. If you decide to retain our services, we would like to note that you only pay if you recover compensation. There’s really nothing to lose if you call us – so fell free to do that right away!
The most usual way for a worker’s compensation case to end is with Compromise and Release, or C&R. When a claim is closed like this, a certain lump sum amount of monetary recovery is paid to the injured party and 15 percent or more of that sum is paid to the claimant’s attorney. The financial recovery is provided by the employer’s insurance carrier. The moment the judge approves the C&R closure of a workman’s compensation case, the case is closed forever. The injured party cannot receive any other benefits on the grounds of the injury.
There are other closures in which the hurt employee is provided a life-long medical care and the judge determines or the parties agree on what the closing medical report should be for that claim. This future medical care or FMC is provided under Stipulation & Award and Findings & Award.
Most injured parties finally chose the C&R closure and waive the life-long medical plan for a number of reasons which are usually case-specific. The ultimate decision should be made with all the information and advice provided by the case-leading attorney.
C&R when workman’s comp was denied
When the employer’s insurance carrier or a third party administrator tells the injured workman that no benefits will be paid out for the injury, that’s called a denial of the compensation claim. Unfortunately, too many legitimate compensation claims are denied every year in the state of California.
The workmen who experience a claim denial commonly decide to retain the services of an attorney in order to appeal to the Workers’ Compensation Appeals Board or WCAB. The applicant’s attorney and the injured party will gather medical reports as evidence for the trial. Simultaneously, the attorney defending the insurance adjuster will investigate the case and hunt for the weak spots.
In the end, both attorneys are usually able to reach an agreement that settles the case in a way that it acknowledges the seriousness of the injury and the risks of not recovering the desired benefits. This is called a compromise and it secures a compensation both parties can accept taking into account the circumstances of the case. C&R allows the parties to avoid the risks of litigation. If the claim was initially denied, that’s commonly because there are some issues that render C&R more acceptable.
Hiring an attorney who is experienced and skillful will ensure you get the adequate guidance in your case. If you or someone dear to you has been denied a worker’s compensation claim in Los Angeles County, don’t hesitate to contact Workers’ Compensation Attorney Group in Los Angeles for a free review.
C&R when a claim is accepted
C&R is a common option even in cases when the initial claim is admitted by the employer’s insurance adjuster. C&R is then resorted to when the hurt worker risks recovering a smaller compensation than desirable or the adjuster is afraid of having to pay more. This is all because of a notion called “nature and extent”. It is generally a challenged issue in every workman’s comp case. With the nature and extent issue it’s acknowledged that the injury happened in the workplace. What is being established by expert medical professionals is how serious the injury is. Like any testimony, doctor opinions can vary and are prone to contestation, which puts both parties at the risk of an uncertain outcome regarding the amount of the compensation. In that case, C&R through a lump-sum compensation could be a satisfactory settlement for both parties.
Claimants often choose C&R as a way of getting out of the workers’ compensation system. The medical treatment and care provided by the employer’s insurance carrier is commonly very complicated and untimely and doesn’t secure proper, prompt and continuous medical attention the injured party requires. By getting a lump-sum compensation in cash, the applicant can have their private medical insurance take care of them.
Hire an experienced attorney in LA County for your workman’s injury case
The best guarantee you can get for reaching a satisfactory closure in your case is retaining the services of an experienced, aggressive and ethical lawyer at Workers’ Compensation Attorney Group in Los Angeles. We are always available to provide you a pressure- and obligation-free case review at no expense. Contact us right away let us evaluate what your chances are. If you do decide to hire us, you will pay only if we win, because we work on a contingent fee. For that reason, if we accept to represent you legally, you can rest assured we’re confident we will win.
If an employee is fired after they filed a compensation claim to get benefits for an injury sustained at work, they should ask a workers’ comp attorney for professional guidance right away. It is not legal to terminate a worker because they incurred injuries in the workplace and then filed a claim for benefits. An employer can dismiss or lay off an employee who filed the workers’ compensation claim, but not because of that. In other words, while the claim is open or pending resolution, the injured employee cannot be terminated because they incurred an injury on the job, reported the incident to the employer, filed a compensation claim or because they need lighter duties because of the injury.
Fear of losing your job after filing a compensation claim
It is very usual for employees who sustained an injury or have a cumulative trauma for performing repetitive job duties that resulted in a health condition to feel fear of termination if they report the injury to the employer or file a claim. They feel apprehensive and unsure about making that move. Because of how they feel, these employees often choose to keep quiet about their injury and continue to work as usual.
Sadly, this often makes things much worse. The injury easily worsens if it’s not taken care of and if there is no recovery. As a result, the worker actually becomes unable to perform their usual job duties in the appropriate manner. Paradoxically, that’s how they get closer to being terminated, which is just what they wanted to avoid by not reporting the injury.
That’s not where problems end. When the injury is not reported in a timely manner, the whole compensation claim is put in serious jeopardy, because it becomes difficult to prove the injury happened in the workplace. So, the injured worker could really get terminated and legally denied the benefits which they rightfully deserve.
How can termination following a claim be terminated
The single most important thing an injured worker can do for themselves is immediately report the injury they incurred while doing their job. They should do so even when they fear termination. It’s important to note that it’s extremely rare for an employer to dismiss a worker because the worker got hurt on the job and filed a claim to get compensation. This is because employers know such a termination would inevitably result in multiple lawsuits. Severe court penalties are provided for employers who terminate employees or discriminate against them because they filed a claim for the injuries they sustained on the job. The Fair Employment Housing Act also provides penalties for employers who dismiss their employee or discriminate against them on the grounds of disability.
Have a workers’ comp attorney in Long Beach protect your rights
Even if you fear termination or discrimination, don’t allow it to prevent you from claiming your rights. You are entitled to ask for compensation if you sustained injuries while doing your job. Employers are aware they would face lawsuits if they terminated you because of the claim, so they vary rarely do such a thing. Workers’ compensation legal system is designed in such a way to resolve the matter to the benefit of both parties. The employer wants to keep the costs of compensation low, and the employee wants due medical care and benefits. If the matter is resolved efficiently, the worker should be back on the job ready to perform the duties.
If you live or work in Long Beach and you got hurt on the job, don’t hesitate to contact an expert lawyer in Long Beach. A workers’ comp attorney from our group is always available for a free case review with you. Our experienced, aggressive and ethical lawyers work on a contingency fee, so you only pay if you recover the compensation. Don’t hesitate to contact us right now – there’s absolutely nothing to lose!
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