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How Social Media Use Can Endanger a Workers’ Comp Claim

A workers’ compensation claim can begin a complex and lengthy process. Especially when the injury is severe and involves high costs, an insurer’s claims adjusters will constantly search for ways to reduce their employers’ liability. Injured employees’ social media accounts are one way an insurer can investigate the merits of an employee’s claim. It’s important for the injured employee to keep their pending workers’ compensation claim in mind when they post to social media.

Insurers examine the merits of every claim

Bear in mind that an insurance adjuster’s job is to ensure that the insurer only pays for expenses that are rightfully covered under a policy. Adjusters are insurance experts. They know the cracks in a policy that might allow a claim to be partly or entirely denied. Adjusters therefore examine every claim to ensure that they tell an accurate story of the injury, its diagnosis, and how it is likely to be treated. Every insurer is vigilant against potential fraud. An employee who files a fraudulent claim will have the claim denied and may face other significant consequences, like a lost job and even criminal prosecution. Criminal fraud involves an intent to deceive the insurer, which may not be the case in many circumstances where an employee has made honest mistakes. But even an accusation of fraud can leave an injured employee without coverage.

Social media posts are a form of evidence

People who routinely use social media platforms like Facebook, Instagram, or Twitter can easily forget that their posts can reach a wide audience. Even if a user studiously controls their privacy choices, for example by not allowing “public” access, social media posts can become the focus of legal disputes, including administrative conflicts over denied workers’ compensation claims. What once was “private” may lose its privacy protection as a consequence of obligations in discovery or a subpoena. Social media posts can also reach coworkers and managers. Do not discount the possibility that a manager could alert an HR department about a social media post that they believe raises concerns. Cases of true fraud—where an employee is caught posting pictures of herself running a marathon two days after claiming to have a broken leg—are more common than one might expect. But social media can create hazards for injured employees in more subtle ways. Anything that contradicts the facts included in claim documents could create doubts in the mind of an insurance adjuster. In the social media world, which places a certain premium on keeping up appearances, a photograph or casual comment could cast doubt on the severity of an employee’s injury.

Call the GGRM Law Firm for help with your workers' comp claim

For over 45 years the law firm of Greenman Goldberg Raby Martinez has helped clients in the Las Vegas area pursue workers’ compensation claims. We offer free attorney consultations to new clients. To schedule an appointment call us today at 702-388-4476 or send us a request through our site.

Filing Complaints with the Nevada Division of Insurance

Filing Complaints with the Nevada Division of Insurance
From a certain point of view, insurers are in the business of denying claims. Finding a way to limit the scope of benefits a claimant can receive is how insurance adjusters make their living. Naturally, an insurer is legally permitted to aggressively defend itself against the possibility of fraud or inflated damages claims. But an insurer’s aggressive posture can and often does cross the line into the realm of bad faith or, even worse, fraud on the part of the insurer. When an insurance dispute arises the insured has the option of submitting a complaint to the Nevada Division of Insurance.

What does the Nevada Division of Insurance do?

The Division of Insurance has a number of important functions, with consumer protection being among time. The Division has staff dedicated to helping resolve disputes between consumers and insurers. They will investigate cases and offer mediation services to bring the dispute to amicable resolution without involving the relatively slow and expensive court system. The Division oversees state licensing of insurance professionals, which means that it has the authority to revoke the license of a professional or even a business if it has committed serious violations. The complaint process begins by submitting a form online, or alternatively by mail. A consumer must provide all the information the Division needs to evaluate the claim, including a signed release form to permit the Division to seek medical information from the claimant’s doctors, if necessary. The Division considers cases involving potentially improper denials of claims, improper cancellations of policies, and disputes related to the necessity or efficacy of medical treatments. Once the Division receives the complaint and provides a notice to the insurer, the insurer has a short time to respond to the complaint.

The Division of Insurance has limited power to resolve disputes

Although the Division can help a consumer in a number of important ways, its authority in disputes is limited to a mediator role. Among other things, it cannot handle complaints brought by consumers who are represented by an attorney. Essentially, the Division offers no-cost assistance to consumers who otherwise cannot find or afford the help of an attorney. The Division also cannot order an insurer to provide coverage or alter a decision. A consumer who feels that an insurance company is acting in bad faith or unethically may find that pursuing recourse through litigation offers a greater chance of a favorable outcome. This is especially true when a case involves complicated issues that make it difficult to compile a comprehensive complaint without an attorney’s help. Speaking to an attorney needn’t foreclose submitting a complaint to the Division of Insurance. The consumer can’t be represented by an attorney in a matter that is submitted to the Division, but an attorney may be able to help the consumer determine whether it makes sense to pursue a remedy through the Division complaint process or through litigation.

GGRM is a Las Vegas personal injury law firm

For more than 45 years the law firm of Greenman Goldberg Raby Martinez has represented injured clients in cases involving personal injury, workers’ compensation, and insurance disputes. If you aren’t sure whether filing a complaint with the Division of Insurance is the right move for you, call us today for a free attorney consultation at 702-388-4476 or reach us through our contact page.

Workers’ Compensation Fraud in Nevada

Workers’ Compensation Fraud in Nevada
Committing fraud in connection with Nevada’s workers’ compensation system is a crime. Anyone in the system can potentially commit fraud. Conviction can carry hefty financial penalties, jail time, and the long-term consequences that come with a felony on one’s record. The state attorney general’s Workers’ Compensation Fraud Unit investigates suspected cases.

Injured workers must avoid committing applicant fraud

A worker who behaves dishonestly to get workers’ compensation benefits may be committing applicant fraud. Applicant fraud includes things like faking injuries, lying about pre-existing conditions, trying to pass off an injury suffered at home as work-related, or continuing to work while receiving disability wages. Workers sometimes think they can get away with these things because they are small fish in a big pond. But insurers vigilantly defend themselves against claims fraud and won’t hesitate to report suspicious activity. Bear in mind that criminal fraud requires an intentional act to deceive. Mistakes on a form or forgetfulness during a physician evaluation don’t rise to the level of fraud unless a worker decides not to correct the problem once it’s discovered. Also remember that the no-fault nature of workers’ compensation means that an injury suffered while working is covered regardless of whether the employee’s negligence caused the injury. It’s important to tell the truth about what caused the injury; lying to hide mistakes may not only threaten a fraud charge, it may also place one’s coverage at risk.

Insurers and health care providers can commit fraud, too

An insurer or doctor’s office can commit fraud as well. Insurers commit fraud by deliberately undermining a worker’s claim to avoid costly payouts. Of course, an insurer will often work hard to find excuses to deny claims, and once it finds a defensible rationale it will reduce or eliminate an injured worker’s benefits with the expectation that the worker will not have the resources to fight the decision. Sharp business practices, by themselves, aren’t fraud. Like applicant fraud, insurer fraud requires a deliberate, dishonest act. A health care provider can also commit fraud to rack up unwarranted fees. It can do this in a variety of ways, many of which will be invisible to the worker (lying on reimbursement forms, for example) while others may give the worker reason to be suspicious (ordering unnecessary treatments or dragging treatment on well after the incident). Workers must take care not to become part of a fraudulent scheme by an insurer or health care provider. Paying attention and asking questions can go a long way toward avoiding becoming a part of a criminal enterprise. If something doesn’t seem right, don’t hesitate to reach out to the attorney general’s office or consult with a personal lawyer.

Workers are not alone

The law firm of Greenman Goldberg Raby Martinez represents workers’ compensation clients in the Las Vegas area. If you think you may be the victim of workers’ compensation fraud and would like to talk to an attorney about your legal options, we are happy to help. For a free attorney consultation, reach out to us today at 702-388-4476, or ask us to call you through our contacts page.