In response to R. Murphy: The penalties imposed by statute is the remedy applied for “wrongful denial” or ‘delay in payment” of benefits. Usually, wrongful denial or delay in payment results from either claims processing errors, or unintentional/mistake by the adjuster. Criminal sanctions (jail time)is not the appropriate penalty for “negligence”. On the other hand, “Fraud” requires a wrongful intent on the part of the perpetrator to obtain an undue benefit. it does not arise out of “mistake” when an employee files a fictitious claim or a doctor submits a bill for treatment not performed, or an attorney directs his client to go a certain doctor who intentional diagnoses an injury, when there is no evidence of an injury.
Why is the plaintiff bar bellyaching? We all know how difficult it is to prove fraud. Of the number of cases in which fraud is proven, I would’n’t be surprise if there 5X the amt. of cases, in which the case smells, looks & walks like “fraud” but since the carrier cannot provide absolute proof of “fraud”, then the benefits are ordered by the commission or court.
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How about creating laws that hold insurance providers criminally responsible for wrongfully denying and delaying the claims of injured workers?
After all, if people go to jail for filing false claims, shouldn’t claims examiners go to jail for stealling from the injured?
In response to R. Murphy: The penalties imposed by statute is the remedy applied for “wrongful denial” or ‘delay in payment” of benefits. Usually, wrongful denial or delay in payment results from either claims processing errors, or unintentional/mistake by the adjuster. Criminal sanctions (jail time)is not the appropriate penalty for “negligence”. On the other hand, “Fraud” requires a wrongful intent on the part of the perpetrator to obtain an undue benefit. it does not arise out of “mistake” when an employee files a fictitious claim or a doctor submits a bill for treatment not performed, or an attorney directs his client to go a certain doctor who intentional diagnoses an injury, when there is no evidence of an injury.
Why is the plaintiff bar bellyaching? We all know how difficult it is to prove fraud. Of the number of cases in which fraud is proven, I would’n’t be surprise if there 5X the amt. of cases, in which the case smells, looks & walks like “fraud” but since the carrier cannot provide absolute proof of “fraud”, then the benefits are ordered by the commission or court.