Inside Pool Mag: Fraud
- Thread starter Black-Balled
- Start date
..... Deleted, not even worth it.
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I agree. My reply was in regards to the movie "Sicko" directed by the far, left wing liberal Michael Moore, who would not know the truth if it smacked him in the face. Just not exactly the guy you want backing up the posters argument.
Heck, I don't want anyone to sit by. I put out the Fraud Hotline and Fraud TEXT number so folks could report fraud a few posts back ! Call now and report a fraudster today and you could be rewarded with CASH...
So when I see someone steal your car, I won't stick my nose in your business and I will make the world a better place. Right?
If this guy is legit, nothing will happen to him. He will be checked out and he will continue to receive his W/C. No one says you have to be dead to receive W/C.
If this guy is collecting W/C and not disabled, he is taking money out of your pocket just like a guy stealing your car.
You just don't get it, do you?
LOL Rich R.
Disability is an issue that is fraught with circumstance. There are many people who appear to be healthy but have debilitating problems that will not let them perform a normal 40-hour a week job. I do not think that those who defraud the system are anything less than criminals. I do think that people who have no information outside a magazine article should keep their uninformed opinions to themselves. I have not read the article in question, nor do I know who the player is. I don't like to see anyone blasted without all the facts in place, and I seriously doubt that any employer pays a disabled employee $5000 a month out of his own pocket. If you really think this individual is receiving benefits unjustly, then do what you have already done, (rat him out) but to the proper authorities. Otherwise, MYOB.
Excellent points...mostly :duck:
Many employers do pay lost wages. Insurance company writes the checks but employer has to keep the account funded...
Self-insured companies pay the lost wages 100%, up to a certain amount. There are criteria to be met as far as company size, so most self-insureds are nationwide/worldwide (think Wal-Mart, Fedex, US Air, etc.).
Instead of paying high premiums to an insurance company, they hold that money (could be anywhere from $1,000,000 up) in a seperate account to cover most situations (and they tap into that fund for other things as well). Once they hit that $1,000,000 mark during the fiscal year, the insurance company kicks on, and thier low premiums will slowly start getting higher.
The real scary part is that because they are self-insured, they have a greater amount of control over how the claim proceeds.
Instead of paying high premiums to an insurance company, they hold that money (could be anywhere from $1,000,000 up) in a seperate account to cover most situations (and they tap into that fund for other things as well). Once they hit that $1,000,000 mark during the fiscal year, the insurance company kicks on, and thier low premiums will slowly start getting higher.
The real scary part is that because they are self-insured, they have a greater amount of control over how the claim proceeds.
Sort of...but they still must operate within the context of their WC provisions...and it behooves both employer and injured worker to know the law.
"Sort of...but they still must operate within the context of their WC provisions...and it behooves both employer and injured worker to know the law."
Even though they're required to operate within those provisions, they don't. If they have 30 days to send out an appeal, you can bet they will wait until the 30th day. Sometimes they will postmark the envelope with the 30th day and hold off on mailing it for another week. It simply buys them more time.
Here's an interesting read pertaining to some of the things insurance companies and thier attorneys will do to delay benefits :
http://www.workerscompensationinsur...621-Internal-Memos-Insurance-Training-Seminar
And they don't select the "fakers". They do this to everyone.
Insurance companies are about saving money. Lawyers are about saving thier clients money. Employers are about saving money. For everyone involved, save for the injured worker, it's about money. The truly injured worker justs wants to get better. And they have to put up with the antics in the link above.
Sad state of affairs when an inmate can get better medical treatment than an injured worker.
Even though they're required to operate within those provisions, they don't. If they have 30 days to send out an appeal, you can bet they will wait until the 30th day. Sometimes they will postmark the envelope with the 30th day and hold off on mailing it for another week. It simply buys them more time.
Here's an interesting read pertaining to some of the things insurance companies and thier attorneys will do to delay benefits :
http://www.workerscompensationinsur...621-Internal-Memos-Insurance-Training-Seminar
And they don't select the "fakers". They do this to everyone.
Insurance companies are about saving money. Lawyers are about saving thier clients money. Employers are about saving money. For everyone involved, save for the injured worker, it's about money. The truly injured worker justs wants to get better. And they have to put up with the antics in the link above.
Sad state of affairs when an inmate can get better medical treatment than an injured worker.
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IMO Playing pool is not like working 40 hrs. A lot of people can play
pool when they feel good enough to do so, does not mean they can hold a job. Shame on Inside Pool. I am canceling my subscription. Not killing
the messenger. I admit it was in bad taste for BB, but I make bad decisions too .
pool when they feel good enough to do so, does not mean they can hold a job. Shame on Inside Pool. I am canceling my subscription. Not killing
the messenger. I admit it was in bad taste for BB, but I make bad decisions too .
Oh I get it quite plain. Tell me this, do you or the other self rightious in this thread claim your gambling winnings to the IRS on your taxes? No different is it, maybe someone should stick their nose in all the betting going on in here. Be a different tune to the jukebox if that was the case, but it is no different then what the high and mighty are on a horse about this guy, with no proof but a bunch of assuming gossip.
Worry about yourselve's and not someone else.
Do you know this guy personally?
Do you know for a fact that he can work and isn't?
Are you just jealous?
What is it, because inquiring minds want to know?
Many people are off work for all sorts of reasons yet still physically capable of playing and winning a pool tournament. What kind of glass house do you live in?
Careful of where you throw stones.
"Appears to be on the correct side of the law, no?"
And there are people that will back-date the car payment check so it appears that the post office screwed up. It's not supposed to happen, but it does. All the time.
"That is a foolish practice and you can bet neither I nor my carrier would risk the Commission's eye for what little time it would buy."
The more time delaying things buys, the more chance an injured worker will give up. I'm sure most business owners would say the same as you, and I'm not trying to imply that you or any other business owner who is NOT self-insured would do that, either. But you can bet the insurance company will. And if you think they're going to tell you that's what they did, you're only fooling yourself.
Plausible deniability. Your employee wants to know what's going on with thier benefits check, and you can honestly tell them that you've been informed by the insurance company it's been mailed out.
"Everyone must be treated equally-and legally- nio?"
True, everyone should be treated equally. But that's not always the case.
"I believe that is true in most cases"
In most cases, yes. Ask any injured worker. Most just want to get back to the way things were before the injury. But at the same time, there are people that fully recover from thier injury, but don't want to return to work (malingerers). So they begin to develop symptoms that in some cases have something to do with the original injury, in an effort to continue receiving replacement wages.
Don't misunderstand. "Injured workers" and "recovered workers' make up about 5% of insurance / WC fraud. And a worker found guilty of fraud should be prosecuted to the fullest extent possible.
But it's not just the insurance companies and employers that are contributing to the remaining 95%. The physicians are just as guilty.
This one company did an experiment (and I'll be darned if I can remember where to find the link) with doctors, WC and non-work injuries. If I can find the link I'll post it.
They sent two men of the same age, same build, same weight, and the same type of occupation to a doctor's office. Both men were given copies of the EXACT SAME X-Ray. The difference was that one man would tell the doctor that he injured himself at home. The second man would tell the doctor he was injured on-the-job.
The first man was written a prescription for Ibuprofen, given instructions on the timely use of a cold pack, and sent on his way. Call us if your conditions gets any worse.
The second man ? He was prescribed Vicodin, sent for an MRI, and pulled out of work for the next four weeks. Weekly follow-ups with the doctor were ordered to "continue to check on his condition and how he responds to meds."
Why send someone for a $1500 MRI when a $40 x-ray will tell the same thing, as evident by the experiment above ?
Money. Money. Money.
And the truly injured worker is the one "screwing the system" ?
And there are people that will back-date the car payment check so it appears that the post office screwed up. It's not supposed to happen, but it does. All the time.
"That is a foolish practice and you can bet neither I nor my carrier would risk the Commission's eye for what little time it would buy."
The more time delaying things buys, the more chance an injured worker will give up. I'm sure most business owners would say the same as you, and I'm not trying to imply that you or any other business owner who is NOT self-insured would do that, either. But you can bet the insurance company will. And if you think they're going to tell you that's what they did, you're only fooling yourself.
Plausible deniability. Your employee wants to know what's going on with thier benefits check, and you can honestly tell them that you've been informed by the insurance company it's been mailed out.
"Everyone must be treated equally-and legally- nio?"
True, everyone should be treated equally. But that's not always the case.
"I believe that is true in most cases"
In most cases, yes. Ask any injured worker. Most just want to get back to the way things were before the injury. But at the same time, there are people that fully recover from thier injury, but don't want to return to work (malingerers). So they begin to develop symptoms that in some cases have something to do with the original injury, in an effort to continue receiving replacement wages.
Don't misunderstand. "Injured workers" and "recovered workers' make up about 5% of insurance / WC fraud. And a worker found guilty of fraud should be prosecuted to the fullest extent possible.
But it's not just the insurance companies and employers that are contributing to the remaining 95%. The physicians are just as guilty.
This one company did an experiment (and I'll be darned if I can remember where to find the link) with doctors, WC and non-work injuries. If I can find the link I'll post it.
They sent two men of the same age, same build, same weight, and the same type of occupation to a doctor's office. Both men were given copies of the EXACT SAME X-Ray. The difference was that one man would tell the doctor that he injured himself at home. The second man would tell the doctor he was injured on-the-job.
The first man was written a prescription for Ibuprofen, given instructions on the timely use of a cold pack, and sent on his way. Call us if your conditions gets any worse.
The second man ? He was prescribed Vicodin, sent for an MRI, and pulled out of work for the next four weeks. Weekly follow-ups with the doctor were ordered to "continue to check on his condition and how he responds to meds."
Why send someone for a $1500 MRI when a $40 x-ray will tell the same thing, as evident by the experiment above ?
Money. Money. Money.
And the truly injured worker is the one "screwing the system" ?
Here is another WC story and how they can treat you...
I was helping one of our so called "lineman" set a pole one morning at work. I had just started with this crew so I assumed he knew what he was doing. WRONG! He starts jerking the boom while I'm on the butt of the pole with my rubber gloves on trying to keep the pole top out of hot phases above my head. He got so bad he threw me into the truck with the pole top almost smashing my hand between the pole and truck.
At this point I'm in survival mode and get the butt out from under the truck and as I do I slip in a ditch and the pole top comes with me, pinning my left ankle under the pole. I start feeling the pain of a 2,500lbs. 50 foot pole and scream to him to "boom left" to get the pole off my ankle. Instead of booming left he lays the boom straight down and at this point the pole is STANDING straight up on the inside part of my left ankle. If I didnt wear my 16" high climbing boots everyday the doctors said I wouldnt have had my foot today.
So after the grunt runs over to grab the pole butt I hobble up the ditch and sit in the road in front of the truck and pick myself up with the winch and big metal bumpers we use. From there I do everything by the book. Call the foreman, report it, he immediately calls our Area Manager and he tells my foreman to write me up for not wearing steel toes (at the time they were NOT mandatory) and he asked every member on the crew did they have on steel toes and they said no. So I was wrote up so they could try to get out of paying my comp claim even though I had no idea what workers comp was at the time. We go to the E.R. where my forearm just drops me out at the sliding doors (mind you I still couldnt put weight on my left foot) and I try to hop with 10lbs. of boots on. Luckily a woman sees me and runs out with a wheelchair.
The initial diagnosis was strained tendons/ligaments in my ankle/foot and they splint me for the weekend. If I wasnt better by the next Monday (this was our last day of work as we worked 4/10's) I was told to go to the orthopedic doctor. Monday comes and I go. Still in major pain and he puts me on light duty and puts a walking cast on up to my knee. Well in linework there is no "light duty" and they tell me to stay home. Monday my boss calls and asks how come I didnt come to work and I told him why. He tries to raise his voice to me and back then I was a 23 year old hot/hardheaded man and I rip him a new one over the phone. I knew he hated cussing so I cussed him out. He said since I was at my friends house that I could come to work. Like most normal human beings I drove my Dodge Quad Cab 4x4 automatic with just my right foot so I didnt have to use my left foot. He tells me then that I "looked ok" when I left after the E.R. the day of my injury. I then cuss some more and tell him I left in a splint and crutches you idiot. I continue to cuss more and then hang up on him.
Well that same week a woman comes to my parents house (I worked on the road so I never bought a home as it would be useless) and I answer the door with my cast on. The woman then tries to interrogate me and asked me repeatedly if I was working somewhere else. I finally had to tell her off and to talk to my lawyer as I wasnt putting up with this crap anymore. She then asks about me working elsewhere before I shut the door in her face. She was there for an insurance company I cant really say as in my final settlement I was told I couldnt bad mouth them but they are a large insurance company.
During this time I walked a good bit to see my little nephew play teeball, etc. but never overdone it. I was on permanent light duty until noted otherwise so I'm at home making 70% (or close) of my check a week from the insurance company. Even though we were working in Alabama, the branch my powerline contractor was out of was Douglasville Georgia so I had to go by Georgia rules on WC. 70% check and the lawyer could get 25% of my check instead of 10% less on both if it was under Alabama law. To say the insurance company gave me a run around they did for over 2 years. They would wait until the last minute to pay my bills (to the point where they would almost file it on my credit), and even one day turning down my meds and trying to make me pay $300 for them. My lawyer was out of Atlanta and I thought I had a good one until he starts telling me he knew the insurance companies lawyers (they were out of Atlanta too) and he told me I'd get fixed up and make about $7,500 off of it. So I start asking around and people are telling me he's screwing me. After some more calls and he doesnt help me in crunch time I dump him and pick up a lawyer in very very South Georgia. He was your typical shyster lawyer and was even in trouble and temp disbarred for mismanaging funds which I asked him about and he told me the truth about it. I tell him whats going on and he goes after the insurance company like a pitbull because he wants some money.
So now I'm happy that I have a lawyer I trust and I finally found a doctor I liked (dont let them tell you that you can only see one doc as I seen about 6) and the only thing I hated was the walking cast. I did go out and would play golf and even though I'm a Southpaw I played golf right handed so I could put all my weight on my back foot and could swing a club as the cast stopped me from twisting my foot. After awhile though I could tell my ligaments would strain easily as it would have my left foot throbbing and I would quit playing then. That was the only hobby I could still do being that limited. Pool I couldnt play as it messed with my stance.
Halfway through that 2nd year they determined I damaged all the nerves in my ankle/foot and it was NOT fixable. So we decide to set up mediation to settle the suit and get it over with. We settle in mediation in Columbus Georgia for $54k and my lawyer got like $12k or so as I dont feel like doing the math. But it still shows you that someone on workers comp can STILL do things. I could only work on light duty and we didnt have light duty. You cant be on a linecrew with no boots on. So I was told to go home. The same could apply to this guy that won money in that tourney.
Sadly enough now I'm on permanent disability and my Neurosurgeon thinks my disease will NOT progress from where it is now. My spine swells everyday and I'm in intense pain 24/7/365. I still play pool, but can only play for so long before the back pain is too bad I cant go further. There are members on this board that I played on an APA league team with that can tell you by looking at me if I was hurting bad or not. One member on this board hosted me every Wednesday and he could tell you the same, and he could tell when I had my bad days or good days. Most shots on the table if there are no balls on the table I'll lay down on it to try and keep the pressure off my back. Its the only hobby I have left. I cant play golf anymore, can throw the baseball with the nephew every now and then (very short), cant swing a bat or run or pick up anything over 5lbs. or I risk paralyzing myself. But I'm lucky to shoot twice a month if I'm that lucky. It takes an OxycontinIR just to get me out of bed just to function. Muscle relaxers out the ying yang as well. I know there are others worse than me that play and I dont say "well he's cheating the system" because I dont know what he goes through like he doesnt with me. So I wouldnt be so quick to judge the guy until I found out what he has wrong with him.
I was helping one of our so called "lineman" set a pole one morning at work. I had just started with this crew so I assumed he knew what he was doing. WRONG! He starts jerking the boom while I'm on the butt of the pole with my rubber gloves on trying to keep the pole top out of hot phases above my head. He got so bad he threw me into the truck with the pole top almost smashing my hand between the pole and truck.
At this point I'm in survival mode and get the butt out from under the truck and as I do I slip in a ditch and the pole top comes with me, pinning my left ankle under the pole. I start feeling the pain of a 2,500lbs. 50 foot pole and scream to him to "boom left" to get the pole off my ankle. Instead of booming left he lays the boom straight down and at this point the pole is STANDING straight up on the inside part of my left ankle. If I didnt wear my 16" high climbing boots everyday the doctors said I wouldnt have had my foot today.
So after the grunt runs over to grab the pole butt I hobble up the ditch and sit in the road in front of the truck and pick myself up with the winch and big metal bumpers we use. From there I do everything by the book. Call the foreman, report it, he immediately calls our Area Manager and he tells my foreman to write me up for not wearing steel toes (at the time they were NOT mandatory) and he asked every member on the crew did they have on steel toes and they said no. So I was wrote up so they could try to get out of paying my comp claim even though I had no idea what workers comp was at the time. We go to the E.R. where my forearm just drops me out at the sliding doors (mind you I still couldnt put weight on my left foot) and I try to hop with 10lbs. of boots on. Luckily a woman sees me and runs out with a wheelchair.
The initial diagnosis was strained tendons/ligaments in my ankle/foot and they splint me for the weekend. If I wasnt better by the next Monday (this was our last day of work as we worked 4/10's) I was told to go to the orthopedic doctor. Monday comes and I go. Still in major pain and he puts me on light duty and puts a walking cast on up to my knee. Well in linework there is no "light duty" and they tell me to stay home. Monday my boss calls and asks how come I didnt come to work and I told him why. He tries to raise his voice to me and back then I was a 23 year old hot/hardheaded man and I rip him a new one over the phone. I knew he hated cussing so I cussed him out. He said since I was at my friends house that I could come to work. Like most normal human beings I drove my Dodge Quad Cab 4x4 automatic with just my right foot so I didnt have to use my left foot. He tells me then that I "looked ok" when I left after the E.R. the day of my injury. I then cuss some more and tell him I left in a splint and crutches you idiot. I continue to cuss more and then hang up on him.
Well that same week a woman comes to my parents house (I worked on the road so I never bought a home as it would be useless) and I answer the door with my cast on. The woman then tries to interrogate me and asked me repeatedly if I was working somewhere else. I finally had to tell her off and to talk to my lawyer as I wasnt putting up with this crap anymore. She then asks about me working elsewhere before I shut the door in her face. She was there for an insurance company I cant really say as in my final settlement I was told I couldnt bad mouth them but they are a large insurance company.
During this time I walked a good bit to see my little nephew play teeball, etc. but never overdone it. I was on permanent light duty until noted otherwise so I'm at home making 70% (or close) of my check a week from the insurance company. Even though we were working in Alabama, the branch my powerline contractor was out of was Douglasville Georgia so I had to go by Georgia rules on WC. 70% check and the lawyer could get 25% of my check instead of 10% less on both if it was under Alabama law. To say the insurance company gave me a run around they did for over 2 years. They would wait until the last minute to pay my bills (to the point where they would almost file it on my credit), and even one day turning down my meds and trying to make me pay $300 for them. My lawyer was out of Atlanta and I thought I had a good one until he starts telling me he knew the insurance companies lawyers (they were out of Atlanta too) and he told me I'd get fixed up and make about $7,500 off of it. So I start asking around and people are telling me he's screwing me. After some more calls and he doesnt help me in crunch time I dump him and pick up a lawyer in very very South Georgia. He was your typical shyster lawyer and was even in trouble and temp disbarred for mismanaging funds which I asked him about and he told me the truth about it. I tell him whats going on and he goes after the insurance company like a pitbull because he wants some money.
So now I'm happy that I have a lawyer I trust and I finally found a doctor I liked (dont let them tell you that you can only see one doc as I seen about 6) and the only thing I hated was the walking cast. I did go out and would play golf and even though I'm a Southpaw I played golf right handed so I could put all my weight on my back foot and could swing a club as the cast stopped me from twisting my foot. After awhile though I could tell my ligaments would strain easily as it would have my left foot throbbing and I would quit playing then. That was the only hobby I could still do being that limited. Pool I couldnt play as it messed with my stance.
Halfway through that 2nd year they determined I damaged all the nerves in my ankle/foot and it was NOT fixable. So we decide to set up mediation to settle the suit and get it over with. We settle in mediation in Columbus Georgia for $54k and my lawyer got like $12k or so as I dont feel like doing the math. But it still shows you that someone on workers comp can STILL do things. I could only work on light duty and we didnt have light duty. You cant be on a linecrew with no boots on. So I was told to go home. The same could apply to this guy that won money in that tourney.
Sadly enough now I'm on permanent disability and my Neurosurgeon thinks my disease will NOT progress from where it is now. My spine swells everyday and I'm in intense pain 24/7/365. I still play pool, but can only play for so long before the back pain is too bad I cant go further. There are members on this board that I played on an APA league team with that can tell you by looking at me if I was hurting bad or not. One member on this board hosted me every Wednesday and he could tell you the same, and he could tell when I had my bad days or good days. Most shots on the table if there are no balls on the table I'll lay down on it to try and keep the pressure off my back. Its the only hobby I have left. I cant play golf anymore, can throw the baseball with the nephew every now and then (very short), cant swing a bat or run or pick up anything over 5lbs. or I risk paralyzing myself. But I'm lucky to shoot twice a month if I'm that lucky. It takes an OxycontinIR just to get me out of bed just to function. Muscle relaxers out the ying yang as well. I know there are others worse than me that play and I dont say "well he's cheating the system" because I dont know what he goes through like he doesnt with me. So I wouldnt be so quick to judge the guy until I found out what he has wrong with him.
I'd rather be at work than sitting at home everyday. I made a helluva lot more money working than I do on disability now. After my comp claim I did go back to work for another company as part of my settlement I had to resign which I did. But 2 years later I didnt know I would get a rare spinal disease that would put me out for good.
The most outrageous and out of line investigation about workers compensation. I don't disagree that they check over their work but to do it on the day of a memorial service is distasteful and grounds for firing someone.
NYC took a first responder body back to the morgue for investigation before the memorial service. The mayor approved it too. He was a former city police officer.
NYC took a first responder body back to the morgue for investigation before the memorial service. The mayor approved it too. He was a former city police officer.
like i posted earlier i have been playing pool while on workwes comp also. i had a 2'' forstner drill bit go into my arm cutting 2 nerves, bruising several others and cut 2 tendons also . had surgery to repair what they could. dr said no work for 6 months. i had no problem with my employers ins paying every thing. they started sending me workers comp checks 2 weeks after i got hurt.
after 3 months dr put me in physical therapy 2 times a week . 3 months later he put me on light duty but my employer would not put me to work, said he had no light duty work. dr had put me on 5 lb weight limit.
during this same time i started back playing pool although i had pain and could only wrap 2 fingers around a cue. was even playing on a league team with my employer during this time. he didnt have an issue with it, he knew i was injured and not able to perform my job at this time. he told me he was not going to put me back to work until the dr released me.
dr just released me 2 weeks ago and diagnosed me with 39% disability in my right forearm and hand. part of my hand and arm has no feeling and the rest hurts constantly, especially during changes in the weather.
looking at me you wouldnt think im disabled unless i try to use my right hand. i have very limited mobility in my fingers, hell i cant even hold an inkpen to write my name but i can hold a pool stick with 2 fingers.
after 3 months dr put me in physical therapy 2 times a week . 3 months later he put me on light duty but my employer would not put me to work, said he had no light duty work. dr had put me on 5 lb weight limit.
during this same time i started back playing pool although i had pain and could only wrap 2 fingers around a cue. was even playing on a league team with my employer during this time. he didnt have an issue with it, he knew i was injured and not able to perform my job at this time. he told me he was not going to put me back to work until the dr released me.
dr just released me 2 weeks ago and diagnosed me with 39% disability in my right forearm and hand. part of my hand and arm has no feeling and the rest hurts constantly, especially during changes in the weather.
looking at me you wouldnt think im disabled unless i try to use my right hand. i have very limited mobility in my fingers, hell i cant even hold an inkpen to write my name but i can hold a pool stick with 2 fingers.