WC Fraud

[prplegal]

What is the name of your state? PA

I work with a woman who filed a wc comp claim for an injury she did not receive at work. I specifically remember her using pto time to visit the doctor a week prior to her claim for a shoulder injury she sustained lifting weights. She moved a few boxes at work and claims that is how she injured her shoulder.

Her claim was accepted and she was off of work for apprx 3 months for a torn rotator cuff. We work for a bank doing back office admin work.

I kept my mouth shut. I figured the HR dept would discover her fraud. They did not.

If I went to the HR dept with this information is there something that can be done?
Does the Whistler Blower policy come into play.

Or, did she just get a 2/3 paid vacation?

Thank you in advance.

 

[racincrazy]

If she saw her doc about it the week before I would think the IC would know about it. When I was injured I had to sign a form so the IC could get my past medical records. They talked to my regular health insurance company to see if I had any simular claims before. Besides laying in bed after isn't a very nice vacation. If you have no proof that she is committing fraud I wouldn't say anything. She may have a legit injury and you would make her life he!!. But if you have concrete irrefutable proof like a affidavit from her doc by all means go ahead.

 

[LSCAP]

I commend (I think?) your loyalty to a business that will fire you at the drop of a hat.

But, do you know all the facts.

Consider this. Suppose she really did injure it at work. On her own she tried to repair the damage. (weight lifting, which often helps, though I prefer straight exercise)

Then gave up and went to a doctor, who recommended treatment. She went back to work and gently tried to use her shoulder strength, and decided the pain would be too much. She would have to give up and have the treatment.

She then reported it as a new injury, as it would be too difficult to prove the original time of the injury.
If you report her, neither she nor the bank will appreciate the extra work involved in an otherwise simple insurance situation.

Especially if another co-worker appears who states, “ I remember when she hurt her shoulder. I told her to report it when it happened.”

A “whistle Blower” can be a good thing, if you are one hundred percent sure of your facts. Otherwise you are listed as a trouble maker and will be shunned by co-workers.

 

[prplegal]

wc fraud

Thank you for your replies.

I am 100% sure she injured her shoulder prior to the wc claim.

She confided in me that she was "working" the system to have the summer off.

I would have thought the IC would have requested prior records and found her recent appointment.

And to think "I'm" the one that struggled with the moral issue as to whether or not notify HR of my conversation with her.

Meanwhile, she's off again for a sickness and planning on "working" the system again to get the holidays off.

 

[LSCAP]

She would deny ever telling you anything. And you have no documented proof.

That is why I would hesitate.

People who "work the system" usually become ex-employees.

People who are trouble makers are usually fired.

My opinion.
The moral issue is do you have the right to get involved, and possibly get someone else fired.
and morally you are betraying a confidence.
And none of this is protected by "whistle blowing rules"