When Being a Good Neighbor Leads to Workers’ Comp Fraud

I had an injured worker call my office a few weeks ago, we will call him Mike. Mike was a very nice man who was genuinely injured at work and looking for help.

• What Mike’s story will teach you:
  • It is YOUR responsibility to follow the doctor’s orders
  • You must ALWAYS follow your doctor’s restrictions – even at home
  • Violating doctor’s orders can have serious consequences
  • Even when you want to help someone, you must protect yourself
  • Workers compensation fraud is a very serious matter

As we got to talking, Mike told me that he worked at a local retail store and a forklift smashed his left hand when he was unloading some product – OUCH!!!!

After his injury, Mike’s doctor had placed him on Light-Duty work with the limitation that he was not to use his left hand.

Mike’s employer could not accommodate his restricted duty status of no use of his left hand so Mike was to remain off of work for the time being. As Mike continued to talk he told me about his neighbor and friend John.

John’s family was in need of a new water heater and John did not know how to properly install it, so he asked his buddy Mike for assistance.   Mike and John had been friends for several years and had helped each other with things like this in the past, as neighbors often do.  However, Mike resisted helping John for several days because of his restricted duty status (remember, the workers compensation doctor said Mike was not able to use his left hand) but eventually John wore him down and Mike felt bad about his neighbor’s family going without hot water so Mike gave in and helped John with his home improvement project.

Later in the week, John went into the retail store where Mike worked to get some supplies and mentioned to one of the other employees that Mike had recently helped him install a new water heater in his home. Word got around the store and eventually, the supervisors at the store were made aware of the situation.  It sounded to the supervisor like Mike was fine and should have been back to work at the store instead of off of work collecting a workers comp check.  Mike was fired and now he not only faces losing his workers’ compensation benefits (his lost wage pay AND coverage for his medical care) but now Mike could be forced to pay back anything he has already collected, not to mention the possibility of criminal charges!

When I spoke with Mike he insisted that he did not use his left hand and therefore did not violate his doctor’s restrictions; while I would like to believe him, I am afraid it will be very hard to convince the Commission that this is the case.  This would be an argument that would EXTREMELY difficult to prove!

The moral of the story:

ALWAYS FOLLOW YOUR DOCTOR’S ORDERS, EVEN IF YOU ARE NOT AT WORK. Don’t even put yourself in a position where your actions could be called into question because, in the end, it is injured workers’ and their families who suffer the consequences.