Steve Shockley doesnt like to see employees get money without working. Because of that, he spent 10 years helping investigators catch, and ultimately convict, a former employee for workers compensation fraud.
His persistence saved hundreds of thousands of dollars for the Ohio employers that pay the bills. It also brought the 54-year-old Gahanna business owner satisfaction.
Workers comp fraud is a costly problem throughout Ohio. In 1998 alone, about $80 million was lost to fraud committed by injured workers, lawyers and medical providers, according J.C. Benton of the Ohio Bureau of Workers Compensation. Heres what one Columbus area employer did to fight back.
Benefit of the doubt
For Shockley, who runs his familys business, S.L. Shockley & Sons Decorating Inc., a painting contractor with about $200,000 in annual sales, the story began in 1986. He hired James Hinerman Jr. as a painter, despite hearing negative reports about him from his previous employer. Shockleys practice: Unless someone harms you, you should give them a chance.
He says Hinermans job performance was fine, he was friendly and he didnt miss much work in his first years at S.L. Shockley & Sons.
In hindsight, however, Shockley realizes he missed the first signs of trouble. A few months after being hired, Hinerman started making workers comp claims for medical expenses from minor injuries, like getting solvent in his eye, but never told Shockley; Hinermans lawyer notified him by mail instead.
Shockley wasnt concerned about the claims because, over the years, the system has paid the bills of seven of his other employees for minor on-the-job injuries as well as for a more major one of his own.
I fell off a roof myself and collected medical expenses, he explains.
Besides, Shockley was busy running his 12-employee business, which specializes in painting new houses for custom builders, and didnt have time to investigate minor claims.
The real trouble started one Friday in July 1988 when Hinerman didnt show up for work. Shockley talked to Hinermans wife, who told him her husband was in jail for assaulting her and resisting arrest the night before. A week later, Hinermans lawyer sent Shockley a workers comp claim, which said Hinerman couldnt work because hed strained his neck lifting a door the day he was arrested. Shockley rejected the claim and started fighting back.
He testified against Hinerman several times and says he discovered the production line at hearings of lawyers and doctors working together to benefit themselves and employees like Hinerman. He was also very frustrated with an unresponsive bureau that started cracking down on fraud only in recent years.
Despite his frustration, Shockley didnt give up trying to prove that Hinerman wasnt disabled and could work. After all, Shockley says he treats his employees well, providing health insurance, paid vacations and holidays, and he expects them to be honorable in return.
The tip off
Eventually, Shockley started hearing, sometimes anonymously, from people who knew Hinerman and who said he was working delivering pizzas and even painting again. As Shockley readily acknowledges, this was all hearsay, secondhand information, but in his effort to get the truth out, he passed it on to the bureau.
Eventually, those tips paid off. The bureau discovered Hinerman working for a local painting business.
He was indicted in September 1997 on two counts of workers comp fraud and two counts of theft for submitting false wage statements. He was sentenced to 18 months in jail which was suspended plus five years probation and 120 hours of community service. In addition, Hinerman must pay back $23,183.98 to the bureau.
By helping to convict Hinerman, Shockley saved the system about $203,000 in potential losses. He also got the last word in July 1998, when the bureau asked him if hed rehire Hinerman. He said no. The outcome was very satisfying, one of the most satisfying experiences, Shockley says.
Shockleys advice to other employers is to be cautious about new hires and take the time, be persistent even though youre busy to investigate suspicious behavior.
The light should have come on when Hinerman went to a lawyer, Shockley admits.
As for the bureau, Shockley says it has made big improvements since 1988 and now does a damn good job controlling fraud.
Today, a 125-member Special Investigations Department at the bureau uses computer cross matches to identify potential fraud, according to bureau spokesperson Benton. Thats a far cry from the three bureau employees who were assigned to look for abuses statewide in 1993.
It had no investigators when the Hinerman situation surfaced in 1988, Benton says, because workers comp fraud wasnt considered a crime then.
In addition to extra staff dedicated to identifying and stopping cheats, fraud investigators also train claims representatives in regional offices to recognize the warning signs of fraud. Computer cross-match programs at the Ohio Bureau of Employment Services and the Ohio Department of Rehabilitation and Correction have also located hundreds of workers comp cheaters.
Since 1995, nearly $241 million in fraud has been identified and more than 230 people have been convicted on fraud-related charges a 99 percent success rate, according to the bureau.
Heres what you can do to fight fraud:
- Complete a detailed accident report each time an employee is injured.
- Carefully review the facts on the claim application.
- Compare emergency room records, if you have them, with injuries listed on the benefit application.
- Stay in touch with the injured worker and your bureau claims representative.
If you suspect an employee of fraud, call the bureaus hotline at (800) 644-6292. You dont have to give your name.
Richard Spencer (firstname.lastname@example.org) is a free-lance writer.