Defense Base Act Compensation Blog

The Modern Day DBA Casualty

Lying in DBA Claims is OK for the Attorney, Insurance Company, and the Employer as long as claimant does not die

Posted by defensebaseactcomp on July 3, 2010

All else is on the table

§ 931. Penalty for misrepresentation; prosecution of claims

(c) A person including, but not limited to, an employer, his duly authorized agent, or an employee of an insurance carrier who knowingly and willfully makes a false statement or representation for the purpose of reducing, denying, or terminating benefits to an injured employee, or his dependents pursuant to section 9 [33 USC § 909]if the injury results in death, shall be punished by a fine not to exceed $ 10,000, by imprisonment not to exceed five years, or by both.

8 Responses to “Lying in DBA Claims is OK for the Attorney, Insurance Company, and the Employer as long as claimant does not die”

  1. Vince said

    That’s just wrong. This is a loop hole that needs to be fixed.

  2. anonymousonpurpose said

    Hello again,

    Unfortunately no fines have ever been levied against these lawbreakers. The Government watchdogs in charge of these overseeing these “law breaking scum” have no desire in enforcing laws which these men and women routinely break.

    Why aren’t they being prosecuted?

    The law is blind…to lawyers that is…

  3. brit guy said

    Anybody recognize any of this and had it done to you ? Fraud I agree is not a matter of opinion as we would all be guilty.
    However to deliberately lie about a doctors prognosis and there recommendations to minimize a claim to advantage of the insurance company to reduce its liability well you judge.
    I.E.

    Adjusters statement
    As you are aware your doctor feels you will continue to heel without any further medical intervention so any future benefits for the medical portion of your claim will be minimal and reflect a compromised part of the settlement.

    Reply from the Doctor
    That is not what I said at all in fact I have made it clear in all my clinical letters and medical reports that in my profesional opinion you will require further surgical intervention at sometime in the future.

    Below is a definition of fraud.

    I am prepared to be judged by twelve good men (women) of true value.
    So am I trying to deceive and lie to obtain benefits to which I am not entitled or is the adjuster guilty of fraud?
    The jury is out I await your decision.

    http://legal-dictionary.thefreedictionary.com/fraud

    A false representation of a matter of fact—whether by words or by conduct, by false or misleading allegations, or by concealment of what should have been disclosed—that deceives and is intended to deceive another so that the individual will act upon it to her or his legal injury.

    Fraud is commonly understood as dishonesty calculated for advantage. A person who is dishonest may be called a fraud. In the U.S. legal system, fraud is a specific offence with certain features.

    Fraud must be proved by showing that the defendant’s actions involved five separate elements: (1) a false statement of a material fact,(2) knowledge on the part of the defendant that the statement is untrue, (3) intent on the part of the defendant to deceive the alleged victim, (4) justifiable reliance by the alleged victim on the statement, and (5) injury to the alleged victim as a result.

    These elements contain nuances that are not all easily proved. First, not all false statements are fraudulent. To be fraudulent, a false statement must relate to a material fact. It should also substantially affect a person’s decision to enter into a contract or pursue a certain course of action. A false statement of fact that does not bear on the disputed transaction will not be considered fraudulent.

    Second, the defendant must know that the statement is untrue. A statement of fact that is simply mistaken is not fraudulent. To be fraudulent, a false statement must be made with intent to deceive the victim. This is perhaps the easiest element to prove, once falsity and materiality are proved, because most material false statements are designed to mislead.

    Third, the false statement must be made with the intent to deprive the victim of some legal right.

    Fourth, the victim’s reliance on the false statement must be reasonable. Reliance on a patently absurd false statement generally will not give rise to fraud; however, people who are especially gullible, superstitious, or ignorant or who are illiterate may recover damages for fraud if the defendant knew and took advantage of their condition.

    Finally, the false statement must cause the victim some injury that leaves her or him in a worse position than she or he was in before the fraud.

    Injury means loss and does not need to be physical but can be financial.

  4. Superman said

    Lying lawyers??? Hum what a surprise!!!

    The law firms up in San Francisco have been doing this from the beginning. This is to include the “Top Dog” up there. But trust me as soon as they know they have a looser of a case they will drop it like a hot potatoes. If they know they have a looser they will make up anything crazy to drop the case. One such case we have heard about is the Law Firm of “L” when the prosecution spanked them badly, they claimed the claimant called and threatened their law firm. When asked details, they claimed, “we received a call from someone who did not leave their name, we think it’s your client”. Please give me a break. Like they only have one enemy??? That law firm is a co-conspirator of the insurance fraud being committed. And I know there are a few cases out there now that will set precedence.

    Just look at the case from the worker from
    Scott A Ruby vs. Shaw Group Case No. 2008 LDA 00271 OWCP No. 02-141295
    http://www.oalj.dol.gov/DMSSEARCH2/SEARCHRESULTS.jsp

    A simple back injury case, He hurt his back playing “Basketball”, they settled for $250k plus $3k for 20 years. And now he’s back to work.

    Hum therefore if you have serious injuries like PTSD or TBI or lost a leg or arm all due to direct enemy confrontation and are now totally disabled for life? Does that mean these cases are worth $4-6 million? Maybe more? Probably more? Definitely more!

    But CNA continues to drag their feet not treating and denying claims. They continue to claim the Contractor was “Never in Danger”. No problem, just submit some photos or videos that everyone has that will shut them up on that argument.

    CNA and their Co-Conspiriting lawyers are nothing less than an “Enemy to the State”.

    • defensebaseactcomp said

      http://www.oalj.dol.gov/Decisions/ALJ/LDA/2008/SR_v_THE_SHAW_GROUP_2008LDA00271_(JAN_08_2009)_101040_CADEC_SD.PDF

    • ClaimsAdjuster said

      When I got into the profession I had heard about this claim and ironically enough it was discussed in a class that I took. I was intrigued by it whereas I did some more research on it and here is what I had found out.

      Point #1: Mr. Ruby was not hurt from any enemy contact which is true but while going through his rehab the company he was working for had released him in an effort to downsize but within one month hired approximately 8 more employees for the same position he was in but at a cheaper cost. Unfortunately the company had not followed the correct procedure whereas they were to keep him employed for one year at his current pay rate but in a job that he was capable of doing. Upon reading different reports, he was not authorized / cleared by the doctors to whom he was told to see by The Shaw Group to do any heavy lifting which in watching the news and seeing what the men over there were wearing on a daily basis exceeded the maximum weight allowance he was to carry.

      Point #2: By the report he was playing basketball but as it turned out this was a mandatory team building exercise that all security members of his outfit were to be at whereas if it was not mandatory there is no way of knowing if he would have been present.

      Point #3: While additional testing was going on for his injury, AIG determined that Mr. Ruby’s benefits were to stop since he was released from The Shaw Group which was a NO NO. Mr. Ruby went through over three years of testing, evaluation and rehab at the hands of the doctors set forth by The Shaw Group and AIG whereas in Point #1 they did not clear him to perform the same type of job he was working at when he was injured. In doing so, Mr. Ruby was not able to make the type of money he was earning while he was employed by The Shaw Group.

      Point #4: Even though it seems unfair on the amount of money they two parties settled on but in honesty Mr. Ruby could have gotten more. The $250K was for the amount of back pay owe to him while he was going through the testing and such after AIG stopped his benefits and the $3k thereafter is to make up for the difference in pay he loses from here on out on a monthly basis.

      Mr. Ruby is an example of a person who does not let the insurance companies rule the outcome rather defends what is rightfully his. I hope this does not get your blood boiling Superman but rather shed some light on the example you wish people to read.

  5. Superman said

    http://go2.wordpress.com/?id=725X1342&site=defensebaseactcomp.wordpress.com&url=http%3A%2F%2Fwww.oalj.dol.gov%2FDecisions%2FALJ%2FLDA%2F2008%2FSR_v_THE_SHAW_GROUP_2008LDA00271_(JAN_08_2009)_101040_CADEC_SD.PDF

    take a look at this

  6. brit guy said

    I am afraid to say this just goes to prove my point in an earlier post. Any claim not involving any enemy or insurgent action the insurers are desperate to get out of. There is no money in it for the money grabbing scum it is lose, lose, lose as they cannot go running to the Dept of Defense please sir can I have my money back oh and do not forget the 15% admin fee.

    Those of us injured by an insurgent attack are fair game for the money grabbing scum and the cowardly scum that represent them. The longer they drag it out the more pain they inflict the higher the cost the more money they make at our expense whether it is financial or physical regardless of the medical evidence.

    What is even more staggering is that the US government condones this action and does nothing to stop this abuse.

    So a message to you Obama and your administration.

    STOP LECTURING THE WORLD ON HUMAN RIGHTS AND TELLING OTHER PEOPLE WHAT TO DO WHEN YOU ALLOW THIS TO GO ON IN YOUR OWN BACK YARD.

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