Ethics Case Discussion

[scott]

I offer the following, purely hypothetical case, for discussion"¦

A friend's wife works for one of your clients. She was injured on the job and is collecting workers' compensation. On a visit to your friend's home you learn that she is now 100% healed. She tells you her doctor says she is OK to work but has agreed to provide her with a note that says she should stay out of work for another 6 months. She admits that she is working the system as she likes staying home.

What do you do?

[independent guy]

Are we to assume we're the agent for the worker's comp policy?


Either way, its fraud. Both the woman and her doctor should be busted for it. Even if the husband was my friend, he wouldn't be for long if he tolerated a marriage to that kind of loser.

[etimer]

Unless you are the agent of reord, you tell her it is wrong and drop it. Look at it this way, like my friends that are police say, "you can't be on the job 24 hours a day." Now if we were Hitler Youth in 1930, we would be telling on our friends and family.

Personally I don't have friends that would behave in such manner so I don't really need to worry.

I offer the following, purely hypothetical case, for discussion"¦

A friend's wife works for one of your clients. She was injured on the job and is collecting workers' compensation. On a visit to your friend's home you learn that she is now 100% healed. She tells you her doctor says she is OK to work but has agreed to provide her with a note that says she should stay out of work for another 6 months. She admits that she is working the system as she likes staying home.

What do you do?

[Big Dog]

She needs to be aware of the potential risk she is taking. If the insurance carrier suspects anything, and they start investigating, she needs to be aware of both the potential monitary fines, along with jail time.

Workers comp carriers do have SIU's - special investigation units - who's only purpose is to investigate potential fraud. Do they really want to wind up on 60 Minutes?

Recommend she do the right thing, and get the doctor to amend the note to reflect she can go back to work.

[JSJAG]

So if you catch your son smoking pot, instead of telling him not to do it..........you would call the police and send him off to face jail?

As a friend it is up to you to warn her of the perils but I really don't think it is up to you to fink to the government. If that is how we as a society are headed...it is a world I don't want to have any part of. There are enough laws on the books that we could spend our time feeding our friends and neighbors to the government. We will have a life not trusting our neighbors, friends, etc. Hey neighbor of 20 years, I saw you painting that wall without a permit, I'm telling on you!

Leave it up to the professionals to catch her, you are a friend not a spy. But then again maybe not?

How does that go, let him without sin cast the first stone?

Are we to assume we're the agent for the worker's comp policy?


Either way, its fraud. Both the woman and her doctor should be busted for it. Even if the husband was my friend, he wouldn't be for long if he tolerated a marriage to that kind of loser.

[independent guy]

^ Alright, maybe I wouldn't report her, but I doubt they'd be my friends anymore as I wouldn't have any respect for them anymore. All of my friends have a very healthy (and respectable) work ethic.

But what can you do in this situation? How can you address it and get this woman to do the respectable and honorable thing? And what about the doctor?

[CATHIEA]

The original post was your friend works for your client. The choice here is do you protect your client or your friend? I certainly would not want to be the agent who is explaining to the judge at the DOI hearing why I didn't make that call to my carrier.

[scott]

Assume you are the agent on the wc policy.

Does this change anyone's answer?

[brokerdave]

Very interesting responses so far. One thing that you folks need to realize is that your friend's wife is jeapordizing your livelihood!

A friend's wife works for one of your clients. She tells you her doctor says she is OK to work but has agreed to provide her with a note that says she should stay out of work for another 6 months. She admits that she is working the system as she likes staying home.

You are the Agent and she is a claimant a policy that you placed. She has admitted to you that she is committing Insurance Fraud.

Let's say that you look the other way. She gets busted and tells investigators that she told you all about it. By saying/doing nothing, you have become complicit in Insurance Fraud. At the least, your appointment with the Carrier involved is gone. More likely, your State yanks your license and you're out of the Insurance business for good.

I don't know about you, but I have no friends that I'll jeapordize my family's well being for.

I'd advise her of the issues and let her know that I'm going to monitor her claim. If she persists in committing Insurance Fraud, I will turn her in...period!

A) It's just plane wrong B) NOBODY messes with my family!

[Dilbert]

My ethics depend on whether or not the woman is my ex-wife....it does sound like her....

[volstrike3]

Luckily I don't have friends like that. I would have to turn it in. No question about it.

[pita3333]

Clients employee makes it CRYSTAL clear...you have to protect both your client and your license! Could do the reporting annony...

Now if not a clients employee...things get a bit stickier there...talk about your moral dilemma!

Bottom line from my perspective...if not a client, no longer a friend. I have a next door neighbor and in the past a good friend who were/are honestly injured. The hoops they have to jump for legitimate severe claims are insane...I have no sympathy for someone who purposely defrauds!

[jackweho]

Back to the legal vs. ethical discussion of a few weeks ago (regarding leaving an agency and contacting that agency's clients)
This time it is the opposite. It is illegal; she is commiting fraud against the carrier and her employer. The carrier pays out and the employer's rates go up. Cut and dry!
Your license is toast if it comes out that you knew and did not notify the carrier and the DOI; sounds like this woman would be the type to say that you knew of it and did not comment on it being the wrong thing to do, therefore implying that it was all right-everyone does it. Your silence makes you complicit and an accomplice, not any less so than if you had planned it with her and the doctor. By the way, the Doctor should have his license pulled as well.
Stand behind her in line at the supermarket; probably using food stamps illegally as well (just a hunch!).

[etimer]

Oh?!?!? That puts an entirely different twist on the subject, I didn't take that much time to read the original post.

I always tell my friends, that are clients, " when it comes to the insurance deal, if I know it, I have a responsibility to tell it." So I guess if I had a friend that was stupid enough to do such a thing, they would also be stupid to tell me. Plus they would be putting me in jeopardy of losing my license. Hm?????

The original post was your friend works for your client. The choice here is do you protect your client or your friend? I certainly would not want to be the agent who is explaining to the judge at the DOI hearing why I didn't make that call to my carrier.

[92builder]

What caught my attention is the Doc's response; Is he giving her the note just to be safe even tho she could start back tomorrow, or is he actually helping her commit fraud? I'm concerned about HIS motive. If it's the earlier of the two, I have no problems with this deal whatsoever. I wouldn't say a thing, but to tell her that she should start back asap to avoid the appearance of fraud.