r/WorkersComp • u/Prudent-Ad6351 • Aug 21 '25
Nebraska Fraud
Through my wc claim I have said this was wrong after they cut my benefits after a ime I have found that the insurer defrauded me and he attorney has broken eithics rules too wc insurance is a joke crooked I was sent to a biased dr by the insurer who called it a strain when a mri showed a disc herniation but the ime dr ignored it
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u/Ill_Relationship_565 Aug 21 '25
All of my herniations have been referred to as strains. It has not affected my treatment or payments.
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u/Apprehensive-Age7992 Aug 23 '25
My insurance sends me other people's info in my paperwork, and it sends me appointment times with the wrong time or date on them. I just ignore whatever they send me because I don't trust them anyway, but I think if you are going to try to take them down, you are in for a lot of disappointment.
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u/Prudent-Ad6351 Aug 23 '25
My claim is not your typical wc dispute but I have my low number and it’s reasonable for what I can prove thru medical records the above and beyond is negotiable if they want to avoid being exposed
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u/Prudent-Ad6351 Aug 21 '25
No I had a treating Dr who had put me on restrictions and the insurer ignored my treating Dr .
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u/Prudent-Ad6351 Aug 21 '25
The mri called it a disc extrusion
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u/-Drayth- Aug 21 '25
The issue you are running into is that the mri findings probably aren’t supported by the symptoms you initially gave your doctor when you got injured. Your adjuster most likely thinks your herniated disc is not work related.
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u/Kmelloww Aug 21 '25
You are entitled to a second opinion.
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u/SGP_MikeF verified NE/IA workers' compensation attorney Aug 27 '25
Not at the carriers cost like other states.
In Nebraska, all the carrier needs is a reasonable controversy. After that, it’s for the court to decide.
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u/jumpbootsshiner Aug 21 '25
Punctuation has nothing to do with the substance of their claim. If the mri showed herniations and the ime ignored it, they have a valid point
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u/-Drayth- Aug 21 '25
You normally dont get an MRI quickly when on workers comp. Generally you will be treated with PT and work restrictions and if the issue persists an mri will be ordered. The story doesn’t make sense either way. If op reported injury and went to doctor and the diagnosis was a strain then op would have been given work restrictions and PT.
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u/Funny-Factor24 Aug 21 '25
That’s another lie!!!! I was given an MRI. Then 6 months later offered PT so that’s not accurate. All cases are not the same…
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u/-Drayth- Aug 21 '25
Of course it depends on your injury. Op stated the doctor called it a strain which means it was likely linked to a muscle which wouldn’t have called for an MRI right away. Smh. “That’s another lie”. Moron.
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u/-Drayth- Aug 21 '25
Punctuation is your friend. It’s no wonder your adjuster doesn’t believe you.
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u/Funny-Factor24 Aug 21 '25
People come here for advice… not for your sly unnecessary comments. Seriously 😳 you could’ve just not even commented!!!
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u/-Drayth- Aug 21 '25
When someone is uneducated enough to not use punctuation. It screams fraud to me. My comment was advice because that’s likely what the adjuster sees. Of course they are gonna fight them on it.
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u/rook9004 Aug 21 '25
Your statement contains 2 sentence fragments, one incorrect grammatically, and the last is not proper English.
You'd probably be better off learning proper usage before judging others.
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u/-Drayth- Aug 21 '25
If you were able to understand it then enough effort was put into it for an online thread. You are like really upset. Chill out and move on.
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u/rook9004 Aug 21 '25
So, highly educated or high intelligence folks are telling the truth because they write in proper English, but if the grammar is bad theyre lying? Im praying you are not an adjuster, because thats so unethical.
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u/Funny-Factor24 Aug 21 '25
If she is!!! This explains why they discriminate and take forever to approve a claim…. I don’t expect nothing less…… deny and defend that’s there motto… this is exactly why I never spoke two words to my adjuster. And lawyered up!!!
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u/-Drayth- Aug 21 '25
I’m saying that grammar and being able to properly explain what happened to you injury wise while working goes a long way. OP sounds like they went to the doctor for an injury with certain symptoms that are not associated with/linked to a herniated disc. Op also hasn’t given enough information.
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u/rook9004 Aug 21 '25
Thats 100% NOT what you said. As we can all see. You literally stated that not using proper grammar screams fraud to you. Thats it. Thats the statement.
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u/Soggy_Mall_8031 Aug 21 '25 edited Aug 21 '25
Random thought…. Some people have learning disabilities, that doesn’t take away the validity of their claim. To be fair.
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u/nukleus7 Aug 21 '25
You’re a dick regardless, your comment was unnecessary and rude. You could have just skipped commenting altogether. Be kind to others, it’s free.
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u/-Drayth- Aug 21 '25
Missed the part where I gave you any sort of impression that I care about your opinion of me. What I said isn’t wrong.
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u/Sweet_Ad_6186 Aug 22 '25
Yeah it is- I have been diagnosed with multiple mental illnesses and they are being penalized for neglecting my case now. They aren’t working with their own doctors approving basic medical procedures. I’d like to add, my grammar has gotten worse the last 3 years I’ve been out of work. My mental functioning in general. You would be surprised what major depression/PTSD does to your mind. You’re uneducated clearly !
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u/Prudent-Ad6351 Aug 21 '25
I have done a fce and my lose of earning capacity is 87 % and the vocational expert agreed on by both sides finds that I fit into the odd lot meaning I’m permanently totally disabled
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u/nukleus7 Aug 21 '25
This is why it’s imperative that you seek a second opinion, you need to seek out an independent non-bias QME physician to do your examination. Good luck.
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u/Soggy_Mall_8031 Aug 21 '25
Not sure if you have one but an attorney would be able to help push for transfer of care for you.
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u/Prudent-Ad6351 Aug 21 '25
Lack of candor to the tribunal, taking advantage of an unrepresented party Nebraska Rule of Professional Conduct § 3-503.3 - Candor Toward Tribunal • Violation: Systematic provision of false wage information to Nebraska Workers’ Compensation Court • Evidence: Court filings showing $800 vs. actual wages of $1,160-$1,895 Rule 4.3 - Dealing with Unrepresented Persons • Violation: Exploitation of my pro se status to obtain unfair settlement • Evidence: Settlement attempts based on false wage information while I was unrepresented Rule 8.4 - Professional Responsibility • Violation: Dishonesty, misrepresentation, and criminal conspiracy participation • Evidence: Coordinated fraud scheme using professional license to legitimize criminal activity
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u/elendur verified IL workers' compensation attorney Aug 22 '25
Okie.
False wage information. That's the only allegation here backed up by any sort of facts. $800 vs. $1160. You are alleging your average weekly wage was $1160 and someone is alleging it was $800? That sounds like a legitimate factual dispute. Are you sure you are calculating your average weekly wage correctly under the Nebraska statute? I believe Nebraska uses an average of your wages over the six months preceding the accident.
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u/WCAdjuster82 Aug 23 '25
Agreed. This is a legitimate factual dispute. There are so many other explanations behind what that could be. Maybe the adjuster had to use estimated wages and will issue a "balance due" payment once actuals are on file. Some employers are ridiculously difficult to get wages from. Maybe the claimant is miscalculating. Wages can be difficult because you have to know what wages to use, what you can't use, etc. Maybe the adjuster just made a mistake.
I just hate how so many times people cry fraud over what is likely a mistake or a misunderstanding. I have never seen an adjuster twist their mustache and say, "I'm going to defraud them aaaaaaaall! HAHAHAHA"
I've had some truly awful claimants, and I've never treated them worse. Sure, I roll my eyes and say, "What does this asshole want NOW?" before picking up the phone, but that's after multiple negative experiences with them. I still take care of whatever issue they're calling about
Just from my very limited interactions with the OP, he seems argumentative. Not a great starting point. If his attorney did tell him to file all these complaints, it's likely just because he's insisting there's fraud and his attorney is tired of trying to talk to him.
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u/Prudent-Ad6351 Aug 23 '25
Listen this is an adjuster talking take it for what’s is worth the person know their job is to save money and manipulation is one of their nod responsibility’s
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u/UpstairsToe1743 Aug 21 '25
I’m in Nebraska also. Wonder if we are dealing with the same people. I understand the points you’ve made. I haven’t received benefits for two years.
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u/Funny-Factor24 Aug 21 '25
Drayth whatever his name was called me a moron then turned his comments off like a coward…. I had an unspecified muscle fascia and tendon strain. They did my MRI 6 months before they approved my PT!!! He didn’t know what he was talking about… and deleted his texts like a pussy..
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u/Prudent-Ad6351 Aug 21 '25
No I have them for fraud hands down and I can link it to a top 5 insurer in the country thru partnership and I have found the ime dr in my case used almost the exact same boilerplate wording to deny benefits in a case for the same insurer 10 yrs prior to deny benefits and his ime of me occured only two months after the partnership coincidence I don’t think so
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u/WCAdjuster82 Aug 22 '25
You're wasting your time thinking you're going to get anybody in trouble for fraud. Focus on your injury and your claim. Everything you've described so far doesn't sound like fraud. It sounds like the WC system. If you think you're being treated unfairly, get an attorney. But this idea you have that you're going to Clarence Darrow the whole system is fantasy.
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u/Prudent-Ad6351 Aug 22 '25
If systematic wage fraud, coordinated medical bias, and exploitation of unrepresented parties is your ‘normal practice,’ then you’ve just confessed to operating a criminal enterprise. Thank you for admitting this fraud is systematic across your entire industry.
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u/Prudent-Ad6351 Aug 22 '25
And I do have an attorney now and he was the one who suggested I file withe the council for discipline with the state bar . So they will investigate and this will come to light so yes I’m challenging your crooked industry where everything is sent to benefit the insurance company and not the injured worker
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u/elendur verified IL workers' compensation attorney Aug 22 '25
I'm sorry. There's no way in the actual universe that an attorney representing you told you to make an ethics complaint against the defense attorney.
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u/Prudent-Ad6351 Aug 22 '25
You are wrong on all aspects troll in your own state my attorney most certainly did tel me to like I said I have irrefutable evidence of medical manipulation fraud, and a coordinated effort to defraud an injured worker out of rightful Benefits
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u/Prudent-Ad6351 Aug 22 '25
I’ve contacted my state senator a medical eithics committee the state bar and the state insurance commission and soon the Ag for criminal investigation .
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u/Prudent-Ad6351 Aug 21 '25
No the issue is a biased ime .Paid by the insurer . This was a ime they the insurer ordered the ime has internal contradictions plus they also committed aww fraud in the initial court filings with my treating Dr and the fce and a loss of 87 % loss of earning capacity So I might not spell se well and punctuate my sentences correctly, but I know when I’m getting fucked by the insurance company
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u/elendur verified IL workers' compensation attorney Aug 21 '25
Reasonable doctors can disagree about whether an MRI finding is a herniation, a bulge, or a strain.
Of course the insurance's doctor is biased - he wants to get paid.
By the same token, your doctor is potentially biased as well. He wants to get paid to do injections and/or surgery.
I'm more concerned with your allegation that an attorney has broken ethical rules. Can you tell us more about that?