Horsing Around

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File with focus on the text Disability Insurance and blur effect. Concept of individual protection.

The Ohio Industrial Commission and the Special Investigations Department of the Ohio Bureau of Workers’ Compensation (BWC) determined that it was appropriate to terminate permanent disability benefits that were being awarded to a man who was caught training and taking care of horses. (I guess you could say he was “horsing around” while getting paid for being permanently disabled.) The Ohio man, who was trying to buck the workers’ compensation system, now finds himself in the middle of a workers’ compensation fraud debacle where the two state agencies are trying to define the actual date when the permanent disability payments are officially terminated.

The man at the center of today’s workers’ compensation fraud case, who experienced an on-the-job injury in the early 1990s, was not awarded permanent total disability compensation until 2006. At that time, the Ohio Industry Commission determined that he was unable to sustain lucrative employment, qualifying to receive benefits until any changes in his circumstances warranted ceasing the award.

Approximately seven years after his permanent total disability classification, the Special Investigations Department of the BWC discovered that the man in question possessed an active groomer/owner license with the Ohio State Racing Commission while receiving disability payments. (Aha! Evidence of a job, while he was supposedly unable to work.)

Investigators went to work and began surveillance in 2014 at a racetrack, where they saw him running horses around the track, wearing riding attire, caring for horses, removing a two-wheeled horse cart from a horse, hauling a horse trailer with his vehicle, pushing and dumping a wheelbarrow and walking a horse to its shower stall. The BWC found out that the man traded working at the stable and performing duties for other horse owners for part ownership in a horse. (I’d say there’s something very stinky here, and it’s not the horse manure.)

After uncovering the workers’ compensation fraud evidence mentioned above, the BWC filed a motion with the commission requesting that the man’s disability compensation be terminated. It was eventually determined that the man’s activities were deemed as gainful and lucrative employment, therefore fraudulent. The man filed an appeal with the state’s Supreme Court. The seven judges ended up directing the case back to the commission to determine the appropriate termination date for the Ohio man’s disability compensation. (I’d say the Supreme Court effectively stopped this supposedly disabled man from galloping away with workers’ compensation benefits he did not deserve.)

Today’s “Fraud of the Day” is based on an article, “Disabled man’s caring for horses classified as a job,” posted on businessinsurance.com on August 23, 2019.

The Ohio Industrial Commission was right to terminate permanent disability to a permanently disabled worker who was caught caring for horses at a raceway, but a divided Ohio Supreme Court ruled Thursday that the commission needs to re-address when it should have terminated benefits after agreeing that the man had committed fraud.

Kenneth Seibert sustained workplace injuries in the early 1990s and the state’s Workers’ Compensation Commission awarded him permanent total disability compensation for his injuries starting in 2006. In granting the award, the commission found that he “was incapable of performing any sustained remunerative employment” and that his benefits would “continue without interruption unless or until future facts and circumstances justify the stopping of the award,” according to documents in The State Ex Rel. Seibert v. Richardson CYR Inc., et. al.; Industrial Commission of Ohio, filed in Columbus, Ohio.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.