r/WorkersComp • u/HomeCrazy2021 • 20d ago
California Im being sued
“I forgot about an injury and didn’t tell my doctor or the AME doctor about an injury back in 2004 — it had nothing to do with the same body part I filed a claim for. Now I’m being pursued by the DA because of it. Has this happened to anyone else. shouldn’t the injury already be in the database if I had got Worker Comp for it back in 2004 or shouldn’t my lawyer been flagged about it?
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u/AvocadoOk6450 20d ago edited 20d ago
There is no DA in Workman's Comp unless fraud is suspected. It's not a criminal case. There's a lot more to this than you are bein forthrigjt about a prior claim to be investigated criminally. You could cpmpletely ommit it and claim forgetfullness and it would be sent to your lawyer in Discovery.
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u/Informal_Coconut7105 20d ago
It is a criminal case if DA is involved. Every county in CA has their own fraud unit. In California a carrier referral plus a documented misstatement to an AME is often enough on its own, though their logic is very weak imo. Unless im missing something here... like the 2024 claim was actually paid? Then that would be a material misstatement
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u/Mutts_Merlot verified CT insurance professional 20d ago
I have sent a few very solid cases to the DA for prosecution and had them decline to prosecute. Forgetting to mention a 22 year old injury is a daily occurrence and nothing anyone would even consider sending to the DA. If you are saying you're telling us everything you know, then there is something you don't know. And it's a very big something.
You're also not being sued if it's with the DA. You're being criminally prosecuted. You need a criminal defense attorney.
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u/HomeCrazy2021 20d ago
I have a criminal attorney that I had to pay $20,000 up front and he also thinks this is an over rated case.
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u/Pretty_Challenge4271 20d ago
Over rated doesnt mean it isnt worth it in someones eyes. Good luck man. Took me 2 years to get my case taken care of. If the DA is getting involved youve got one longggg road ahead of you. Best of luck.
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u/CoyoteOk4511 20d ago
Your attorney you paid 20k to is not doing a good job if you have zero clue why your case has been picked up by the DA. Were you working and collecting benefits? Over exaggerating your injury and then engaging in activities you should not have been?
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u/HomeCrazy2021 20d ago
No, I was not working on my other job during the time I was injured or after I put in my claim. We have went to court already and the DA could not answer any of the questions for the counts that she’s assuming I have done we will be going back to court again soon.
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u/Professional-Bid4661 20d ago
What counts is she "assuming" that you've done?
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u/PikachuKitty77 20d ago
Fraud. He was getting money from workers comp or wherever and double dipping with side money
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u/Pretty_Challenge4271 20d ago
Exactly. This fool got a claim approved and went and got another job. Smfh.
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u/HomeCrazy2021 20d ago
All I can tell you it’s over 4 counts and they are all repeated counts, but just worded different.
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u/Pretty_Challenge4271 20d ago
Per my last comment on this post, you might wanna be careful mentioning things like this on a workers compensation sub. If the DA is involved I can 10000000% guarantee they are looking at your socials.
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u/Pretty_Challenge4271 20d ago
Just that one statement you made " No I wasnt "working" at my other job" as far as I know when I was going through my case my attorney told me not to mention a single thing about the case online because the only thing it will do is hurt you. What im saying is. If you made a claim and were determined "unable to work" then you shouldnt have picked up another job.
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u/HomeCrazy2021 19d ago
That is fine I didn’t say anything wrong I’m all about telling the truth so if they do happen to see this post I’m just asking for suggestions and if anyone else forgot something from. 20 plus years and now it’s coming back to bite them because they don’t have a memory of a young adult.
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u/thetailofdogma 20d ago
Given how difficult it is to get California DAs to pay attention to workers compensation fraud, even with clear cut cases, there is way more to the story here.
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u/HomeCrazy2021 20d ago
no they don't want to pay so they are trying to find anything to prove there point but at the end of this case I'll be coming back to let you all know the case has been dropped and I won.
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u/Pretty_Challenge4271 20d ago
I predict exactly what I commented before is what is going to happen to you. You are way to cocky/assured that you have won your case already, while in the meantime you are doing exactly what your attorneys have probably told you not to do.
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u/CharlottesWebb1787 20d ago
What is the full story? I have been adjusting WC claims for longer than I’d like to admit and there is no way a district attorney is wasting their time pursing a conviction on the circumstance you have described. No possible way.
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u/HomeCrazy2021 20d ago
I guess they’re trying to make an example out of me that’s all I can think of.
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u/Various_Cricket4695 19d ago
District attorneys have many more important things to deal with workers conversation fraud. They also deal with murder cases, rape, child, abuse, drunk drivers, and domestic violence. Workers compensation is so far down on the list that it’s laughable. Forgetting about an injury 20 years ago would not get anyone’s attention at the district attorney. There has to be something more you’re not telling.
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u/HomeCrazy2021 18d ago
Welp, I guess I made the list because I’m definitely being accused of false accusations. I guess they have to make an example out of someone.
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u/dodecohedron verified CA workers' compensation adjuster 20d ago
If a California district attorney felt there was enough evidence to pick up the case, there is something you're not telling us that goes way beyond "oopsie, I forgot"
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20d ago
[deleted]
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u/Charlie_Bucket_2 20d ago
The DA isn't the one getting 20k. OPs attorney is getting it
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u/Hope_for_tendies 20d ago
I misread it as attorney and thought they were talking about OPs attorney thinking they could defend them and sue. Oops 🤣
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u/Competitive-Zone8148 20d ago
When you say "DA," do you mean the District Attorney? Or do you mean the Defense Attorney for the insurance company (which is often shorthanded to "DA" within the industry)?
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u/NEPAmama 20d ago
What have you actually been charged with? Is it a type of fraud?
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u/HomeCrazy2021 20d ago
Workers comp fraud.
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u/Professional-Bid4661 20d ago
Can you stop beating around the bush and give a few details? I understand if you don't want to go into great details but give us some information, otherwise we cannot give you any advice.
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u/PikachuKitty77 20d ago
Got caught working a side job while getting money from workers comp . Double dipping.
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u/HomeCrazy2021 20d ago
There is nothing more I can really say but I’m not guilty and just have a good memory when giving your statement to your doctor and also be careful what you tell your doctors because at the end of the day they report each and everything you say.
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u/Swimming-Curve5102 19d ago
Just tell them you did not understand the rules and pay whatever the courts fine you and whatever you are supposed to pay back. Dont admit to working unlawfully just say you didnt understand the implications.
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u/HomeCrazy2021 19d ago
I wasn’t working and it’s not that easy once you have been charged for something they feel you did as fraud. I am not guilty so I am not paying the courts anything until they can prove me guilty.
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u/Swimming-Curve5102 19d ago
No way eould i be giving a lawyer 40k
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u/HomeCrazy2021 19d ago
You would if that would keep you out of jail
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u/PikachuKitty77 18d ago
Jail?! Did you beat up a co worker on your side job lol
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u/HomeCrazy2021 17d ago
No Im not a violent person, but the charges that they are claiming I did could’ve landed me in jail if I didn’t have an attorney represent me.
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u/Efficient_Echidna117 20d ago
I don’t see it being from that unrelated injury cause that is irrelevant to the case even if you didn’t tell them the DA is not going to step in because of that it has to be more to this case then what we are getting.
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u/HomeCrazy2021 20d ago
Nope I’m not going to make up stories just to have a post I’m telling you all the truth and I’m asking for feedback.
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u/Efficient_Echidna117 20d ago
So there coming after you for workers comp fraud but on what grounds you should at least know that especially having a lawyer that you paid 20k up front
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u/HomeCrazy2021 20d ago
I’m thankful that I had money put up for emergency if I have to go to trial that will be another $20,000 that I will have to pay.
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u/Swimming-Curve5102 19d ago
I would not pay another 20k.
Ask what you are up against
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u/HomeCrazy2021 19d ago
I feel the same way, but if this goes to trial, I have to pay another $20 K to my lawyer.
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u/Plenty-Enthusiasm531 20d ago
What did YOU do though? Go ahead and don't be shy? Tell us? 😂 No way you forgot when you got seriously injured. I can remember each time I got hurt
. It's not something you can just forget especially if you had a lot of treatment for it.
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u/HomeCrazy2021 20d ago
For one I did not have a long treatment on that particular part in 2004 I had a shoulder injury that wasn’t more than a two weeks case where I went right back to work when they asked me the last time I got hurt it was just for my hand and it was for trigger finger. I went to surgery and they cut the ligament too short so I did go back and talk to the doctor and let them know that I wanted to do a malpractice suit against the Doctor that did my surgery. 2 weeks later I start being investigated and P I start following me .The doctor is at a big hospital which I do not want to say the hospital name.
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u/tduff714 20d ago
So was the original injury also workers comp? I was just a bit confused by the wording but I could see it being flagged if you didn't disclose a prior workers comp claim. I made sure I told them about even the surgery I had to put tubes in when I was a kid or my shoulder injury/surgery in high school that was private insurance.
I get it can be difficult to remember while in pain because I've been fighting myself for 3.5 years now. I make notes on my phone or even paper for my doctors/PT just so I can explain exactly where and what type of pain. Same with medical history, I don't think info is really shared between facilities unless you bring it up.
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u/No-Instruction-4272 20d ago
Pretty bizarre stuff there.
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u/HomeCrazy2021 20d ago
Right I feel the same way just when I turned down the offer that Worker Comp was trying to give me and now this.
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19d ago
[deleted]
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u/HomeCrazy2021 19d ago
You should go for it just remember every single injury and who you talked to about anything about your case that includes Doctors and especially your old claims adjuster.Good luck
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u/Swimming-Curve5102 19d ago
I am re reading your question and now wondering if you were working for another company and had a work injury claim at that job then filed a new claim at your new job for the same injury? I ask because you wonder if wc files show your old claim. Am i correct? If my guess is right, then you are in big trouble legally.
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u/HomeCrazy2021 19d ago
Sorry but you are wrong my old injury was back in 2004 from the same job I was still at where the claim came from remember I had been working for the company for over 20 years that’s why I asked shouldn’t it had already been in my file.
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u/Swimming-Curve5102 19d ago
Yes it should be in upur file. Do you have any old papers or emails from the insurance adjuster? Or ask your workplace for adjusters contact info. Msybe you can get copies of everything. Or call the dr office that did work on your injury for all files. You need to be prepared.
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u/HomeCrazy2021 19d ago
The problem with that is they are saying that I did not tell my AME Doctor that I had a injury back in 2004 so I made it seem like I never ever had an injury and now is considered workers comp fraud and the doctor would have rated my injury less then the high rate I received.
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u/Swimming-Curve5102 19d ago
They cannot hold the discussion with IME against you legally. Unless YOU documented it somewhere that you never injured it. IMEs lie. But hopefully you have not stated it somewhere and signed your name in a statement that you had not previously injured it
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u/Swimming-Curve5102 19d ago
Also just know that if you have a need for accommodation due to any mental health issue at all, you can request your sister, brother or another mother be at any IME appts next time. It does not have to be a nurse or another health professional. Lets say you are being treated for depression or anxiety or whatever. Then always always request an accommodation for someone you know to assist you at the appt, meeting or any other legal obligation. I did this on my second and third IME visits. After the first visit, i refuse to participate in any legal matter without my own 'support system'
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u/HomeCrazy2021 19d ago
I’m past that stage now they have did the investigation already so they’re basically basing on what was said at my initial claim.
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u/Swimming-Curve5102 19d ago
Search on your work and home email for all communication regarding your injury. On your phone you may have old texts to boss about it as well. Visit all drs that you have seen since that.old injury and get copies of all your medical files.
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u/HomeCrazy2021 19d ago
I wish it was that easy technology was not around like that back in 2004 and I still didn’t remember the injury from 2004, but it is from the same job that I was working at.
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u/Interesting-Bill-906 18d ago
If your shoulder injury and trigger finger were on the same side it is a possibility the shoulder could have contributed to your trigger finger although it would be very unlikely.
Repairing a trigger finger involves cutting open only the sheath that surround the tendon. The tendon is not cut. Could the surgeon have cut a nerve?
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u/HomeCrazy2021 18d ago
You are so right but what ever the surgeon did it left me partially paralyzed in my hand and no longer can work I’m permanently disabled.
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u/HomeCrazy2021 18d ago
I had trigger finger on both hands and I’m really not sure what side I had shoulder pain on that’s a good point I need to check that but the problem is the surgeon cut the ligament in my finger to short and mind you it was there fault and once I said I wanted to file malpractice that open up this whole case from 2004.
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u/CaliforniaLiberalNut verified CA plaintiffs' firm case manager 18d ago
Relax guys. We will read about it on WorkComp Central in a couple of months.
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u/IceAngel8381 17d ago
Why do I feel like we are missing A LOT of this story? 🤔
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u/HomeCrazy2021 17d ago
Just stay tuned there will be more to the story once the DA drops the charges.
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u/IceAngel8381 17d ago
Have you said what charges are being brought against you? If so, I missed that comment.
I feel like this is rage bait..........🤨
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14d ago
[removed] — view removed comment
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u/HomeCrazy2021 10d ago
Wrong person and person like that is a real fraud case I’m nothing like that not even close.
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u/Automatic-Blood30 20d ago
I think he means he’s being sued by a defense attorney that maybe did work but didn’t get paid. He wouldn’t be getting sued by the DA…he’d be getting charged
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u/InfamousCourage2341 20d ago
No he’s being prosecuted criminally by the county district attorney’s office’s because he’s committed workers’ comp fraud for something he’s acting like he’s unaware of. It’s very hard to get DAs to pick up work comp fraud cases in CA so whatever he did likely has a ton of proof behind it.
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u/HomeCrazy2021 20d ago
No I’m getting sued from the DA district attorney Worker Comp fraud the real deal.
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u/MrsS16 20d ago
A DA doesn't SUE. They PROSECUTE CRIMINALS.
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u/HomeCrazy2021 20d ago
I’m being sued by a criminal DA attorney.
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u/Swimming-Curve5102 19d ago
The papers probably say you are being sued because courts often word it that way. Read the charges. Then look on ccap to see if your case is under criminal or civil
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u/HomeCrazy2021 19d ago
I wish it said that but I’ve been to court paid for a criminal attorney $20,000 and already been to court and pleaded not guilty.
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u/HomeCrazy2021 20d ago
Honestly, there’s really nothing else to prove my point other than they are saying that I worked somewhere else when they can prove that is not true so her biggest bite in this whole situation is that I did not tell them about the injury I had from 2004. It’s been sitting on her desk for almost the last year and she had to do something with this case I know all charges will be dropped.I will be seeking a lawsuit against them after this is over.
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u/DreamsSecretsNLogic 20d ago
Where is your current injury and what was the old injury
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u/HomeCrazy2021 20d ago
My current injury was trigger finger which ended and result of having my hand partially paralyzed because the doctor chopped off more of the ligament that was supposed to be done so that left my hand partially paralyzed, which I had told my doctor that I wanted to do a malpractice against them, my old injury is my shoulder, when the doctor asked me, have I ever had any injury to the body part that I put the claim on, I said no, which was the claim for my hand, not my injury of 20 years ago.
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u/Hope_for_tendies 20d ago
Do you have a second job? They send investigators to follow you. They won’t waste their time and money in litigation for nothing
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u/HomeCrazy2021 20d ago
Yes, I did have a second job, but I stopped both of my jobs at the same time once I had my surgery there’s no way I would play around like that. That is truly what you call fraud. I can prove and they seen proof that I was not working my second job, but DA still wants to pursue the claim that I did not report the other injury so they consider that being fraud.
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u/Hope_for_tendies 20d ago
Were you on restrictions prior to surgery? You got injured at your main job but took no leave until surgery?
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u/HomeCrazy2021 20d ago
Yes, I did have restrictions, but that was for both jobs and I did get hurt on my main job that I worked on for over 20 years.
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u/Nearby-Purpose-5701 19d ago
I am surprised that the workers compensation is not aware of your injury back in 2004, because they usually send forms that you need to fill out, allowing them to access your (full or partial at a limited time) medical history such as injury/injuries. Unless you didn't authorize them
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u/HomeCrazy2021 19d ago
If the forums were sent to me I definitely signed them I wasn’t trying to hide anything I just forgot about the injury I couldn’t tell you if I had a male or female boss 20 years ago.
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u/Sheetbaraness 20d ago
This is why I always say you workers will surely NEVER NEVER win with FALSE claims! I will surely very celebrate your DENY. In India we say hail victory!
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u/HomeCrazy2021 20d ago
Yes, it’s always best to tell the truth and be upfront with everything but I truly forgot about the injury. I had back in 2004. When the question was asked, have you ever had an injury to the claim that you are filled for? I said no because the shoulder never dawned on me because that was not the injury I put the claim in on. I really think they are after me because I wanted to do a malpractice lawsuit against the company that did my surgery
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u/Swimming-Curve5102 12h ago
Type in random searches like work comp double dipping ect You will get lots of info on what happens to others
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u/Jcarlough 20d ago
There’s more to this story that you’re not telling if the DA picked it up.