Workers Compensation fraud is a widespread and serious problem that’s not only illegal, but leads to higher insurance premiums for all businesses – including yours.
According to industry experts, Comp-related scams often involve one or more of these “red flags.” Although no one sign should necessarily be cause for alarm by itself, two or more should raise suspicions and could trigger an investigation of the claim:
- Monday morning report of injury. The alleged injury occurs first thing on Monday, or late Friday afternoon, but is not reported until Monday.
- Change in employment status. The reported accident occurs immediately before or after a strike, job termination, layoff, end of a major project, or the conclusion of seasonal work.
- Suspicious providers. The claimant’s medical provider or legal consultant has a history of handling dubious claims.
- Lack of witnesses. No one else saw the accident and the employee’s description does not support the cause of the injury.
- Conflicting descriptions. The employee’s account of the accident doesn’t match with the medical history or injury report.
- History of claims. The employee has filed a number of questionable or litigated claims.
- Refusal of treatment. The claimant declines a diagnostic procedure to confirm the nature or extent of the injury.
- Late reporting. The employee delays reporting the incident without a reasonable explanation.
- Elusiveness. The allegedly disabled employee is hard to reach.
- Instability. The claimant changes physicians, addresses, or jobs frequently
If one of your workers files a claim that has some of these warning signs, be sure to let us know. We’ll work with you and your Workers Comp carrier to check it out.
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It’s frustrating when you suspect that a Workers Compensation claimant is milking the system. However, you can reduce potential malingering significantly if you attend to it from the get-go.
Start by designating a manger as the “firm’s rep,” to ensure that any employee who makes a Comp claim gets a doctor promptly and to inform your insurance company immediately. The rep should transport the employee to the physician, stay at the office during the examination and treatment, and then take him or her home or back to work.
While at the doctor’s office, the firm’s rep should ask the physician about the medical condition, recommended treatment, and a reasonable return-to-work date. If the claimant or physician objects, the rep should assure them that he or she will work with the insurance company to make sure all reasonable and necessary benefits and medical bills are paid.
Resist any employee excuses for not seeing a doctor. If the employee has an attorney, suggest getting a second opinion (which you will provide at no cost). If the claimant already has a doctor, have the firm rep offer to take him or her for a consultation– and ask about diagnosis, treatment, and return-to-work status.
The rep should then: 1) follow up with the employee at least every two weeks – and more often if possible – face to face or by phone; and 2) stay in touch with the claims adjuster to share information about visits with the doctor and claimant that might help him or her return to work as early as possible.
Although these techniques won’t always work, anecdotal evidence suggests that they can reduce malingering claims by up to 70%.
What’s not to like?
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You’re traveling at 70 miles per hour on a busy highway when you blow a tire. Your car hits an unexpected slick spot and starts to fishtail. Your brakes or steering suddenly lock up.
In these situations, preparedness can literally make the difference between life and death. That means making sure your employees are trained to deal with common driving emergencies by following these guidelines:
A blown tire:
- Hang on to the steering wheel.
- Don’t brake suddenly.
- Ease off the gas and coast until you have control of the car.
- Turn on your hazard lights to warn the drivers around you.
- Steer smoothly.
Skidding or hydroplaning:
- Don’t make any sudden moves, such as braking hard or jerking the wheel.
- Ease off the gas.
- Steer the car’s nose gently in the direction you’d like to go. Make adjustments gradually, as needed, until the vehicle is moving in a straight line.
Failed steering:
- Don’t brake – a sudden change in speed could send the car spinning.
- Ease off the gas.
- Turn on your hazard lights.
- Coast to a stop, using your brakes gently once the car slows on its own.
Your brakes fail:
- Downshift.
- Move to the right, remembering to signal as needed.
- Because the failure might be temporary, keep your foot on the brakes. If you have ABS, apply steady pressure; If you don’t have ABS, pump the brakes.
- Shift into neutral and apply your emergency brake.
- If possible, use friction to slow or stop the vehicle by running it along a curb or something alongside the road.
For more information, feel free to get in touch with us.
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With slips, trips and, falls remaining one of the top causes of workers compensation claims, safety experts stress the need for preventive measures and ergonomic workplace design.
Such accidents need particular attention in nonindustrial environments where employers often install terrazzo or marble floors that can be dangerous to walk on.
According to the U.S. Bureau of Labor Statistics, same- level slips, trips and falls (in which workers slip and fall on the surface where they’re standing) accounted for 134,580 lost workdays and 111 deaths in 2011. The number of same-level falls increased 42.3% from 1998 to 2010, the highest growth of any accident type during this period. These mishaps are costly, in 2010, Liberty Mutual a a leading workers comp insurance company, paid $8.61 billion in same-level fall comp claims.
Implementing safety measures such as, cleaning spilled liquids promptly and placing floor mats on smooth flooring will help prevent workplace injury. Reviewing injury records to find trends will help determine additional safety measures to implement in the workplace. Many businesses are replacing surfaces that contribute to these mishaps which is a highly cost effective investment that can curb expensive litigation and workers comp liabilities.
Although these precautions have prevented thousands of slip-and-fall accidents, the risk will remain a problem until employers work with design professionals to create ergonomically friendly safe buildings. The National Institute of Occupational Safety and Health (NIOSH) is sponsoring a “Prevention Through Design” initiative to address ways that architects and engineers can get involved in designing safer workplaces (for example, by training college engineering and architecture students about safety and ergonomic considerations).
Our workers comp specialists would be happy to check your business for slip and fall hazards and recommend steps to help keep your staff and visitors from slipping.
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Create a safety culture within your organization. Let every employee know safety is the number one employee benefit. The top executive takes the lead and mentions some safety news in every company meeting. Simply talking and promoting safety is time, it does not cost a great deal of money.
Some specifics:
Drivers must use seat belts, must be sober and drug free, not use cell phones or text while driving, and not pick up unauthorized passengers. At least semi-annually, drug test every driver and check their driving records. Randomly test one quarter of the drivers every three months. Establish a threshold for tickets and accidents, and stick to that standard. These minimum safety standards cost about as much as a tank of gas in a pick-up.
Supply personal safety protective equipment for employees. Although this requirement comes from OSHA regulations, it’s a great investment too. One eye wash at the local doc in the box costs about as much as a hundred pairs of safety glasses.
Harnesses to tie off workers at heights cost little next to broken bones and death from a fall.
Hard hats are about fifteen to twenty dollars each. Closing a head wound runs about five thousand.
Reflective vests or coveralls, again, cost much less than a man versus loader collision.
Now, suppose you could save five percent of your workers’ compensation premium for the next three years from reduced experience mod or lower premium rates. You can afford to make the investment in safety equipment.
Consider an incentive program like this: quarterly bonus for no injuries and perfect prompt attendance. Perhaps pay everyone who meets those criteria an extra fifty cents per hour for the quarter. This extra pay amounts to about one hundred dollars per month. Wouldn’t it be worth everyone earning it? Or, maybe one quarter the earners get a pair of Red Wing boots, a gift card to their favorite tool store, a gift card oriented towards their spouses, a flat screen television or use your imagination.
Small investments in safety awareness and loss prevention do pay large dividends in reduced losses.
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