Family of Employee Killed on the Job Sues Minnesota City’s Insurer
The family of a Sauk Rapids, Minnesota, a maintenance worker who fatally injured after being struck by a car while emerging from a manhole, sued the city’s insurance provider.
According to a report from the St. Cloud Times, the city employee was killed on June 19, 2006, while employed by the city.
The lawsuit filed in Benton County District Court alleges the insurance provider for Sauk Rapids is breaching its contract by not compensating the family underinsured motorist benefits. The case is scheduled to go to a pretrial hearing in January.
According to the lawsuit, the driver was an underinsured motorist, and her insurer already has paid its policy limit of $100,000 to finalize a wrongful death claim filed by the victim’s family. The driver also pled guilty to inattentive driving.
The decedant’s family has been seeking underinsured motorist benefits from the League of Minnesota Cities Insurance Trust, the defendant in the lawsuit and the city’s insurer, but their application was denied. (workersxzcompxzkit)
The accident led to a $25,000 fine against the city from the Occupational Safety and Health Administration.
According to OSHA, the work area was not properly marked by traffic signs, barricades or other devices.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
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©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
A Case Study:
Physician Allegedly Makes False Work Injury Report with Intent to Defraud
A California medical doctor reportedly made false medical statements claiming to have suffered a hospital work-related injury stating an inability to sit, stand, or walk with the intention of committing insurance fraud according to the Orange County (California) District Attorney’s Office Investigators.
Here’s What Happened
1. The doctor (employed by a large California HMO) created an allegedly false “accident scene” in an examination room, calling a medical assistant who witnessed the doctor lying on the floor. The doctor said after slipping on an oily substance on the floor, injury occurred to the lower back and neck and the physician was unable to get up.
2. Over a six-month period, the claimant visited two physicians claiming suffering from severe pain as a result of the fall, citing an inability to sit, stand or walk for more than a 5 minute period and could only lie on one side in bed.
3. The defendant is accused of claiming all prescribed pain medication and physical therapy was ineffective; sleep was impossible; and body rotation was compromised due to the pain.
4. Authorities said the doctor arrived at appointments in a wheelchair because of constant pain and inability to walk or stand for more than 10 minutes. The defendant is accused of claiming having trouble finding rides to make it to the appointments.
5. After being placed on modified work restrictions recommended by doctors, the accused failed to return to work because the employer was unable to accommodate restricted modified duty terms.
6. Various examinations, X-rays, MRIs, and bone scans detected no abnormalities and offered no explanation as to the pain from which the defendant claimed to be suffering.
What the Employer Did
Because the defendant’s treating doctors could find no objective evidence to explain the employee’s pain and alleged disabilities, the employer hired an investigative service to conduct surveillance of the individual on three occasions over a three-month period. (workersxzcompxzkit)
Surveillance showed the defendant (by videotape) participating in physical activities such as sitting, standing, and walking – the very activities the doctor supposedly was unable to do as a result of the workplace injury.
As a result, the defendant was arrested and charged with 10 felony counts of making fraudulent statements and representations and, if convicted, faces a maximum sentence of 14 years in state prison.
Author: Robert Elliott, J.D.
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©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
16 Steps for Implementing a Transitional Duty Checklist Transitional duty programs are put in place to get your injured employee back to work as soon as possible. This is good for both the company and the employee. Even in a limited capacity, the sooner you can get your injured employee back to work the better. It maintains a stable workforce and helps the employee recover more quickly. Workers' Comp Kit (http://www.workerscompkit.com/) provides a checklist form to indicate how to begin a transitional duty program. Important things a company should do to implement an effective transitional duty program include: 1. Knowing about your states' law in regard to returning an employee to work. 2. Making sure all employees receive the workers' comp policy. 3. Explaining employee rights, roles and responsibilities. 4. Informing treating physicians about your transitional duty policy. 5. Getting treating physicians to approve transitional duty jobs. 6. Hold weekly meetings with the injured employee returning to work for a transitional duty position. During this time therapy and treatment may still continue. As the employee heals, do the following: 1. Remind supervisors of the employee's physical limitations so they do not push him or her to exceed said limitations. 2. Identify transitional duty jobs creatively. Make a wish list of things you'd like to have done but don't have time to do. Consider off-site, work-hardening modified duty programs if you do not have any positions at your workplace. 3. Visit worksites to determine tasks similar to the employee's existing job. 4. Jobs should be meaningful and not demeaning, demoralizing or punitive for the injured employee. 5. Be sure to train the employee in the new position, if needed. 6. Send the transitional duty job offers first class, certified mail with confirmation receipt and enclose a stamped envelope. 7. Be sure not to violate union contracts; work with the unions. For more information, read this article aobut light duty and the unions: http://reduceyourworkerscomp.com//Return-to-Work-Programs-Unionized-Companies.php. 8. Get medical restrictions from the employee's doctor even if the employee isn't quite ready to return to the workforce. 9. Continue to pay the injured employee at their same rate. Consider doing so even if the employee works partial hours to avoid paying lost wage benefits; in many states (e.g. NY) this will reduce future settlements. Be sure to advise your third-party administrator of this. (workersxzcompxzkit) Consult with your insurance broker's claim analyst about this also. 10. Ask the employee for feedback on the transitional duty position – this should begin three to five days after you send the transitional duty offer letter. Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
WC IQ Test: http://www.workerscompkit.com/intro/ WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php WC Calculator: www.reduceyourworkerscomp.com/calculator.php Follow Us On Twitter: www.twitter.com/WorkersCompKit Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers' comp issues. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
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