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AUSTRALIA Part-time Retail Workers Have Twice As Many Injuries as Full-Time Workers


If you think Workers' Comp is a problem only experienced by U.S. employers, think again. Visitors to our site come from Canada, Australia, New Zealand, EU Countries, and just about every other country on the planet! Although called work injury "schemes", other countries have funds to compensate injured workers. These employers and the governments, visit our website researching U.S. cost control techniques.

 Safe Work Australia   Council Chair, Tom Phillips, recently announced the release of six reports based on an analysis of the 2005-06 Work-Related Injuries Survey (WRIS) on the construction, health and community services, manufacturing, agriculture, forestry and fishing, transport and storage and retail trade industries.

The WRIS  is conducted every four years by the Australian Bureau of Statistics (ABS) as a supplement to the Labor Force Survey. Safe Work Australia partially funds the survey to complement its collection of workers' compensation data.  The WRIS reports explore the types and causes of work-related injury and provides information on those workers who are not covered by workers' comp such as self-employed workers.  Some of the main findings of the reports include: 1.  Part-time workers  in the retail trade industry recorded a frequency rate of injury nearly double that of full-time workers. 2.  Agriculture, forestry  and fishing workers experienced the highest rate of injuries, with 109 injuries per 1000 workers. 3.  Employees in  the construction industry recorded a similar rate of injury to self-employed workers. Similarly there was little difference in rates of injury between those working on a contract and those not working on a contract. 4.  Young workers  (15 to 24 year olds) in the Manufacturing industry recorded an injury rate 44% higher than the corresponding rate for young workers in the Australian workforce as a whole,. 5.  Transport and storage  workers aged 35 to 44 years recorded an injury rate 75% higher than the rate recorded by all Australian workers of this age Phillips said  these reports add significantly to our understanding of work-related injuries and provide information on the extent and frequency of work-related injuries that is not available using workers' comp data alone. "By publishing data  from a range of data sources, Safe Work Australia demonstrates a commitment to providing the best possible information to improve workplace safety," said Phillips. The next WRIS  covering the period 2009-10 is currently being conducted and Safe Work Australia will publish the results of this analysis in 2011. Full reports are available for download at www.safeworkaustralia.gov.au.   The ABS report on the WRIS is available on its Web site at: www.abs.gov.au

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 860-553-6604.

We accept WC cost containment. Contact us at: Info@WorkersCompKit.com.

FREE TOOLS: WC Calculator: www.reduceyourworkerscomp.com/calculator.php WC 101: www.ReduceYourWorkersComp.com/workers_comp.php NEW ARTICLE: Return to Work in Unionized Companies http://reduceyourworkerscomp.com/Return-to-Work-Programs-Unionized-Companies.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers' comp issues.

©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in Safety and Loss Control, WC in Other Countries (International) |


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Dangerous Farm Equipment Kills Employee: Employer Does Not have Workers Compensation So Widow Seeks Third Party Recovery


How Would You Decide:  Can uninsured employer seek contribution/indemnity from third part to recover losses paid in wrongful death action filed by employee's widow? Here's what Tom Robinson, J.D., writer for Lexis Nexis Workers Comp Law Center reports. Here's What Happened An employer  purchased a used posthole digger for use in its operations.  While using the posthole digger and tractor to do fencing work, an employee became entangled in the auger blade and died as a result of his injuries.  When the employee's widow sought workers' compensation benefits, it was determined that the employer was not enrolled in a workers' compensation plan at the time of the employee's death.  As a result, the state uninsured employers' fund paid the widow's claim.  The state then  sought reimbursement against the employer for the sums paid.  The widow subsequently filed a wrongful death action against the employer and others in the U.S. District Court.  The employer ultimately settled the case with the widow, paid settlement monies (through an insurance carrier), and then sought to recover from the posthole manufacturer via an alternative claim of contribution or indemnity.  The U.S. District Court certified the following question (as amended) to the Supreme Court of Montana: "Is an uninsured employer prohibited from bringing either a contribution claim or an indemnity claim against a third party after settling with the injured employee?" Here's What The Court Decided: In State Farm Fire & Cas. Co. v. Bush Hog, LLC,  2009 MT 349, 2009 Mont. LEXIS 500 (Oct. 21, 2009), the Supreme Court of Montana answered, "Yes."  Acknowledging first that in Montana, the right to contribution was established by statute, while the right to indemnity was an equitable principle, the Court indicated that the two concepts had essentially the same purpose: to shift one's losses to another.  The doctrine of contribution is to allocate liability among all responsible parties whereas the doctrine of indemnity springs from the equitable theory that one has been compelled to pay for damages caused by another.  The Supreme Court  agreed with the manufacturer that it was not equitable to require a stranger to the employer-employee relationship to indemnity an employer for liability that was wholly avoidable if the employer had simply obeyed the Workers' Compensation Act and provided coverage for its employees.  But for the employer's failure to provide workers' compensation coverage to the employee, the employer would have had no liability to the employee's widow.  The essence of the contribution/indemnity claim was directly attributable to the employer's own violation of the workers' compensation laws of the State.  The Court concluded that allowing an action for contribution or indemnity would relieve an uninsured employer of the responsibility and consequences of its own violation. (workersxzcompxzkit) See generally  Larson's Workers' Compensation Law, §§ 102.02, 118.01, 120.01, 120.04. Tom Robinson, J.D. is the primary upkeep writer for Larson's Workers' Compensation Law (LexisNexis) and Larson's Workers' Compensation, Desk Edition (LexisNexis). He is a contributing writer for California Compensation Cases (LexisNexis) and Benefits Review Board – Longshore Reporter(LexisNexis), and is a contributing author to New York Workers' Compensation Handbook(LexisNexis). Robinson is an authority in the area of workers' compensation and we are happy to have him as a Guest Contributor to Workers' Comp Kit Blog. Tom can be reached at: compwriter@gmail.com. http://law.lexisnexis.com/practiceareas/Workers-Compensation We accept articles! Contact us at: Info@WorkersCompKit.com.

Use our tools FREE WC IQ Test: http://www.workerscompkit.com/intro/ WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers' comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in Litigation Management, Settling WC Claims |


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Drug Use Does Not Bar Collecting Workers Comp In Illinois


Employer Must Pay Pot Smoker Workers’ Comp Benefits

Even with a post-injury  drug test demonstrating an Illinois workers’ comp claimant recently smoked marijuana, his employer must pay lifetime benefits,  an Illinois appeals court recently determined.

The claimant,  a 21-year-old apprentice carpenter,  fell through a hole in the second-floor of a house under construction. He now reportedly has paraplegia.

Even though expert  testimony showed that a post-injury drug test revealed “proximal use” of pot and impairment, an arbitrator said the claimant was entitled to $445 per week for life and the Workers’ Compensation Commission upheld the award. Proximal use as it relates to this case means the claimant consumed pot as much as a day and a half prior to the accident.

The employer   sought to have the appeals court rule that claimants are prohibited from receiving benefits if scientific evidence documents they are impaired by marijuana consumption.

The Illinois 3rd District Court of Appeals confirmed the state’s Supreme Court opinion, which previously ruled there are only two ways an employer can use intoxication as a defense in work comp cases.  (workersxzcompxzkit)

1. If the injury was the result of intoxication rather than arising out of a worker’s employment.
2. If the worker was so intoxicated it can seen as an abandonment of his workplace duties.

The appeals court  said the claimant was performing his workplace duties until the accident happened so his work was a contributing factor. The court also determined the employer basically sought to have the court abandon the intoxication defense standards the Supreme Court established.

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 860-553-6604.

Budding writer? Contact us: Info@WorkersCompKit.com.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php

New Article: Return to Work in Unionized Companies
http://reduceyourworkerscomp.com/Return-to-Work-Programs-Unionized-Companies.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.


©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in Drug, Alcohol & Impairment Testing, Litigation Management |


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Should an Employer Pay Minor Medical Expenses: The Politics of Paying Those Small Medical Bills


Litigation Problem:

1.  An employer   should not need to pay workers comp medical bills directly due to a slow claim processing unit. Adjusters needs to set up a claim file and verify accidents before authorizing treatment or paying initial medical bills.

2.  Problem:  a failure to pay the initial medical bills promptly may force a claimant directly into the hands of an attorney.

The Defense Attorney Problem

1.  Defense attorneys  cannot  and do not coach their employers to take actions inconsistent with their policy reporting requirements  but, that said,  direct payment of minor medical claims,  can be an extremely effective method of lowering an employer’s experience rating if the minor medical claims go unreported. 

The Reality 

1.  The practice  of paying minor medical claims occurs on a nationwide basis throughout the work comp industry because of the driving goal to lower experience ratings. What difference does it actually make if the employer pays the salary of the plant nurse or pays the company clinic for a visit for the minor scrapes and cuts?  In Illinois, an employer is only required to report to the Commission all claims involving 3 days or more of lost time.  Minor medical claims need not be reported to the Commission.

2.  Both the employer  and TPAs need to be aware of the practical goal of lowering claim histories and allowing the prompt payment of medical bills on any new claims, if for no other reason than to prevent an injured employee from feeling forced into seeking legal help.

3.  Larger employers  can and do have an on site company nurse for exactly this purpose of providing minor emergency medical care. These minor incidents are not necessarily reported to the carrier or the TPA as a formal claim.  A company nurse or plant medical personnel can certainly pay for themselves over time if these minor injuries are all too common a problem at a particular facility.

Suggested Solution:

1.  Employers can  and do pay initial medical visits as a way to prevent injured workers from immediately seeking an attorney and litigation. If the initial medical bills are paid promptly, many of the claimants will never pursue filing a formal claim for benefits.  If these minor medical claims are not turned into the carrier as an actual claim, the employer then enjoys the benefit of a lowered experience rating, a lowered accident  history, a lowered mod rate and ultimately by lowering next year’s insurance premiums. But, the employers need to do this in cooperation with their carrier or TPA.

2.  TPAs and carriers  need to adopt or accommodate a policy of instructions for employer direct payment of minor medical expense like setting a dollar figure of say under $500, $750 or even $1,000 for that matter as defined as “minor medical” only claims like a trip to the company nurse or company clinic which does not involve any further medical care nor require any mandatory claim reporting.

3.  Keep in mind,  a visit to any modern day emergency room  easily costs over $1,000 and would with no doubt be serious enough to report to the carrier. (workersxzcompxzkit)

4.  An employer/TPA accommodation  would require the employer to keep accurate records of even minor medical events handled or paid internally so that later, if there are more serious developments, the employer does not prejudice the insurance carrier or the TPA in their defense or in investigation of the claim.

Brad Bleakney of Bleakney & Troiani in Chicago, IL practices in the areas of work-related injury claims third party litigation for accidental work injuries. He has a background in industry where he helped a Fortune 500 company reduce their workers’ compensation losses significantly. Brad can be reached at: Brad Bleakney, Bleakney & Troiani, 1 North Franklin (2625) Chicago, IL 60606 312-541-0045 or fax 312-541-0041 info@WorkComp-Chicago.com

We accept articles on WC cost containment. Contact us at: Info@WorkersCompKit.com.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php

New Article: Return to Work in Unionized Companies
http://reduceyourworkerscomp.com/Return-to-Work-Programs-Unionized-Companies.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.


©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in Litigation Management, Medical Issues |


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Workers Compensation Insurance Fraud Blotter


A survey of what the media, state agencies, insurance companies, and others report in terms of workers’ comp fraud, listing recent arrests, charges, and convictions.

Criminal complaints and indictments are accusations only.  Defendants are presumed innocent until proven guilty.

 A former nursing aide  in New York State was arrested on multiple workers’ compensation fraud charges after he allegedly returned to work at a North Carolina hospital.

The arrest lead  to the man’s arraignment on charges of offering a false instrument for filing, insurance fraud, grand larceny and violating the Workers’ Comp. Law – all felonies.

Investigators said  the alleged defendant began receiving compensation payments for an injury he suffered in 2004 while working as a nursing personal care aide at the Finger Lakes Developmental Disabilities Service Office in Rochester, NY, part of the New York State Office of Mental Retardation and Developmental Disabilities.

The aide, classified in New York as permanently partially disabled, said he injured his lower back attempting to prevent a patient from falling to the ground. The investigation revealed, however, that he returned to work at Dorthea Dix Hospital in Raleigh, NC, as a healthcare technician during 2007. Investigators also learned that during 2008 he filed again for workers’ comp. benefits, claiming he injured his finger while working at the North Carolina hospital.

“Workers’ compensation  fraud hurts businesses and honest working men and women across our state in the best of times, but places a further strain on our economy in the tough times we are facing now,” NYSIF Chief Deputy Executive Director Francine James said. “We continue to crack down on workers’ compensation fraud because to do otherwise would be to fail in our commitment to the businesses and people of New York.”

Investigators said  the claimant sent signed statements to NYSIF indicating he had not returned to any type of work while receiving workers’ compensation benefits from NYSIF, but allegedly collected more than $9,000 in NYSIF benefits while employed following his injury. (workersxzcompxzkit)

At the time  of his arrest, investigators he was collecting workers’ compensation benefits from both NYSIF and the State of North Carolina. Investigators estimated the potential future savings on his NYSIF claim to be $135,582. The investigation was conducted by NYSIF in cooperation with the New York State Insurance Department Frauds Bureau and the Office of the Workers’ Compensation Board Fraud Inspector General.

Reposted with Permission:  Visit LexisNexis for more information and full reports.

Budding Workers Comp writer? Contact us at: Info@WorkersCompKit.com.

WC Calculator: www.reduceyourworkerscomp.com/calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.


©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com

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Posted in Fraud and Abuse, Litigation Management |


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CANADA Saskatchewan Workers Comp Board to Reduce 2010 Average Premium


The Saskatchewan Workers’  Compensation Board (WCB) proposes in 2010 to reduce its average premium rate by 1.8% to $1.63. It is the fifth premium decrease since 2004.

The proposal  will be presented to employer and industry organizations in a series of consultations to be held this week in Regina, Saskatoon and Prince Albert. Feedback from the meetings will be considered by WCB Board Members when final rates are determined in November. Final rates will be announced in December, and become effective Jan. 1, 2010.  The proposed 2010 rate continues a trend in rate reductions. Since 2004, the WCB’s average premium rate has dropped by 20.5%.

 ”Several factors  impacted our decision,” says WCB Chair David Eberle. “Most importantly, the provincial injury rate continues to drop. And that’s due to the safety and prevention work that employers and workers have done in workplaces across our province. Our vision of Mission: Zero has become the way many Saskatchewan workplaces approach their daily work.”

Eberle says  higher payrolls driven by the steady provincial economy did affect the 2010 rate proposal, but the key factors were injury numbers and injury claim durations.

According to Eberle,  the Saskatchewan WCB is in a fortunate position compared to nationwide peers. “Our current economic climate positively impacts the average premium rate. But if we don’t get a handle on bringing down the injury rate and keeping it down, the progress we’ve made since 2004 will be lost to a greater number of claims.”

Peter Federko,  chief executive officer of the WCB, added that the rate proposal means that 33,150 employers will pay lower WCB premium rates in 2010. Another 2,215 employers will pay the same rates as they did this year, while fewer than 4,700 employers will pay higher rates, based on their work injury record. Federko says workplace safety remains the surest way for employers to manage their WCB premiums. (workersxzcompxzkit)

“Building a workplace safety culture  that identifies and reduces hazards means there are fewer injury claims. That impacts an employer’s costs right away and means that workers go home safe everyday,” Federko noted.

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 860-553-6604.

We are accepting short articles* (300-800 words) on WC cost containment. Contact us at: Info@WorkersCompKit.com. *Non-compensable.

Reduce Your Workers Comp: www.ReduceYourWorkersComp.com/
Workers Comp Kit: www:workerscompkit.com/

New Article: Return to Work in Unionized Companies
http://reduceyourworkerscomp.com/Return-to-Work-Programs-Unionized-Companies.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.


©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in Canada Workers Comp, Insurance Issues, Rates, Premiums |


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How to Show the Financial Impact of Workers Comp Cost Containment


Reducing Lost Work Days Will Control Comp Costs 

Today we’ll talk about reviewing  how reducing lost days will help employers control workers’ comp costs.

To calculate  the financial impact of  having too many employees out of work, and not having a light duty, modified duty or transitional duty work program, use the http://www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php.  The Calculator is very helpful in showing employers how much they can save in EBITA or sales by returning injured employees back to work within an appropriate disability duration time period.  According to the 2009 RIMS Benchmark Survey, last year, the average cost per employee of workers’ comp was $755.

The survey gives  more detail by breaking down by size of company and by 14 industry groups. Typically, the cost per employee is less for larger companies, most likely due to the fact they have a larger base over which to spread the cost of risk.

Your insurance broker,  third-party administrator or insurance company in most cases can assist you in developing a program to lessen the cost of workers’ comp insurance and retained losses. Amaxx also provides a cost-reduction program in conjunction with Advisen, LTD. There is a discount for RIMS members.

Finally,  in order to start attacking the problem, it is important to find out why the costs are high. Getting your http://www.ReduceYourWorkersComp.com/workers-compensation-target-score.php is an excellent way to begin. (workersxzcompxzkit)

Much like  a credit score, the employer learns how many best practices they have implemented in each business location. There is also a discount for RIMS members.

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 860-553-6604.

WC Best Practices IQ Test: http://www.workerscompkit.com/intro/
WCBooks: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: www.reduceyourworkerscomp.com/calculator.php

A NEW Article: Return to Work in Unionized Companies

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workman’s comp issues.

©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in WC 101, Workers Comp Kit |


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How To Select a Project Team for Your Workers Comp Cost Reduction Program


Select Your Project Team

When you begin a cost containment program, think about it as a process — how will you tackle the problem, one bite at a time. It’s a problem, not unlike any other problem at your company, so approach it with a fresh perspective. First think about WHO will you need to work on the program with you, then you and the team can plan WHAT you need to do. The most important thing to do, is to take the first step. That is where most employers are derailed, before they begin, because they can’t take the first step. Here’s an overview of the 4 step process. It’s a fluid process, so you can change team members if that is necessary at some point.

Your Injury Management Planning Team should include:
1.
  Risk manager or workers’ compensation manager.
2.  General manager or plant manager.
3.  Director of personnel or human resources.
4.  Labor relations and others as warranted.
5.  External consultants provide industry expertise (optional).

The Planning Team will be responsible for:
1.
  Analyzing the frequency and severity of lost time injuries.
2.  Inventory and briefly analyze the open lost time claims.
3.  Review the company’s current procedures for claim handling, injury management, transitional duty and steps taking place when an injury occurs. (workersxzcompxzkit)
4.  Review loss trends with appropriate benchmarks.

Select Your Team Leader

Select a strong team  leader who has sufficient time to dedicate to the project because the team leader is expected to devote 90% of his or her time to the project.  If the team lead has an admin, it could take less than 90% of their time, because some things can be delegated. IF you are serious about implementing a program, plan to spend most of your time on the program for the first few weeks, then the time commitment will taper off, especially if the forms and templates in Workers Comp Kit® are used; using the kit will reduce the time required of you by at least 50%, because you won’t be starting from scratch. Your team  should include individuals who can influence the outcome of workers’ compensation activities in the workplace.

Consider selecting  team members from all walks of risk management as a first step in the Assessment and Recommendation Phase. You want teammates who can contribute vital information about all aspects of your current program, including vendor partners, associated claims, and reported losses.

Position titles  may vary from company to company, so you want to select teammates in comparable roles.
1.  Risk manager or injury coordinator; general manager or plant manager.
2.  Director of personnel or human resources.
3.  Labor relations and others as warranted.
4.  Company medical personnel.
5.  External consultants to provide industry expertise (optional).

The planning team  begins by identifying programs, activities, and procedures currently in existence at the company so a baseline can be established.  Think of it as an inventory including:
1.  Analyzing the frequency and severity of lost-time injuries.
2.  Identifying and analyzing open lost-time claims.
4.  Reviewing the company’s current procedures for claim handling, injury management, transitional duty and steps taking place when an injury occurs. (workersxzcompxzkit)
5.  Reviewing loss trends with appropriate benchmarks.

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 860-553-6604.

WC Calculator: www.reduceyourworkerscomp.com/calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
Follow Us On Twitter: www.twitter.com/WorkersCompKit

Return to Work in Unionized Companies
http://reduceyourworkerscomp.com/Return-to-Work-Programs-Unionized-Companies.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.

©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in Workers Comp Kit |


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CALIFORNIA Beating Workers Comp Fraud Case by Case


New Fraud Prevention Program Results in Conviction

“Work Comp fraud  goes beyond the few employees who abuse the system,” said Ron Paine, vice president of Risk Control for CHSI. “Phony providers and double billing are a major problem. Employees can be taken advantage of by unscrupulous attorneys. Our new  One Source  doctor network and our employee support program are going to help us in beating Work Comp fraud.” 

“Fraud hurts everybody,”  commented David Mitchell, chair of the California Restaurant Mutual Benefit Corporation (CRMBC Board.) “Employers face a challenging economy and Work Comp fraud makes it that much tougher. It can cost jobs. Our aggressive anti-fraud campaign is one of the reasons that we have been able to cut costs for our employer members.”

Under the new program,  (CRMBC) reports another conviction for felony workers’ compensation fraud committed against one of its employer members.

A California man  pleaded guilty in Ventura County to one count of work comp fraud after being arrested for collecting benefits illegally and making false statements while an employee of a CRMBC member in Ventura.

The individual  reportedly received more than $30,000 in tax-free disability payments while receiving treatment over a 15-month period. During this period he took a job at another restaurant. (workersxzcompxzkit)

At a deposition  following his arrest, the man reportedly denied working at any job since the injury. Intercare, the claims management company working for CRMBC, used its fraud investigation unit to develop information for the California Department of Insurance, Fraud Division. The District Attorney for the County of Ventura prosecuted the case.

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.

FREE TOOLS:
WC Calculator: www.reduceyourworkerscomp.com/calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
Return to Work in Unionized Companies
http://reduceyourworkerscomp.com/Return-to-Work-Programs-Unionized-Companies.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.


©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in California Workers Comp, Fraud and Abuse, Litigation Management |


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Have You Tried Calling Your Workers Comp Carrier?


Information is  the most essential ingredient in work comp claim management, but from where does information originate? The employer  tends to see itself as a source of information more than a recipient, believing, or hoping, the carrier will make all necessary efforts to gather useful facts – but is the carrier doing its job? The answer is a phone call away. Carriers are equipped  to obtain information contained on mandatory forms, such as reports of injury, and to a lesser extent, information obtained by investigators.   But, what about information appearing unannounced and unexpected? That is the sort of information which is often the game changer in difficult claims, especially those involving fraud or undue exaggeration of the disability. Such information  comes from sources close to a worker – co-workers, acquaintances, neighbors and relatives – who are understandably cautious in reporting suspicious behavior but sufficiently upset by it to make an effort to report it. A single phone call from such sources can save an employer hundreds of thousands of dollars — but only if the phone call gets through.  Social Security and the IRS go to great lengths to move such calls into dedicated hot lines but does an employer's carrier? An employer  should find out by making a call to its carrier, avoiding the inside numbers and calling on the general numbers found on websites or in phone books – the very places an unconventional source will seek them. What usually follows will in most cases leave a employer troubled, especially if it has a suspicious claim in progress. Carriers, for  nearly two decades, have relied on phone systems designed to delay a caller from reaching a live employee. Even then, it is usually an operator who directs the call to an answering machine were a recorded message informs the caller to leave a name, phone number and purpose of the call someone will call back. An employer  should test how long it takes to receive a call back when the caller is identified as someone who "has important information" and is reluctant to leave a full name. Most callers with sensitive information are reluctant to do even that much, preferring to hang up as soon as they are connected to an answering machine. If the employer leaves a name and phone number on an answering machine and never receives a return call the employer is only experiencing the same reception given to the most valuable calls. An employer, therefore, must consider itself the guardian of its claim info and take special steps to see that it is transmitted to, and acted on, by proper units within a carrier. If the claim has been in progress and the carrier has appointed counsel then counsel should also be copied, with a request that counsel call the employer to discuss the info. (workersxzcompxzkit) An employer  should not hesitate to request a conference with the claims supervisor to discuss unanswered calls or ignored claim material.  Nor should an employer be kept distant from the "carrier's" attorneys. (The attorney's primary client is always the employer – not the carrier – even when the attorney is selected by the carrier.) Author: Attorney Theodore Roncais a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers' compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. We accept articles on WC cost containment. Contact us at: Info@WorkersCompKit.com.

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers' comp issues.

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