For failing to carry compulsory Employers’ Liability Insurance (workers’ compensation insurance) a shop owner was fined £2,100 ($3,147.00) and ordered to pay £1,850.80 ($2,773.00) in costs following an investigation by the Health and Safety Executive. HSE’s investigation found the employers violated the insurance requirement four times.
While public liability insurance is generally voluntary, employers' liability insurance is compulsory and enables an employer to meet any costs relating to employees' injuries or illness whether caused on or off site.
HSE Inspector Andrea Robbins, said there is no excuse for not having the insurance. "Employers' Liability insurance is a legal requirement for all employers in Great Britain," Robbins commented. "As well as being a legal requirement, the insurance offers important protection for employers if an employee is injured or suffers from disease as a result of their work. (workersxzcompxzkit)
"The failure of employers to insure is seen as a serious matter and HSE will continue to refer appropriate cases to the magistrates for their consideration."
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
When the Administration announced early last year it would not prosecute law-abiding marijuana growers and sellers in states with medical marijuana laws, the number of medical marijuana dispensaries in California exploded. There are now approximately 2,000 medical marijuana dispensaries in California.
California is not the only state with legal medical marijuana, it is also legal in 13 other states –Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada,
New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington. Twelve other states are in various stages of pending legislation on the use of medical marijuana.
In the states were medical marijuana is approved, it is used in the treatment of cancer, glaucoma, HIV/AIDS, nausea, chronic or severe pain, seizures and some other medical conditions. Chronic or severe pain is the medical condition that has triggered work comp claims testing the boundaries between medical marijuana and workers' compensation. (Of the 14 states approving medical marijuana, only Maine does not permit its use for chronic or severe pain).
In a recent California claim where a work comp claimant was seeking approval to use medical marijuana to treat his work place injury, the judge hearing the case would not make a decision. The judge decided to let an independent medical evaluator determine whether or not marijuana should be provided to the claimant. The independent medical evaluator ruled the claimant had other medical options available to him and denied the use of medical marijuana in treatment of the claimant's work comp claim.
While the California claim did not result in the claimant being prescribed marijuana for his work comp injury, it created a bad precedent. It set the stage for other claimants and their attorneys to petition for the use of medical marijuana. Given a different set of facts, the next independent medical evaluator may decide it is an acceptable treatment in work comp claims.
Colorado and Michigan are two additional states where employees have raised the question of medical marijuana for treatment of their pain conditions.
As it becomes more acceptable for doctors to prescribe medical marijuana for pain management, the potential for its use in the field of workers’ compensation grows. The argument for medical marijuana will be that it is less addictive than heavy narcotic medications like Oxycontin and a lot cheaper.
IF medical marijuana becomes an acceptable treatment for pain management, a “side effect” of medical marijuana being “legalized” for workers compensation will be the increase in the number of questionable or fraudulent work comp claims. There will be questionable claims made for back pain or other subjective injuries where the employee's sole purpose in filing the work comp claim is to obtain marijuana paid for by the employer's work comp insurance.
The introduction of medical marijuana into the work comp system will also create various other problems for the employer. Additional problems would include: (workersxzcompxzkit)
1. Who will control the dosage amount and the frequency of use?
2. Who will pay for the prescription?
3. How will employers enforce a drug-free workplace program?
4. How will safety programs be affected?
So far we have only seen the tip of the medical marijuana iceberg. The topic of medical marijuana for use in the treatment of work comp claims will continue to be pushed by those actively using marijuana (often before the work comp injury occurs). It behooves employers and those involved in the processing of work comp claims to watch for further developments in this area over the coming year.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
As the Risk Manager of your company, you put off as long as possible investing in a claims information system, but you joined the twenty-first century and purchased a state of the art claims computer system.
Or, if your company still cannot afford the computer programming and software needed for the claims information system, you negotiated for access to your claims data with your insurer or third party administrator. Now how can you make the most of your claims information system?
If your claims computer system is flexible you can customize the reports you want to address the issues important to you in your role of managing the work comp claims. If the claims computer system is less flexible, your IT department can produce the reports for you. Here are some recommended reports to assist you in controlling your workers’ comp claims and eliminating work comp claims data in your loss runs. (Some reports you may want every month; others reports on a quarterly basis or maybe only annually).
Controlling Claims
To properly control your claims you need more than the number of new claims open and the number of claims closed. With a good computer system you customize the reports to identify:
1. Employees (by social security number or employee number) who have had a prior work comp claims, prior claims date of loss, prior claims loss coding, payments, etc.
2. Claim files with numerous (you determine the number) reserve changes –stair stepping of reserves.
3. If you require claims above a certain dollar level to be reported to a supervisory location, identify claims reserved at $1,000 or less below the reporting threshold.
4. Files without claim note activity for six months or longer.
5. Files without any payment, indemnity, medical or expense in over six months.
6. Closed claims with payments over $1,000.
7. Claim counts by age of claims.
8. Medical only claims that have been open over 3 months.
9. Lost time claims that have been open over 6 months.
10.Medical only claims over a dollar threshold you set.
11.Lost time claims over a dollar threshold you set.
12.Lost time claims without a return to work date.
13.Lost time claims without an indemnity payment.
14.Lost time claims without an indemnity reserve.
15.Medical only claims with an indemnity payment.
16.Medical only claims without a medical reserve.
17.Claims with a reserve increase over a dollar threshold you set.
18.Reserve changes made within 30 days before settlement.
19.Claims over a year old with no reserve changes since initial reserve.
20.Negative reserves or amount paid greater than reserve.
21.Claims without an ISO index filing.
22.Claims with subrogation potential (from loss description).
Controlling Data
With a modern computer system you quickly identify data errors. You will often see the following data errors in your loss runs due to clerical or adjuster indifference, i.e., the clerical staff or adjuster did not want to take the time to obtain the correct information. (Once you start requiring the clerical staff or adjusters to correct their data errors, a lot fewer of them will occur). Some data errors to look for would include:
1. 99-year-old employees (an age is required for the computer input and it was not known at the time the claim was put into the system).
2. Employees with a social security number or employee number of 999-99-9999 or 000-00-0000.
3. No cause of loss, no loss location, no employee name, no loss description.
4. If your system uses body part coding and a injury code, look for illogical combinations like a big toe that suffered a heart attack.
5. Duplicate claims numbers set up for the same claim.
1. Location codes that do not belong with the state code used. (workersxzcompxzkit)
2. Illogical claim dates opening dates or closing dates like 3-17-17 or 7-12-74.
Other Reports
Take a moment to think about the issues or problems you confront on a regular basis with you work comp claims. What data do you need to eliminate or better handle the issue or problem? The suggested reports are a good start in using your claims computer information system, but these reports should not be the end of your claims information. Anything that can be in putted into your claims information system can be retrieved and compiled by your computer to give you the answers you need in managing your claims and your claims data.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
The old adage “Time is Money” definitely applies to the handling of workers' compensation claims. Experienced claim professionals know the longer a work comp claim remains open, the higher the overall cost to conclude the claim. Every delay along the path from the start of the work comp claim to its conclusion costs your self-insured program or your insurer money (eventually coming back to your company as higher work comp insurance premiums).
Here are some tips and suggestions on ways that you, the employer, can speed up the processing of your workers’ comp claims.
Pre-accident Training
Every employee needs to know what to do in the case of a work comp injury. Your company needs to set the stage for your involvement in the work comp claim process from the very beginning.
Your new hire package must include instructions on the proper and timely reporting of the work comp injury. The accident reporting instructions must specify that the injury must be reported immediately, to whom the employee reports an injury, who are the approved medical treatment providers (in the jurisdictions where this is permitted) and information informing the employee of the return-to-work program your company uses.
Display, where all employees can see them, posters and/or billboards clearly showing these requirements, including the importance of immediately reporting the work comp injury. Be sure to post these materials in the employees’ prime languages in addition to English.
Remind supervisors and manager on a regular basis that all work comp injuries are to be immediately reported to your work comp claims coordinator. The supervisors and managers should be familiar with the information required to complete the First Report of Injury form required in their state.
Prompt Reporting
When the work comp claims coordinator receives the information about the new work comp injury, the claims coordinator immediately reports it to the claims handling office. If for any reason the claims coordinator does not have all the information necessary, the claim is still reported to the claims office with a note indicating the rest of the information will be forthcoming as soon as it is available. This allows the work comp claims adjuster to go ahead and get started on the claim.
Claim Service Standards
When your company starts an insurance program, the insurer or third party administrator (TPA) should provide you with information on their claim handling service standards. Those service standards usually specify within how many hours the adjuster will contact the employee once the claim is reported to the claims office. Great service standards specify the employee will be contacted within 2 (or 4) hours, while good service standards specify the employee will be contacted within 24 hours. If the service standards are silent on how fast the work comp adjuster will be in contact with the employee, ask them to make the 2-hour contact with the employee a claim-handling requirement on your files. If the insurer or TPA is reluctant to require prompt contact with the injured employee, it is time to get another insurer or TPA.
Employee Follow-up
When employees are injured, they are concerned about their future with your company, their future income and their ability to care for their families. When the employee's supervisor or your company's work comp claims coordinator contacts the employee shortly after the accident, the employee knows and feels s/he is valuable to the company.
When the employee initially reports the claim to the employer, the employee is instructed to keep the employer informed of medical treatment and medical progress. Emphasize the employee can expect to hear from the employer if the employee does not provide timely updates to your company.
Keeping in contact with injured employees lets the employees know the employer cares about them and their well-being. Employees who feel valued by their company are less likely to malinger off work when they could return to work, or hire an attorney.
For employees who are off work for an extended period of time, the claims coordinator should be contacting them on at least a monthly basis to inquire about their condition, their treatment and their expected return-to-work date.
Medical Follow-up
In the majority of states the employer is allowed to contact medical providers in regards to when the employee is medically able to return to work. Regular follow up with medical providers reinforces the importance of the employee returning to work.
Return to Work Program
Employees should know the expectation is they will return to work as soon as medically able. Often an employee is willing to return to work, but the treating physician is concerned that the employee may be re-injure by attempting to return to work before full recovery from the accident. Or, the employee is afraid to return to work because of concerns for his/her own safety. To protect themselves from malpractice claims, doctors often keep employees off work longer than is necessary.
The best way to alleviate both the fears of the employee and the fears of the doctor is to have a modified duty return-to-work program available to accommodate the employee. A modified program allows them to return to work before they are 100% recovered from their injury. The return-to-work program is structured to remove from the employee's regular routine the activities the doctor feels could possibly cause the employee to be re-injures, whether it is a lifting restriction, standing restriction, bending restriction, etc.
The sooner the employee is back on the job, the sooner the employee fully recovers from the injury. A modified duty program provides the employee with physical reconditioning for the work they will be doing when the job restrictions are lifted by the treating physician.
The return-to-work program has a major impact on the amount of temporary total indemnity benefits are paid to the employee, reducing your overall work comp cost. Plus, when the treating physician states the employee has reached the maximum medical improvement, the employee who is back to work will normally receive a lower permanency rating then the employee who is still off work. The lower permanency rating also translates into lower work comp cost for your company. (workersxzcompxzkit)
Summary
the proper steps throughout the work comp claim process from before the accident occurs, to when the employee returns to work, the employer sufficiently reduce the lag time in workers’ comp. The time saved translates into savings for the employer through lower workers' compensation cost and improved productivity by the employee being back on the job sooner.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
It’s a fact — employers who actively manage their drug-free workplace program benefit from higher productivity, fewer work related accidents, lower absenteeism and lower medical cost (both from medical insurance claims and workers' compensation claims). Unfortunately 38% to 50% of all workers' compensation claims are related to substance abuse according to the Tennessee Department of Labor. At least a dozen states require the workers' compensation insurers to offer your company a premium discount if your company has a drug-free workplace program.
To achieve the benefits of a drug-free workplace, you need a drug-free workplace policy that is properly managed.
Management of a drug-free workplace program should include all of the following:
1- A Published Drug-free Workplace Policy
When your company implements a drug-free workplace policy, all current employees and all potential new hires must receive a copy of the drug-free workplace policy with an acknowledgment form. Employees or potential new hires are required to read, sign and date the acknowledgment form. Employers need to communicate to their employees that the acknowledgment form becomes a part of their personnel file.
A Drug Testing Program in Hiring
Every time you advertise to hire a new employee whether it is on the internet, newspaper or other media, always include a notice “We drug test all employees.” This approach eliminates many future problems as most regular abusers of drugs or alcohol will not apply for employment at your company.
It is also recommended all job interview locations display a large poster with wording similar to: “We Are a Drug-Free Employer. We Drug Test.” Display the poster where all job applicants cannot fail to miss it.
As a condition for employment, a pre-employment drug test should be performed (a few states require the drug test to be performed after they are hired). As a part of the drug-free workplace policy, all new hires must be free from any substance abuse. If the potential employee tests positive for drugs, the offer of employment immediately withdraw the offer of employment.
Never make the mistake of making an exception to the drug-free workplace policy in regards to hiring or employment of a substance abuser. If you do, you have invalidated your drug-free workplace policy, as all substance abusers will want “equal treatment.”
All new hire benefit packets given to the employees should include a pamphlet on drug abuse and abuse prevention. The packet serves as a reminder to the new employee that your company continues to place an emphasis on a drug-free workplace after hiring.
2- Random Drug Test
Most substance abusers know if they are “clean” for a week or more prior to taking their pre-hire drug test, the urine samples come back negative. They abstain from their bad behaviors prior to your pre-hire drug test, they test negative, you hire them and then they return to their previous substance abuse. The best way to combat this is for the new hire (and all employees) to know random, on-going drug testing is a condition for employment at your company and a positive drug test is grounds for immediate termination.
Random testing is a strong deterrent to on-going substance abuse by your employees. It is recommended you drug test at least half of your employees every year with the drug test being performed on a totally random basis. If you test one percent of your employees each week, you will test half of them in each calendar year.
As a part of your drug-free workplace policy, the employees grant your company permission to drug test any employee any time there is a reason to suspect drug or alcohol abuse. Your supervisors and managers should be trained to recognize the symptoms of drug abuse whether they are performance, behavioral or physical in nature.
3- Workers' Compensation Claims
Approximately 40 states allow or consider the denial of a workers’ comp claim if the injured employee was under the influence of alcohol or illegal drugs at the time of the work comp injury. Therefore, as a part of your drug-free workplace policy, a drug test should be required at the time of the initial treatment for any work comp injury. (If the employee tests positive for illicit drugs, and you terminate the employee for violation of the drug-free policy, many of the states will consider being under the influence as grounds for termination and will deny unemployment benefits to the terminated employee).
Post accident drug testing does cost money. However the money spent on the drug test is money well spent (remember the 38% to 50% of work comp accidents involve substance abuse). The amount of money saved on work comp claims, appropriately denied due to the employee’s use of illicit drugs or alcohol, far exceed the cost of the drug test.
4- Employee Awareness and Education
The poster “We Are a Drug-Free Employer. We Drug Test” or similar posters are not only displayed in the job interview locations within your company, they also are prominently displayed throughout your company. Good locations include in the parking garage or lot, at entrances to your building, in elevators, break rooms, time clock, etc.
Provide brochures, pamphlets and CDs on substance abuse prevention to all managers, supervisors and employees on a regular basis, at least yearly. If you still pay by pay envelope (instead of direct deposit) the brochures can be added to the pay envelope. E-mail is also a very effective way to put the message in front of the employees stating substance abuse is not tolerated.
5- Supervisor Training
Train your managers and supervisors to recognize the symptoms of drug and alcohol abuse. On-going training, at least annually, is key to keeping your managers and supervisors alert to the symptoms of substance abuse. Supervisors and managers with the proper training are then able to identify and deal with the employees suspected of having a substance abuse problem. (workersxzcompxzkit)
Summary
A properly managed drug-free workplace policy has a significant positive financial impact on your company. The number and severity of workers' compensation claims will be reduced, lowering the cost of your work comp premiums. In addition to lower work comp cost, you company will experience reduced absenteeism, reduced turnover, better employee morale and lower medical insurance cost.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
Questions to Ask
Do you ever wonder if the claim handling quality of your insurer or third party administrator (TPA) is as good as it should be?
Do you ever find your insurer or TPA making large reserve changes just before it settles a work comp claim?
Is your insurer or TPA recovering every subrogation dollar it should?
Is your insurer or TPA doing everything it should to resist fraudulent claims?
If you have any of these concerns, you should consider hiring an independent claims auditor to review your workers’ comp claims.
1- Claim File Quality Audits
Your company's service agreement with your insurer or TPA should specify the claim handling standards — the Best Practices– that apply to all of your workers’ comp claims. An audit of the work comp claim file quality focuses on the components of claim handling that optimize the claim resolution results.
The work comp claim file review compares your files against the Best Practices standards you agreed to with your insurer or TPA. The experienced auditor reviews and analyzes how the various aspects of the file interrelate to give your company a total picture of how each individual file is/was handled.
When the audit is concluded, your auditor provides you with an Executive Summary Report outlining the audit findings. The Executive Summary Report outlines your claim handlers strengths and weaknesses. The report provides you with valuable information and recommends solutions allowing your company to avoid future difficulties. The completed claims audit provides your risk management department with peace of mind, or it assists your company to know where your claims are deficient, allowing you to take the appropriate action before you incur extra claim cost.
2- Reserve Audits
When reserves are set too high on your work comp claims, your company's ability to undertake new business is unnecessarily limited and it may impact your company's ability to get financing. When reserves are set too low, your company's available assets are overstated, eventually resulting in unanticipated shortfalls.
Reserves need to be state accurately and they need timely adjustments — soon as information impacting the reserves becomes available. The independent claims auditor evaluates the reserve accuracy and timeliness of reserves for individual claim files and for the entire work comp claim inventory.
Whether you need a reserve audit for underwriting and renewal, retro premium adjustment, a merger/acquisition, collateral adjustment, the professional claims auditor provides you with the accuracy of reserves you need. The reserve audit gives you an objective analysis of your financial funding needs.
3- Subrogation Audits
Every dollar recovered by subrogation is a dollar added to your firm's bottom line. Often busy adjusters overlook subrogation opportunities. Subrogation must be looked for in every work comp claim. While your work comp adjuster knows to pursue subrogation on clear-cut automobile accidents, the work comp adjuster often does not have the liability expertise to recognize the potential for recovery when the work comp claim involves elements of general liability or products liability. The professional claim auditor identifies these potential recovery opportunities and maximize your recoveries.
Subrogation audits are considered for all open files and for closed files still within the statute of limitations. Subrogation audits pay for themselves by bringing in otherwise missed recoveries. When the subrogation audit can be done electronically, your independent work comp claims auditor may often perform the audit for a percentage of the identified file review recoveries.
4- Fraud Audits
An increase in fraudulent work comp claims are being filed during current economic hard times. Nothing hurts the bottom line of your business more than a fraudulent claim, as it is a theft of the amount of money paid on the claim and, as we all know, the company’s loss history is used as the basis for future premium charges. (workersxzcompxzkit)
Separating the fraudulent claims from the legitimate claims can be difficult. The professional auditor can assist in identifying those claims where more can be done to disprove the fraudulent claim.
Summary
The professional claims auditor provides your company with the information you need to determine the claim handling quality of your files. The auditor assists you in verifying or correcting the accuracy of file reserves. A subrogation audit pays for itself in additional identified recoveries, while a fraud audit save your company from paying fraudulent claims. All four types of audits improve the financial status of your company.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
Our fraud message is clear – employers must pursue any and all workers’ comp claims where there is even a hint fraud is taking place. Be bold – investigate. Lately, video-taping seems to be working well. Make sure to check state law though, because in some states, like OH and CO are more restrictive.
Videotape showing a Buffalo man repairing a BMW led to his arrest for collecting $3,850 in workers' compensation benefits he accepted after testifying he was physically unable to walk without assistance or even go grocery shopping.
The New York State Insurance Department reported the individual was arrested following a joint investigation by the Department's Frauds Bureau and Travelers Insurance Company investigators.
The individual, who was released pending a future court hearing, started collecting workers' comp benefits after suffering a back injury while working at a salt factory. Last year, he testified at a workers' comp hearing that the injury prevented him from working or engaging in normal activities, like going to the grocery store.
However, surveillance investigators captured videotapes of the individual demonstrating him working on a car and moving about without assistance. (workersxzcompxzkit)
The man was arrested by Buffalo police and charged with grand larceny and workers' comp fraud.
He could be sentenced to up to seven years in prison if he is convicted.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 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 Seattle man was sentenced to six months of electronic home monitoring and must pay more than $26,000 in restitution for first-degree theft in an insurance case, according to the state Office of the Insurance Commissioner.
The OIC reports the man claimed an on-the-job back injury to his employer in 2006. He was placed on temporary total disability and received disability pay from his employer's insurer, Alaska National Insurance. Doctors subsequently ruled him unable to go back to work.
Five weeks following the injury, investigators working for the insurer videotaped the suspect working on his sailboat at a Seattle marina.
The sanding, painting, climbing and moving of machinery were all contrary to the physical restrictions imposed by his doctors, according to the Washington insurance commissioner's Special Investigations Unit.
When shown the video, the independent medical examination doctors who had originally seen the individual reversed their original opinion as to his ability to work. (workersxzcompxzkit)
The man pleaded guilty to the charge. The restitution covers unnecessary medical expenses and disability benefits that he was not entitled to.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
How Would You Decide? Statutes of limitation for occupational disease vs. injury. When a disease can also be a workplace injury?
Here's what Tom Robinson, J.D., writer for Lexis Nexis Workers Comp Law Center reports.
Here's What Happened
Burress worked at IBP's meatpacking plant from 1987 until 1997. His first few years of work involved significant contact with hogs and hog blood and on at least one occasion during that early time period, he cut a finger while working with the hogs.
During his last eight years of work he worked in IBP's trolley room, where he did not have much contact with hogs, but occasionally did come into contact with hog blood. During this latter period, Burress indicated he cut his finger and elbow and sustained a superficial puncture wound to his face. Six years after leaving IBP, Burress was diagnosed with brucellosis with osteomyelitis. He alerted IBP of a potential workers' compensation claim by letter. On January 3, 2005, Burress filed a claim alleging injury through contact with blood products and tissue from slaughtered hogs.
IBP contended the injury was, if anything, an occupational disease and that Burress' recovery was barred by Iowa Code § 85A.12, which generally required a claim to be filed no later than one year after Burress' last exposure. The deputy commissioner disagreed with IBP, finding that Burress contracted brucellosis as a result of trauma, that Burress did not become aware of his condition until early December 2004, and that his petition for benefits was filed within two years, as prescribed by chapter 85.
The commissioner affirmed and IBP petitioned for review with the district court. That court reversed the agency's decision, finding that Burress suffered from an occupational disease, not an injury, and that Burress had failed to file his petition within one year after the last exposure. After an intermediate appeal to the state court of appeals, the case reached the state supreme court.
Here's What the Court Decided
In IBP, Inc. v. Burress, 2010 Iowa Sup. LEXIS 18 (Mar. 5, 2010), the Supreme Court of Iowa held there was sufficient evidence to support the commissioner's finding that Burress had sustained an injury and not an occupational disease. Accordingly, his claim was not barred by the one-year statute of limitations related to occupational diseases. Acknowledging that brucellosis was included within the list of compensable occupational diseases, the high court stated that the disease could, nevertheless, be an "injury" under appropriate circumstances, such as when the germs gained entrance through a scratch or through unexpected or abnormal exposure to infection [quoting Larson's Workers' Compensation Law]. (workersxzcompxzkit)
The court also observed that in Perkins v. HEA of Iowa, Inc., 651 N.W.2d 40, 43 (Iowa 2002), it had determined that an employee's hepatitis C was an injury because her "infection was linked to a sudden, specific incident of exposure." [Id. at 43]. That Burress could not point to a specific incident did not bar recovery, indicated the court, since the likelihood was that his condition had been contracted through contact with the hog blood at a time when Burress had some open wound. The court also held, however, that there was an issue as to whether Burress had provided notice to IBP of his claim within 90 days of discovery. The case was remanded for such a determination.
See generally Larson's Workers' Compensation Law, §§ 51.01, 51.02, 51.03.
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
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
Employers whose injury and illness rates are considerably higher than the national average are being surveyed by the U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) to collect workplace injury and illness data. Information gathered helps identify workplaces needing to improve their workplace safety programs.
OSHA sent a letter to about 15,000 workplaces with the highest numbers of injuries and illnesses resulting in days away from work, restricted work activities or job transfers, known as the DARTrate.
"Receipt of this letter means workers in that particular establishment are being injured at a higher rate than in most other businesses of its kind in the country," said Assistant Secretary of Labor for OSHA Dr. David Michaels. "Employers whose businesses have injury and illness rates this high need to take immediate steps to protect their workers."
Employers receiving the letters also receive copies of their injury and illness data, along with a list of the most frequently cited OSHA standards for their specific industry. The letter offered assistance in helping to reduce workplace injuries and illnesses by suggesting, among other things, the use of OSHA's free safety and health consultation services for small businesses provided through the states. (workersxzcompxzkit)
OSHA identified businesses with the nation's highest rates of workplace injuries and illnesses through employer-reported data from a 2009 survey of about 100,000 worksites. (This survey collected injury and illness data for calendar year 2008.) Workplaces receiving notifications had DART rates more than twice the national average among all U.S. workplaces.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 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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