The term “average weekly wage” is often used in the discussion of workers' compensation claims. As it is the foundation on which almost all workers' compensation indemnity payments are based, let's discuss it in detail.
The average weekly wage (AWW) is the amount of income the employee earned per week at the time of the workers’ compensation injury or work related illness. [In some states it is referred to as the “state average weekly wage” (SAWW). In this discussion we will use AWW throughout].
Determination of the AWW:
The amount of income an employee averages per week seems simple enough, but when state governments get involved in the determination of how AWW is calculated, it becomes more complex.
Most states calculate the average weekly wage over the last 12 months, but in a few states the average weekly wage is based on the last 90 days. Let's look at some of the ways AWW can be calculated (with the caveat that with 50 states, the U.S. Territories and the District of Columbia each doing their own thing, there can be an exception to almost all of the following points):
1. If the employee's weekly income does not change, for instance the employee is on a weekly salary, the amount of the AWW is easy to determine.
2. For workers paid a monthly salary, the monthly salary is multiplied by 12 and then divided by 52 to determine the AWW.
3. For hourly workers, the number of hours per week is multiplied by the hourly wage to get the AWW.
4. For workers paid by the number of pieces of production, or paid commission or paid mileage (truck drivers paid by the mile), the total income earned over the last 12 months is divided by 52 to determine the weekly income.
5. For workers paid a daily rate or on a per diem basis, the daily amount is multiplied by the number of days worked in the last 12 months and then divided by 52 to determine the AWW.
General Add-Ons:
Just when you think you understand the calculation of the AWW, several states, territories, and District of Columbia have their own ways of adding to the AWW calculation. Depending on the jurisdiction, the AWW has been expanded to include:
1. Overtime pay
2. Bonuses
3. Health insurance and dental insurance if the employer does not continue to provide it while the employee is off work due to the work comp claim.
4. Rent, housing, lodging if the employer was providing it before the work comp injury but does not provide it after the work comp injury.
5. Tips over and above the hourly rate paid to waiters and waitresses.
6. Per diem amounts paid over and above salary or commissions, if they are reported as income for income tax purposes
Cringe Factor Add-Ons:
Now that you think you understand the AWW is the employee's income plus any other employer provided compensation, we get some more add-ons causing employers to cringe when they hear about them . . . such as:
1. The double dippers: Your employee John Doe started working for your company two years ago. Doe's regular hours are 8 a.m. to 4 p.m. Two weeks ago Doe took a second job working 4:30 p.m. to 12:30 a.m. Today he hurts his back at your company (really questionable injury, but he will be out of work a couple of months before the adjuster and/or nurse case manager can convince the doctor to get him back to work).
Guess what . . . . in most states your company does not pay John Doe the AWW based only on your company's job if he is also unable to work his second job. The employee is paid the AWW plus add-ons from both jobs by your work comp insurance! [In an effort to be fair to employees who work two jobs, the states who require this add-on have inadvertently created a situation sure to invite employee fraud].
2. The gone but not forgotten worker: Employee Jane Doe (sister of the double dipper John Doe) also worked for your company. After returning to work after her own work comp injury, she leaves your company's employment for a much higher paying job at her new employer. After working for her new employer for over a year, Jane Doe's medical condition worsens from her work comp injury sustained when she worked for your company and now she is unable to continue to work per the work comp treating doctor.
Guess what . . . . in some states you reopen her work claim, but you do not pay her the AWW from her work at your company — you pay the AWW for the work at her new employer!
Calculation of Benefits Using the AWW:
Each of the states, territories and DC use a percentage of the AWW to calculate the amount of benefits to be paid. One hundred percent of the AWW is not used because the employee does not “take home” his total income. The employee has to pay out of the AWW his federal income tax, state income tax, city income tax, social security, Medicare, benefit contributions, union dues, etc.
While most states used sixty-six and two/thirds percent (66.66%) of the amount of the AWW to calculate indemnity benefits, a couple of states use seventy percent (70%) and a few states use eighty percent (80%) of “spendable income” or “after tax” income. All jurisdictions impose a cap, a maximum amount of benefits the employee can receive each week, regardless of the AWW. The states vary tremendously in this aspect, with state caps on weekly indemnity benefits at the top of the range being more than twice what the state cap amounts are on at the bottom of the range.
While two-thirds of the AWW seems reasonable, in most work comp claims the employee is receiving less than he would have if he was not injured and continuing to work. This encourages the employees to return to work when they are physically able to do so. However, in some states that have high state income taxes and the state weekly indemnity benefits cap is high, the employee is receiving more per week on work comp then he would take home after paying taxes, benefits, union dues, etc. This situation makes it difficult for the workers’ comp adjuster to get some procrastinating employees back to work.
Some states require the work comp adjuster to submit to the Industrial Commission a state form outlining how the AWW was calculated and how the indemnity benefits are calculated. Other states do not get involved in the calculation of the AWW and the resulting indemnity benefits unless a dispute arises between the employee and the employer over what is the correct amount of the AWW. (workersxzcompxzkit)
Summary:
As the indemnity benefits are based on the AWW, it is in the employer's best interest to be sure the employee's AWW information reported to the work comp claims office and/or the work comp insurer is correct. If there is any doubt on what to include in the AWW for your state, use your state's form for reporting the AWW information, if your state uses one. If not, consult with your work comp adjuster on any questions on how to calculate the AWW for your particular state. Also, you may contact us for assistance. See: 50 State Laws and Regulations at
http://reduceyourworkerscomp.com/laws_and_regulations.php
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.
All employers in all sectors of industry in Great Britain are being urged to play their part in sharing information to prevent accidents.For more Information: www.reduceyourworkerscomp.com
The Health and Safety Executive (HSE) has revamped its Safety Bulletin system used to warn industries of problems with equipment, process, procedures and substances leading to injury, with bulletins now available automatically via email, text message or RSS feed, as well as on the website.
HSE recently held a workshop, “Safety Alerts: Everyone Has a Role to Play – What's Yours?,” to demonstrate the benefits of its new system and to encourage industry to do more to help improve the safety alert system as a whole. HSE is asking employers to find more effective ways to share safety information with their own employee alerts.
Workshop participants committed to actions – such as, reviewing the format and method of issuing alerts; sharing alert information with other industries; and setting up forums to share best practices. In return, HSE pledged ongoing support to industry to help organizations progress with their commitments.
HSE Chair, Judith Hackitt noted, "With this new and updated way of issuing safety alerts, we are initiating a better, joined up approach to sharing information that will help towards reducing death and injury at work. HSE is keen to move with the times and take advantage of new ways of communicating.
"We are encouraged by the positive response we have already seen from a number of sectors, but we need to get all areas involved to maximize the benefits of this approach. I am confident that British industry will rise to the challenge of protecting workers through this new system."
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.
What are Government Pools?
Government pools are a form of risk management where small local governments within a single state—towns, small cities, counties, water districts, parks & recreation, public bus lines, etc.,—join together to form a non-profit association to share the risk of loss. The members of the pool collectively self-insure their insurance exposures through a participation agreement. For more Information: www.reduceyourworkerscomp.com
Most government pools operate along the same principles as an insurance company, but the membership is limited to the governmental units within their state. The members of the government pool elect a Board of Trustees from their members, The Trustees are responsible for the strategic direction of the pool. The Trustees can operate the pool or they can select a management team to oversee the management duties of the pool.
Why are They Formed?
During the times of hard insurance markets (when underwriting standards become more rigid and insurance premiums increase due to higher than expected insurance claim cost), it often becomes very difficult or impossible for local governments to buy certain types of insurance coverage from insurance carriers. Insurance companies often look at governmental entities as a higher risk, resulting in escalating premiums if they provide insurance coverage at all.
Government pools are normally created to provide both a consistent and affordable means of insurance coverage. The pools are not designed to create an underwriting profit, but to provide the insurance coverage needed. Therefore, the rates paid by pool members do not include an element of profit, making the overall rates paid by pool members more affordable.
What are Their Objectives?
The primary objective of government pools is to meet the insurance needs of the municipal governments and governmental entities that are members of the pool. By joining together, the members of the pool can jointly manage risk and prevent changes in the insurance market from creating financial difficulties for their members’ budgets. The government pool provides the members an effective way to control the cost of insurance.
What do They Do?
Most government pools are multi-line providers of health insurance, liability insurance, workers' compensation insurance and property insurance to their members. The government pools not only provide the insurance coverage, they also manage the member's claims either through their own staff of adjusters or by providing oversight of a Third Party Administrator hired to handle the insurance claims.
In addition to providing insurance coverage, the government pools usually provide loss control services to the members. They encourage members to educate themselves on how to prevent or minimize their losses.
What is the Member's Contribution?
The members' contribution is calculated along the same lines principles as they would be with an insurance company. For workers' compensation the contributions are based on each member's payroll with rates established by the Board of Trustees for the government pool. Based upon the pool's reserves and assets, the rates charged to the members may be reduced upfront by the pool's management.
Pool members are given the option to lower their insurance cost even further. If the member can afford to carry a high deductible, they can elect to do so. The pool's claims adjusting office will handle the claim to a conclusion and then have the member reimburse the amount of their deductible to the pool.
What are Their Benefits?
In addition to providing a lower cost for insurance coverage, government pools often provide most or all of the benefits of a large insurance company, including:
1. Payroll audits are usually conducted annually at no cost to the members
2. The pool will have on staff or under retainer legal counsel to assist the members in local government specific issues
3. Loss control programs
4. Safety programs
5. Guidance is provided to members on risk management issues and insurance issues
6. Claim handling services are provided
- Electronic claim reporting or toll free claim reporting
- PPO network
- Medical bill review
- Pharmacy program
- Nurse case managers
- Vocational case managers
- Litigation management
Summary:
Government entities can lower their overall cost of insurance by participating in a risk-sharing governmental pool. (workersxzcompxzkit) The non-profit pools, owned and operated by the members, save the local taxpayers money by reducing the operating cost of the local governmental entity.
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.
We all know it is the employer's responsibility to purchase workers' compensation insurance coverage and to report a claim to the claims office when an accident occurs. Unfortunately, way too many employers end involvement in workers' compensation at this point. It’s expensive to be passive about workers' compensation.
However, being an active, responsible participant in your work comp claims process improves the employer’s financial picture.
A Safe Work Environment:
It is your responsibility as an employer to provide a safe work environment. By doing so, you eliminate many work comp claims because the injuries never happen. A strong safety program in which the employees are actively involved in preventing accidents has a major impact on the financial cost of workers' compensation.
Know the Law:
Post in a convenient place state required notices for all employees to see. Notices include their rights under the work comp laws, a list of approved medical facilities (in the half of the states allowing the employer to select the medical provider), post OSHA posters and anything else required in your state. See: 50 State Laws and Regulations at
http://reduceyourworkerscomp.com/laws_and_regulations.php
If an employee is injured, allow the employee to seek medical care as quickly as possible. Do not do anything appearing to interfere with the employee's right to medical assistance.
Report the Claim At Once & Accurately:
It is not enough to report the injury claim to the claims office. Report the injury immediately to the claims office – just as soon as the employer becomes aware the injury occurred. Not next week, not in a couple of days, not when you “get around to it,” but NOW – when the employee is seeking medical treatment for the work comp injury.
All employees and all their supervisors should know that it is a requirement for every work comp claim to be reported to your work comp claims coordinator as soon as medical treatment is needed. The claims coordinator then promptly completes the Employer's First Report of Injury and immediately transmit it electronically or by fax to the claims office. Immediately means, “stop whatever you are doing” and report the new injury/claim.
All supervisors should be trained on the information needed to complete the Employer's First Report of Injury form so it is accurate when it is received in the claims office. It is well established in the claims field that fast and accurate reporting of the claim has a positive impact on the outcome of the claim.
Cooperation with the Insurance Company:
The employer who takes the hands-off approach to work comp claims will see a steady increase in their work comp insurance premiums. The smart employer takes the approach of being actively involved in the work comp claims.
It is your responsibility as an employer to assist the work comp adjuster in their handling of the claim. As the adjuster investigates the claim, there will be a need for documentation from you as to the employee's payroll history. The adjuster may need to speak with the employee's supervisor or co-workers who witnessed the injury. In some situations the adjuster may need to see the employees personnel file or health benefits file. If you are contacted by an attorney for the employee, be sure to notify the adjuster immediately. By providing whatever assistance the adjuster needs on a timely basis you can help to mitigate the cost of the work comp claim.
Employee Contact:
One of the most often over-looked responsibilities of the employer in work comp claims is the human element. The employee's supervisor or the work comp claims coordinator or both, should stay in contact with the injured employee while that person is off work. By letting the employee know your company is concerned about his/her well-being and by keeping the lines of communication open, the risk of the claim becoming adversarial or the employee employing an attorney, guaranteed to delay resolution of the claim, is diminished.
Return to Work Program:
Study after study show the quicker the employee is returned to work, the lower the overall cost of the workers' compensation claim. It is imperative the employer have a Modified Duty Program or a Light Duty Program available for all injured employees.
In most states you can contact the employee's medical provider and ask for the conditions under which the employee can return to work. You have the right to know the employee's medical condition and to have the worker return to work on a light duty program with the medical provider's agreement.
By bringing the employee back to work on a modified duty program, the employee benefits and the employer saves money (remember the more the insurance company pays out, the higher your eventual work comp premium). When the employee is off work, the insurance company is paying benefits to the employee, but the employer is not receiving anything of value. By returning the employee to work, the benefits being paid by the insurance company stop. While an employee on modified duty may not be as productive as an employee on regular duty, the employee is still producing some benefit to the employer. (workersxzcompxzkit)
Summary:
The more pro-active the employer is in the work comp claim process, the lower the overall cost of workers’ compensation. Employers who provides a safe work environment, knows the requirements of the workers’ comp laws in their state and who reports their work comp claims quickly and accurately will lower their cost for work comp coverage. The employer who cooperates with the insurance adjuster's investigation, keeps in contact with the employee and assists the employee to return to work quickly experiences a positive effect on the cost of workers’ compensation.
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 Ohio Bureau of Workers’ Compensation (BWC) Board of Directors recently received details of proposed rules for the newly developed Drug-Free Safety Program (DFSP) designed to promote the health of Ohio’s workforce by preventing workplace injuries attributed to the use or abuse of drugs.
Plans are underway to sunset the current Drug-Free Workplace Program and replace it with DFSP by July 1, 2010. The changes were called for in the recent comprehensive study of Ohio’s workers’ comp system and a collection of safety and business professionals have studied ways to enhance the past program and improve that program’s effectiveness in preventing substance abuse-related injuries. The board is expected to make a final vote on the DFSP when it meets again on March 26.
“A solid substance abuse program in the workplace is essential to preventing injuries and limiting associated increases in workers’ compensation premiums,” said BWC Administrator Marsha Ryan. “The comprehensive study performed by Deloitte Consulting Inc. clearly demonstrates the need for a redesigned program more consistent with similar programs in other states and places a greater emphasis on maintaining drug-free work environments through safety and prevention." See: Drug Testing State Laws http://reduceyourworkerscomp.com/drug-testing-state-laws.php.
The Drug-Free Safety Program simplifies the process for employers to join and implement a program providing measurable results by tracking drug or substance abuse related accidents. The restructured program offers two levels of participation, basic and advanced, and offers premium discounts in the range of four-to-seven percent. (workersxzcompxzkit)
The new program features streamlined safety components meeting the needs in the workplace without overburdening Ohio employers. In addition, the new program is expected to allow some small discount stacking for group employers participating at the advanced level.
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 campaign in Great Britain warning trades people about the dangers of asbestos has won an international award. The Health and Safety Executive's (HSE) "hidden killer" campaign came top in the health category of the European Excellence Awards, held in Vienna, honoring outstanding achievements in public relations.
Approximately 20 trades people a week die in the United Kingdom from asbestos-related diseases and the aim of the campaign, launched in autumn 2008, was to help prevent another generation of plumbers, plasterers, electricians and joiners having their lives cut short.
HSE worked with communications agency MS&L to devise the public relations campaign using a football (soccer) analogy to raise awareness of the numbers of people still dying from asbestos exposure, bringing ex-England player and former plasterer, Ian Wright, on board to spearhead the campaign.
The launch was covered by broadcast, print and online media, including the flagship BBC Radio 4 Today program and GMTV. By the end of the campaign, HSE had seen a 100% increase in calls to Infoline and a six-fold increase in page requests on the campaign microsite.
Steve Coldrick, HSE's asbestos program director, noted, "Asbestos remains Britain's biggest workplace killer, but with the perception that it is largely a risk of the past we needed a hard-hitting PR campaign to capture the imagination of tradesmen, particularly young ones. Using Ian Wright, a former tradesman, ticked all the boxes for us and delivered great results. "We're pleased our approach has been recognized and commended by experts in the communications industry. The award is a testament to the good working relationship between HSE's communications and asbestos program teams and MSL."
The European Excellence Award is one of a number of accolades for HSE's "Hidden Killer" campaign. It was highly commended at the PR Week Awards in October and shortlisted for a PRCA Award in November. The print advertisements won an ANNA "ad of the week" award (Awards for National Newspaper Advertising) and were nominated for "ad of the year" under the same scheme. (workersxzcompxzkit)
The second phase of the campaign has just ended with early indications of success. More than 4,000 calls were made to Infoline during November and there were around 200 items of regional media coverage.
Download Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims Click here: http://www.workerscompkit.com/gallagher/podcast/Fraudulent_Workers_Compensation_Claims/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.
©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
Up to one third of all road collisions in Ireland involve drivers using their vehicles for work, according to a new report from the Road Safety Authority (RSA) and the Health and Safety Authority (HSA). This means more than 76 people die in work-related road crashes in Ireland each year. The RSA and HSA work to make employers aware of their responsibility to ensure the safety of their staff on the roads.
Studies show people who drive company cars have between 30% and 40% more collisions than ordinary drivers, with the risk increasing for those driving over and this risk increases for those who drive more than 40,000 kms (24,855 miles) in one year. Vehicle accidents are the biggest cause of work-related deaths and a significant contributor to work-related injuries.
Under the Safety, Health and Welfare at Work Act 2005 an employer has a duty to protect the health and safety of staff who drive for work. Driving for work includes any person who drives on a road as part of their work (not including commuting) in either a company vehicle or their own vehicle and receiving an allowance from their employer for miles driven.
The HSA safety campaign, supported by a national radio advertising, is asking employers to use the RSA’s and HSA’s “Driving for Work Guidelines” to help in implementing safe driving policies in the workplace.
According to Noel Brett, CEO, Road Safety Authority, “The driving for work guidelines will assist employers in managing their staff’s road safety. It provides an overview of legislation, how to carry out risk assessments and highlights the significant benefits for businesses and the wider community when work-related road safety is managed effectively.
“Managing staff safety, while driving for work, makes good business sense, especially in the current economic climate as it protects staff and business profits. For example, for every €1 claimed on insurance, arising from work-related road incidents, companies may have to pay a further €8 to €36 for uninsured losses,” Brett said.
Martin O’Halloran, CEO, Health and Safety Authority, added, “All employers are required by health and safety laws to put proper measures in place to protect the safety of all their employees. Particularly concerning is that 42% of Irish businesses have no driving for work policy as part of their health and safety management system. A 2008 Health and Safety Authority survey of businesses also found that there was a lack of awareness of their duties to manage work-related driving activities.”(workersxzcompxzkit)
The guidelines, published in CD Rom format are available free of charge and can be downloaded http://www.rsa.ie and http://www.hsa.ie/eng/
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.
Fraud Prevention Program Scores a Hit!
A
program targeting workers’ compensation insurance fraud resulted in 154 arrests in 2009 and $16.6 million in recoveries and estimated savings as reported by the New York State Insurance Fund (NYIF).
Since 1995, NYSIF cases accounted for 1,382 insurance fraud arrests, along with recoveries and estimated savings of $183.1 million. During that time, NYSIF established a national reputation for fighting workers’ comp fraud by working cooperatively with the New York State Insurance Department Frauds Bureau, the Workers’ Compensation Board Inspector General’s Office, local, state and federal law enforcement authorities, and district attorneys in many jurisdictions in and out of state.
“NYSIF has long been a leader in the fight against workers’ compensation fraud and our results this year again show we continue to lead the fight,” NYSIF Chief Deputy Director Francine James said.
“That’s a commitment we make as the state’s largest workers’ compensation insurance company to the people and all businesses of the state of New York . Workers’ compensation fraud is not a victimless crime, it is a felony and we vow to pursue it as such.”
Among anti-fraud special investigation units, NYSIF DCI ranks near the top nationally in annual arrests, and in cumulative fraud savings. In addition, NYSIF auditors have established a standard among insurance carriers for conducting premium audits that discourage improper payroll reporting and worker misclassification.
Recent significant cases resulting in millions of dollars in savings to NYISF have included claimants who receive benefits while operating businesses or remain employed in other capacities, the most prevalent type of workers’ comp fraud. (workersxzcompxzkit)
Other cases involve premium fraud, the most costly type, in construction, asbestos abatement and other contracting, including investigations in conjunction with the U.S. Department of Labor, the U.S. Postal Inspector, and local labor racketeering bureaus. Still other cases involve fraudulent provider billing.
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.
In litigation — especially the long processes of workers compensation, known to drag on for a decade or more — some procedures, normally making sense seem counterproductive. After all, why commit time and resources, both always so limited, to events which may not occur? Isn’t it better to save the efforts until they are needed?
That sounds sensible but it assumes everything else will remain the same until the right time comes along. In litigation and claims, however, evidence and witnesses slowly, but surely, fade away. Every year there will be less of each, unless measures are taken to preserve information which may be needed, in some cases many years later.
Often, in work comp, a claim may appear to be small and limited – and then, years later, the claim is reopened and becomes large indeed. The claims unit then must scramble to collect certain information only to discover much, most or all of it has been “purged,” i.e., lost forever. How much better it would be if basic information was kept, leading to recovering or preserving vital information.
Every employee workers’ compensation claim must keep certain basic information.
1. Date of hire.
2. Names and addresses of prior employers.
3. List of medical plans under which employee had coverage.
4. List of medical absences, however short, with dates of lost time.
5. Copies of medical absence certification by treating doctors.
6. Prior work comp or negligence claims, if known.
If it becomes necessary to reconstruct a worker’s medical history, the above information is used to locate information from a variety of sources.
1. A medical note purged from a doctor’s records may still exist in an old personnel file, even with a prior employer.
2. Rarely are group plan medical records purged beyond recovery.
3. Modern scanning and computer storage nearly guarantees records of surgery continue to exist somewhere, if the surgery was performed in the last 30 years.
4. The identity of an employer’s group medical plans is a public record, maintained by the United States Department of Labor.
Pulling together these types of information can save large sums, provided the name of the prior employer is preserved.
Who locates these records?
A very small, very specialized group in the field of “medical records archaeology” (yes, that term really exists) knows how to navigate the paths, assisted by attorneys with skills in subpoena and/or release of medical info.
However, the task takes a fraction of the time and expense, and produces multiples of results, if the employer provides a jump-start with the basic data. (workersxzcompxzkit)
Preserving the data, even after an employee leaves for a new job, is advisable. Old comp claims are frequently reopened for apportionment with a new claim.
Author: Attorney Theodore Ronca is 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.
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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Collateral Source Benefits, Settling WC Claims, TPA and Claims Administration |
