Consequences of Failing to Report & Respond to Work Injuries

Over the years, state and federal governments have enacted a number of safety regulations in workers’ compensation programs to provide for a safe working environment.  Even for the best employers following workplace safety guidelines, accidents do happen.  When they do, it is important to follow recognized procedures when responding to work injuries.  Failure to properly report and respond to the injury can have significant adverse consequences.

 

 

Penalties under State Workers’ Compensation Act

 

Being aware of requirements under a state workers’ compensation are important for an employer who is required to purchase and maintain workers’ compensation insurance.  It is important to be aware of the statutory guidelines associated with a number of responsibilities an employer has once someone is hurt at work.

 

Some common errors and omissions are as follows:

 

  1. Failure to file the First Report of Injury in a timely manner;
  2. Commencement of wage loss and other workers’ compensation benefits; and
  3. No clear guidance to injured workers as to their rights and responsibilities when it comes to medical and rehabilitation benefits.

 

While an employer is not required to give an injured person legal advice regarding their work injury, each state has basic responsibilities under the Act to their employees.  It is important for employers to understand their obligations and properly follow through after an incident.

 

A best practice to communicate with employees regarding workers compensation benefits is to provide an Employee Brochure. The employee brochure will provide information on the principles of workplace safety, the benefits to the employee workers compensation provide, an action plan for what to expect, and information on the role played by medical providers.

 

 

 

Compliance with State and Federal OSHA Regulations

 

The Occupational Safety and Health Administration (OSHA) is a federal agency within the Department of Labor that has congressional authority to implement workplace health and safety.  All states have similar departments that also advise employers of additional state regulations that govern these same issues.

 

In addition, the responsibilities imposed by a state workers’ compensation act, employers are also required to implement applicable state and federal policies.  In the context of work injuries, this often includes accurate reporting of certain injuries and provides parties with information about incidents.

 

Various OSHA requirements also require employers to have various safety postings and make them available to all workers.  One such posting includes Material Safety Data Sheet (MSDS) requirements that contain information about harmful substances.

 

 

 

Impact on Experience Modifier

 

In order to accurately price workers’ compensation premiums, companies offering insurance base a premium around an employer’s “experience modifier.”  This calculation is based on a period of three years of loss and is recalculated annually.

 

While the purchase of workers’ compensation insurance is a significant driver in costs for businesses, it is fraud to not report workplace incidents.  It is also not ethical to “pay off” an injured employee so he or she does not file a workers’ compensation claim.  If an employer is caught engaging in such practices, it can result in loss of insurance, as well as civil or criminal penalties.

 

 

Loss or Evidence Spoliation

 

Immediate accident investigation is key to driving down costs associated with workers’ compensation claims.  Failing to investigate a claim from the onset can have a number of adverse consequences.  The following is a partial list:

 

  1. Failure to identify and interview witnesses to the event;
  2. Loss of physical evidence that may diminish chances of recovery against a third party in a subrogation claim; and
  3. Court sanctions for the loss or spoliation of evidence.

 

 

Conclusions

 

Failure to report and respond to a work injury can cause problems in the end.  While there is the moral obligation to help a person suffering physically from an injury, there are also a number of legal obstacles that can be difficult to overcome.

 

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

OSHA Dialogue on Hazardous Work Chemical Exposures

Workplace exposure to hazardous chemicals is something no employer can take for granted.

 
The U.S. Department of Labor’s Occupational Safety and Health Administration recently announced it is launching a national dialogue with stakeholders on ways to prevent work-related illness caused by exposure to hazardous substances. The first stage of this dialogue is a request for information on the management of hazardous chemical exposures in the workplace and strategies for updating permissible exposure limits.

 
OSHA’s PELs, which are regulatory limits on the amount or concentration of a substance in the air, are intended to protect workers against the adverse health effects of exposure to hazardous substances.

 
Ninety-five percent of OSHA’s current PELs, which cover fewer than 500 chemicals, have not been updated since their adoption in 1971. The agency’s current PELs cover only a small fraction of the tens of thousands of chemicals used in commerce, many of which are suspected of being harmful. Substantial resources are required to issue new exposure limits or update existing workplace exposure limits, as courts have required complex analyses for each proposed PEL.

 
“Many of our chemical exposure standards are dangerously out of date and do not adequately protect workers,” said Assistant Secretary of Labor for Occupational Safety and Health Dr. David Michaels. “While we will continue to work on updating our workplace exposure limits, we are asking public health experts, chemical manufacturers, employers, unions and others committed to preventing workplace illnesses to help us identify new approaches to address chemical hazards.”

 

Public Comment Sought on Practices, Methods

 
OSHA is seeking public comment regarding current practices and future methods for updating PELs, as well as new strategies for better protecting workers from hazardous chemical exposures. Specifically, the agency requests suggestions on:

 

  • Possible streamlined approaches for risk assessment and feasibility analyses and
  • Alternative approaches for managing chemical exposures, including control banding, task-based approaches and informed substitution.

 

The goal of this public dialogue is to give stakeholders a forum to develop innovative, effective approaches to improve the health of workers in the United States. In the coming months, OSHA will announce additional ways for members of the public to participate in the conversation.

 
The comment period for the RFI will continue for 180 days.

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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WC Cost Reduction Webinar Garners Unprecedented Participation

Lowering Workers’ Comp Costs – Best Practices webinar attracted over 750 industry professionals, including employers, risk managers, safety directors, brokers, consultants, or producers involved in claims management, specific aspects of cost containment, and/or, the latest workers’ comp strategy issues. The webinar was jointly hosted by Advisen and Amaxx Risk Solutions presented on October 9, 2014.

 

A panel of experts speakers, California Pizza Kitchen’s David Williams, Blackstone Consulting’s Mark Newman, AJG’s Bob Walker, Amaxx Risk Solutions’ Rebecca Shafer and Michael Stack, and Advisen’s Dave Bradford, discussed how organizations, big and small, can hone their pre-injury and post-injury procedures in order to significantly reduce their workers’ comp expenses by applying proven workers’ comp best practices.

 

Using the #1 best-selling “Your Ultimate Guide to Mastering Workers’ Comp Costs – Reduce Cost 20% to 50%” as reference material, the panel answered these questions:

  • What should the realistic goal be when reducing workers’ comp costs? Can you benchmark the expense impact that the best organizations achieve?
  • How soon is too soon to get involved with a workers’ comp claim?
  • What is the best way to develop and implement a Return-to-Work program?
  • What are the essential aspects of employee communication around a workers’ comp claim, and how do the best practitioners exceed this criteria?
  • What strategies do risk managers and safety directors employ to get commitment of senior management?
  • How are the leading experts in the field establishing the most effective training programs related to these issues?
  • What does an in-house SIU Director do vs an insurance company’s SIU Director?
  • How does having an in-house SIU Director help the company’s bottom line?

 

These materials are now posted on Webinar October 9, 2014

  • Slide deck
  • Audio file for re-play

 

Author Rebecca Safer, Attorney and Risk Consultant and President of Amaxx Risk Solutions, Inc., is an expert in workers’ compensation cost containment and litigation management systems. National, mid-market, and local companies use her consulting services to develop benchmarking comparisons, assess key cost drivers, structure strategies, and design training to reduce workers’ compensation and risk management costs. Contact: RShaferB@aol.com.

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

 

Take The Extra Step When Describing Workers Comp Injury

 

 

Adjusters are very particular on wording, especially when it describes an injury or event.  Below I am going to use some real-world examples of injury descriptions from real work comp claims.  Don’t laugh, you may be the one reporting injuries this way.  If you are, hopefully you will find some helpful tips to be more expressive going forward:

 

 

Example #1: “Injured Back Lifting Boxes”

 

For example, an adjuster reads the injury report on a new claim and the description reads “Injured back lifting boxes.”   That entire statement says nothing in the mind of an adjuster, other than the back is the area injured.

 

 

Supervisors often provide little information

 

The employer is often contacted first, and this is sometimes a mixed bag of results.  They confirm a back injury, but another supervisor was there and that person knows more about it, they just heard through the grapevine that so and so got hurt last night and are not back at work today.  That is the extent of what the supervisor knows, and the other contact person was not at that location and has no idea what is going on.

 

First of all, that phone call was a waste of time for both people.  Not only did the adjuster get zero information from the employer, but now the adjuster has to talk with the claimant without any prep information, and no information on the accident details.

 

Then when the adjuster calls the injured worker, the injured worker states that he/she was injured when they “Lifted a 65lb box and felt a pop in their back which radiated down the legs causing them to drop the box and EMS was called to take to hospital due to severe pain.”

 

The employee always does the best job of describing an injury.  Leave it to them to tell the adjuster every detail.  And they should, because they are hurt and they want everyone to know what hurts and how they were hurt, and they want treatment for everything that hurts.

 

This entire scenario is how a loss control protocol should not work.  Every claims person out there loves that an employer has a loss protocol set up, and they follow it to the T.  But, what information are they actually providing the adjuster?

 

 

Injury response procedure goal should be to provide adjuster with as much detail as possible

 

The claims person is the one that needs as much information as possible, before they talk to the claimant within a 24-hr period post-notification of the claim.  But if the employer can’t help the adjuster with any information, what good is having protocol to begin with?  Sure, you reported the claim timely, but it is void of any real information that is helpful.

 

I understand that there are technical limitations.  Most injury forms only give you a little area to type in what happened, but be creative and descriptive.  That is what will help the adjuster.

 

Better yet, if you are not using Injury Triage, you should be.  The triage nurse will get the details of the injury, assess its severity, and recommend the property treatment.

 

 

Example #2 on a hernia claim:  “Worker lifted boxes all day and has hernia.”

 

What kind of boxes and how much did they weigh?  Were they lifting one box and had a specific incident that was diagnosed a hernia, or did this person come in and say they have a hernia?  How long is “all day?”  This entire injury statement says nothing other than a hernia.  A great way to correct that statement is “lifted a 45lb box/felt pain/clinic diagnosis hernia.”  Now in that statement, you know the worker was lifting a box, it weighed 45lbs, and that they must have went to the clinic right away because a hernia was already diagnosed by the clinic doctor.  That is good information to know!  Now the adjuster knows more about the injury, the diagnosis from the clinic doctor, and that it appears to be a specific isolated incident.

 

 

 

Example #3 “While unpacking parts she felt a boom in her back.”

 

I am far from a physician, but that is the first time I have heard of a boom in relation to an injury.  So she felt a boom.  What is a boom?  Is that burning pain?  Shooting pain?  A strain? Where was the boom, in her low back or upper back?

 

Other descriptive words do a better job.  Words like “sharp” or “shooting” or “burning” pain help adjusters with the type of pain this worker had at the time of injury.  A way to correct that statement is to label the pain differently, using the examples above.  Also always be sure to include the injured area as specific as possible.  Descriptions such as “While unpacking 2lb parts she felt a sharp pain in right low back.”  Now you have given the adjuster something to work with.  We know the part weight, the type of pain, and the location of the pain.

 

 

 

Challenge Yourself To Provide Specific Information

 

The reason why all of this is important is because of when the adjuster takes the statement from the employee.  Using example 3, the worker may say she had pain all over her back, or she may say she had pain in a different location, or she may say the parts were 25lbs each and not 2lbs in order to make her claim sounds more convincing.

 

So think about your injury statements.  Be as descriptive as possible while providing as much information as you can.  We all know there are only so many words you can put in that description, so challenge yourself to address weight, injury locations, pain types, and anything else you can fit in there.

 

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Washington L&I Cites Olympia Roofing Business

The roofing business can be one of the most dangerous fields out there, especially if safety protocol is not being followed.

 

Recently, the Washington State Department of Labor & Industries (L&I) cited an Olympia roofing company for the seventh time in recent years for safety violations involving fall protection for roofers.

 

The Roof Doctor Inc. was cited for six willful violations and one serious violation, with total proposed penalties of $219,600. Each of the six willful violations carries a penalty of $36,000, and the serious violation has a penalty of $3,600.

 

A serious violation exists in a workplace if there is a substantial probability that worker death or serious physical harm could result from a hazardous condition. A willful violation can be issued when L&I has evidence of plain indifference, a substitution of judgment or an intentional disregard to a hazard or rule.

 

“Falls from elevation are the leading cause of Washington’s worker fatalities and immediate hospitalizations, and they are fully preventable,” said Anne Soiza, assistant director for L&I’s Division of Occupational Safety and Health. “The tragedy, pain and suffering from these incidents are completely unnecessary for the workers’ families and friends and our communities.”

 

Workers Not Using Proper Fall Protection Equipment

 

The Roof Doctor inspection began last spring when an L&I safety compliance officer observed employees working on a rooftop at an Olympia-area residence without proper fall protection equipment.

 

The investigation found that five workers were exposed to falls from as high as 17 feet while engaged in various roofing activities.

 

The employer has appealed the citation. The appeal will be heard by the Board of Industrial Insurance Appeals, an independent state agency separate from L&I.
Penalty money paid as a result of a citation is placed in the workers comp supplemental pension fund, helping injured workers and families of those who have died on the job.

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php

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Workers Comp Claim Adjuster’s Dream Job

For the most part an adjuster works from day to day.  They work in an office or cubicle, and go about their business.  Recent polls and studies have shown that the adjuster is mostly satisfied with their job.  They feel as if they make a difference, and that their job matters in the global sense.

 

However I think if I were to pull a series of claims professionals aside and ask them if they are really satisfied, I think the results would be different.  The key question to ask would be “How could you do a better job, and become more involved and more proactive in the claim versus the environment you currently have?”

 

No carrier is perfect.  When you are dealing with large sums of money and other monetary authority, there are a lot of people that are going to be involved.  These people may or may not have influence on the claim as a whole, but the fact remains that their voice is going to be heard by the adjuster.  That being said, given the claims environment most adjusters are in, how do we make it better?  How do carriers make an impact on the claim, instead of just hitting their audit marks for best practices?

 

I have dealt with claims professionals for a long time, and over the years I think I have a pretty good idea of what the adjuster would want if given a “perfect world” scenario.  This list is probably a dream, and chances are no carrier would ever allow this to be the standard of how they handle claims.  But, maybe if a few of these items were to happen, who knows what the impact would be on the profession as a whole?  I am only going to go in to a few points here, because this list could be pages and pages long.  Keep an open mind, and imagine the possibilities if……….

 

 

The handling adjuster has the freedom to assign whatever vendor they prefer.

 

This is an easy one.  For example, I know plenty of adjusters that avoid using surveillance because they dislike the vendor they are forced to use.  Adjusters feel the SIU vendor is not aggressive enough, they do not communicate enough, or the results just never seem to be there.  On top of that, most adjusters are only allowed to complete a day or two of surveillance and hope they hit a jackpot.  This is rarely the case, so it sours the entire experience.

 

But let’s say they have the freedom to use whatever local vendor they wish.  Every claims person knows the SIU team they wish they could use, because at a prior carrier they had great success with them.  But at Carrier ABC, they are forced to use SIU vendor X, who never seems to get the job done.

 

 

 

The adjuster keeps the file from day 1 until the file is over.

 

Another pet peeve of the adjuster is that once they complete all of the dirty work and investigative tasks, it is then transferred to another adjuster to take it over from there.  I cannot tell you the complaints I hear of an adjuster who set a file up to settle after spending countless hours on it, only to have the file transferred to another adjuster.  The new adjuster then gets to bask in the accolades for a job well done come file settlement.  Sadly the reality is that the new adjuster really just made a few phone calls.

 

Plus when the file is transferred after a period of time, the claimant gets confused.  This confusion can derail many things, and it probably hurts the claim rather than help it.  Carriers have their reasons for transfer, but I could never see the benefit in moving the file from a qualified experienced lost time adjuster to yet another qualified lost time adjuster.  Why not just keep it where it is?  Adjuster 1 has already established a relationship with all involved parties.  Why start over?

 

 

If the adjuster wants to go in the field to perform accident investigations or to complete a recorded statement in person, then let them go do it.

 

Permitted if geographically possible, if the adjuster wants to go size a claimant up by doing a statement in person, why are they not able to do so?  Details obtained over the phone only go so far.  You really cannot truly investigate all aspects of the claim via the phone.  Do you know what the machine looks like that injured the claimant?  Where were they standing?  How were they operating the machine at the time of the injury?  Without being able to actually see these details, I do not think an investigation is truly completed.

 

 

 

Provide claim assistants to help the adjuster manage their time.

 

Maybe the most important, I hear from adjusters that they have to spend too much of their time doing clerical work, instead of actually working on their claims.  This can range from coding bills, to processing mileage checks, to completing forms, calculating wages, and so on.  These are all tasks that could be completed by a claims assistant.  This frees up the adjuster to work on the actual claim compiling investigative data, discussing cases with Counsel, and so on.  Even though the positives of providing such a service to the adjuster chart off the paper, carriers are reluctant to provide little if any assistance to the adjusters.  If you ask me, the adjuster has more important things to do instead of sitting on hold with a doctor’s office waiting to talk to a person to request medical records.

 

I have only scratched the surface here.  In a perfect world, think about how efficient the claims adjuster could be.  How proactive they could be.  How their insight and approach towards claims could differ when given the time and resources to focus on the claim itself.  The possibilities are endless.

 

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Ohio BWC Reports Grants, Comp Fraud Suspect Nailed

It turned out to be some busy days recently for The Ohio Bureau of Workers Compensation (BWC).

 
First, the BWC approved 127 safety grants for Ohio employers totaling more than $3.5 million. BWC designed the Safety Intervention Grant Program to assist Ohio employers in reducing illnesses and injuries and to create a partnership with them to establish best practices for accident and injury prevention.

 
“The safety grant program has proven extremely effective in preventing workplace accidents and injuries. Employers that receive safety grants find their claims in the area of intervention go down an average of 66 percent,” said BWC Administrator/CEO Steve Buehrer. “Many employers are surprised to find a simple adjustment to a work process can make a tremendous difference in reducing the number of injuries and corresponding costs.”

 
Both public and private employers from 10 different industries in 47 counties were approved for the grants.

 
Ohio private and public employers are eligible for safety grants, which include a 3-to-1 matching amount up to a maximum of $40,000. Quarterly data reports and follow-up case studies help BWC determine the effectiveness of employers’ safety interventions and establish best practices.

 
BWC’s microsite allows employers to compare the average rates and average cost per claim in their industry. It also links employers directly to BWC safety consultants who can survey their worksites and advise them on how to prevent occupational injuries and illnesses in their workplaces.

 
Ohio Man Must Repay More than $31K

 
Meantime, a Bethel (Brown County) man was ordered to pay more than $31,000 in restitution to the BWC.

 
Shannon Watson was sentenced in September in Franklin County Court of Common Pleas on one count of workers comp fraud, a fifth-degree felony. He pleaded guilty to the charge in July.

 
Investigators found that Watson was working for a heating and cooling company in Brown County while collecting temporary total disability, and collected $31,100.28 in benefits between November 2007 and July 2009.

 
Watson was placed on community control for five years with basic supervision, must obtain and maintain employment, undergo urine screenings and pay court costs as well as $31,100.28 in restitution.

 
If he violates conditions of his community control, Watson will serve 11 months at the Ohio Department of Rehabilitation and Correction.

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

The Beautiful Face of Workers’ Compensation Fraud

If you could ask employers “what does the workers’ compensation fraudster look like?” they would probably describe a burly guy who did manual labor, was out of shape and didn’t like to work.  They would be wrong.

 

 

 

Fraud Not Limited By Gender, Age, Race, or Type of Occupation

 

People who commit workers’ compensation fraud are not limited by gender, age, race or type of occupation.  Take for instances the example of Shawna Lynn Palmer, age 22, of Long Beach, CA.  Ms. Palmer worked for the Stater Brothers grocery store in Riverside, CA as a supermarket clerk.

 

Per the California Department of Insurance, Palmer reported on March 10, 2014 that she had fractured a toe on her left foot.  Due to her injury, she could not put weight on her foot or wear a shoe.  Palmer obtained from her doctor a special orthopedic shoe and crutches.  Initially, Palmer was instructed to stay off work until March 19, 2014, nine days after the injury.  At her second medical appointment and subsequent medical appointments, Palmer continue to complain of pain and the inability to wear a shoe.  The doctor kept her off work until recently.

 

Palmer’s slow medical recovery became a concern for the workers’ compensation insurer.  Even though Palmer continue to report that she was unable to stand on her injured foot, the insurer’s investigation, followed by an investigation by the California Department of Insurance told a different story.

 

 

 

Claimant Participating In Beauty Pageant Wearing Bikini & Stilettos

 

Palmer had participated in several area beauty pageants including three in March – March 14th (4 days after the injury), March 19th and March 27th.  At the March 14th beauty pageant, Palmer was photographed posing in a bikini and a pair high stilettos.

 

Following the March 14th beauty pageant, Palmer returned to the doctor for a second visit.  Palmer continued to complain of pain and the inability to stand on her foot at this doctor’s visit and at subsequent doctor visits.  The doctor kept Palmer off work due to her painful injury.

 

Palmer would continue to stay off work, collecting indemnity benefits, and spend her time competing in more beauty pageants.  Palmer was proud of the fact that she won third place in the Harley Davidson bikini contest on July 3, 2014.  She posted to her Facebook page a picture of her and the other contestants.  She was wearing a black bikini and her towering black stilettos shoes.  In her Facebook post, Palmer thanked her family, friends and boyfriend for their support in the beauty pageants.

 

In the meantime, Palmer settled her workers’ compensation claim for $24,000 as she continued to claim she was unable to put any weight on her foot or to wear any shoes.

 

 

Investigation Locates Pageant Photos & Video, Claimant Arrested

 

The reader may remember the Amaxx article about insurance adjusters turning to Social Media to defeat workers’ compensation fraud.  The Facebook post with Palmer standing without any difficulty in her high black stilettos was soon discovered by the insurance company, as they had begun their own investigation into why the toe injury was taking so long to heal.

 

As the investigation continued a You Tube clip of Palmer competing in the April 10, 2014 Miss Toyota Long Beach Gran Prix beauty contest was discovered. The video clip showed her walking, without any difficulty, across the stage wearing high heels.

 

The insurance company referred the matter to the California Department of Insurance.  Bryon Tucker of the state’s deputy insurance commissioner office told a local news organization “…here’s a young lady who had beauty….but it really didn’t add up on the brains side of it.”  “She lied to her employer, she lied to her doctor, she lied to a lot of people”. “She eventually got arrested and busted for this.”

 

Palmer was booked on three counts of insurance fraud and has been released on $5,000 bail.  She is facing a court date of October 3, 2014 in the Riverside County Superior Court.  If convicted of insurance fraud, Palmer could receive a sentence of one year in county jail, three years of probation and be required to pay up to $24,000 in restitution.

 

 

Never Assume And Do Not Delay Investigation

 

The next time you think you know what a work comp fraudster looks like, remember the serial beauty pageant contestant.  Ryan Pischke, Executive Vice President at GCS Nationwide Investigative Services states “Unfortunately in our industry, often we see an employer wait 6-9 months to do any type of investigative work on cases like this. Through the use of proactive investigative resources, such as social media investigations or a medical canvas, at the onset of a claim or very shortly thereafter, employers can save themselves time spent on the claim as well as thousands of dollars in undue payout to the claimant, and all for less than the cost of a trip to the ER “

 

 

All workers’ compensation claims should be considered legitimate but be properly investigated. If you need any assistance with your workers’ compensation fraud prevention program, please contact us.

 

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Ohio BWC Honors Fallen Workers

Never forgetting workers killed on the job is something officials in Ohio don’t take for granted.

 
The Ohio Bureau of Workers Compensation (BWC) recently held the fourth annual Fallen Workers Memorial honoring workers who died in the past year due to workplace injuries. The annual service commemorates these workers and recognizes their service and sacrifice. The names of 118 workers were read aloud during this year’s ceremony.*

 
“Each life lost represents a hardworking Ohioan who left behind grieving loved ones, friends and colleagues,” said BWC Administrator/CEO Steve Buehrer. “One workplace death is too many and a sad reminder of the tremendous sacrifice workers make in the course of their labor.”

 
The ceremony was held in BWC’s William Green Building in downtown Columbus. Buehrer was joined by members of the BWC Board of Directors, including Chairman Nicholas Zuk, Peggy Griffith and David Caldwell, along with labor and business leaders, including Tim Burga, president of the Ohio AFL-CIO, and Andrew Doehrel, president of the Ohio Chamber of Commerce.

 

All Ohioans Asked to Pay Tribute

 
Griffith recited the poem, “Memorial for Workers,” and the names of the fallen were read by Tina Kielmeyer, BWC’s chief of customer services, and BWC employees Shirley Hubbert and Mary Albayati. During the ceremony, Buehrer read a resolution issued by Governor John Kasich. The resolution recognized the memorial and asked that all Ohioans pay tribute to those who lost their lives on the job. The ceremony concluded with the tolling of a bell.

 
Buehrer also reflected on BWC’s core mission of preventing workplace accidents, caring for injured workers and assisting families of those who lost their lives while working. “Paying compensation to a family left behind is only part of what we do at BWC,” Buehrer said. “Ohio has come a long way in terms of protecting our workers, and making safety a top priority in every workplace, but we constantly ask ourselves what we can do to keep workers safer in the future. We will continue to seek the answers.”

 

Names of the fallen workers are available here.

 

*Including 72 allowed claims with dates of death in the last policy year (7/1/13-6/30/14), as well as 46 allowed claims with dates of death that fell within the two-year filing period and were not included in previous memorials.

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

OSHA Top 10 List Can Help Employers Avoid Costly Penalties

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Okay, as far as entertainment value goes, it may not rival late night television hosts and their opening monologues, but OSHA did publish its list of the “Top 10” most frequently cited construction standards, following inspections of work sites in 2013.

 

 

No, OSHA was not intent on pitting itself against the likes of David Letterman or Conan O’Brien in a comedic battle of wits. Rather, it was attempting a pre-emptive strike, aimed at saving businesses from needlessly paying out high penalty fees (up to $7,000 for a serious violation, and as much as $70,000 for repeated or willful violations).

 

 

 

Top 10 Lists Alerts Employers About Commonly Cited Standards

 

OSHA annually publishes this “Top 10” list to alert employers about commonly cited standards, so employers can take steps to find and mend recognized hazards before OSHA ever takes punitive action against a company. Normally, OSHA does not grant advanced notice of its inspections, and inspections are generally performed at sites where imminently dangerous situations are known, fatalities or catastrophes have occurred, complaints or referrals have been given, the work site has been issued a citation in the past, or inspections may be pre-planned or programmed.

 

 

While it poses no threat to replace the heroes of late night television, OSHA is meeting its goal of reducing fatalities, injuries, and illnesses in the workplace.

 

 

Too many preventable injuries occur on the job, leading companies to spend unnecessary dollars on fines and healthcare costs.

 

 

Medcor offers a variety of safety compliance training courses designed to meet the requirements and needs of companies, including OSHA compliance, emergency medical, emergency response, industrial fire suppression, and technical rescue. For more information, contact the author at Raymond.loch@medcor.com

 

 

Yes, OSHA citations can be costly, but for the most part, they are avoidable.

 

 

 

And now… here are the “Top 10” Most Frequently Cited OSHA Construction Standards for 2013:

 

#10: 1926.451(b)(1) – Scaffolds not fully planked at each work level.

 

 

#9:1926.451 (e)(1) – Scaffold access/egress. Many citations involve climbing on the cross bracing.

 

 

#8: 1926.453(b)(2)(v) – Fall protection in aerial lifts. Users must receive training in the manufacturer’s instruction.

 

 

#7: 1926.501(b)(10) – No fall protection for flat roofing. Consider using parapet guardrails and portable-type fall arrest anchorage.

 

 

#6: 1926.451(9)(1) – Fall protection on scaf­folding. Fall protection starts at 10 feet.

 

 

#5: 1926.102(b)(1) – No safety glasses. Hun­dreds of eye injuries occur each year from working without safety glasses.

 

 

#4: 1926.100 – Hard Hats. Fatalities occur when workers are hit by falling objects.

 

 

#3: 1926.501(b)(1) – Open sided floors that were more than six feet in depth were not protected with standard guardrails or equivalent. Guardrails must be able to withstand 200 pounds of force.

 

 

#2: 1926.1053(b)(1) – Training in the safe use of ladders. Ladder falls killed over 100 workers in the last 10 years. Ladders need to extend three feet above the landing.

 

 

And now… (drum roll!)

 

 

the #1 citation for 2013 is… 1926.501(b)(13) – Fall protection in resi­dential construction. Having no fall arrest has been the ongoing #1 OSHA citation since 2007.

 

 

Author Raymond Loch, Safety Training Services Leader, Medcor, is a certified safety professional with over 32 years of experience as an instructor, operator, and consultant in safety, emergency preparedness, and emergency response for general industry, construction and fire service.   He has developed and implemented training programs for OSHA compliance, technical rescue, and industrial fire suppression. Ray has worked with Fortune 100 firms and with small companies and government entities.  . http://medcor.com.  Contact: raymond.loch@medcor.com

 

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