Ohio Individuals Cited After Violating Comp Rules

Ohio Bureau of Workers Compensation (BWC) Administrator/CEO Steve Buehrer recently announced that several individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers comp system in March. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID).

 
The following are a sampling of cases that resulted in guilty pleas or convictions during March:

 

Kevin Gruver (Elyria, Lorain County) pleaded guilty to a first-degree misdemeanor count of workers comp fraud in the Franklin County Court of Common Pleas March 16 for working while receiving benefits. SID began investigating Gruver after receiving an allegation indicating he had returned to work with Adecco while collecting benefits for a workplace injury. Investigators found that Gruver did return to work with Adecco and worked as a temporary employee for multiple companies, including Leggett and Platt, Wal-Mart, Pontoon First Energy Fieldglass, and 3M. This employment activity was inconsistent with Gruver’s receipt of temporary total disability benefits. Gruver was sentenced to 180 days in jail, suspended for two years of community control under the conditions that he maintain employment and pay restitution in the amount of $6,959.65.

 
Charles Bentley (Mentor, Lake County) pleaded guilty plea to one misdemeanor count of workers comp fraud in the Franklin County Court of Common Pleas on March 10 for working while receiving benefits. SID began investigating after receiving an anonymous allegation stating Bentley had been working “under the table” for a landscaping company for three years. Bentley should not have been working at all as he was receiving workers’ compensation benefits for a workplace injury. The investigation confirmed that Bentley returned to employment during the winter season as a snowplow truck driver while receiving temporary total disability benefits. Bentley had already paid the entire restitution in the amount of $22,125.60 to BWC. He was sentenced to 90 days in jail, suspended for 90 days of community control.

 
Amato Zaccone Jr. (Hubbard, Trumbull County) pleaded guilty to a first-degree misdemeanor count of workers comp fraud in the Franklin County Court of Common Pleas March 10 for working while receiving benefits. SID began investigating Zaccone after a wage cross-match with the Ohio Department of Job and Family Services indicated he was working during the same time period he was receiving BWC benefits for a workplace injury. Investigators conducted field interviews and obtained financial records that confirmed Zaccone was working as a cook for McMenamy’s, LLC while receiving Temporary Total Disability. Zaccone was sentenced to 90 days in jail, suspended for one year of community control on the condition that he pay restitution in the amount of $1,045.20.

 

 

 

 

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 Employers Secret to Workers Comp Defense: Attorney Ted Ronca Tribute

We recently learned some sad news that one of our long-time contributors to Workers’ Comp Roundup, Attorney Ted Ronca, has passed away due to health complications.  Ted was a wealth of knowledge in representing employers in workers’ compensation and a frequently used legal resource for questions and clarification by our primary blog writers, Michael Stack and Rebecca Shafer.

 

We pay a tribute to him with a compilation of some of this extensive writings. Because his library of articles is so large, and the information so valuable, we have broken it into 3 parts. Employers are recommended to use this information as a reference for workers’ compensation defense best practices.

 

Part 3 of 3:

 

Little Used Federal Laws Give Employer Disability Management Control

Employers interact with employee disability through a number of laws. Until now, there has been little attention focused on how to coordinate statutory compliance to achieve better overall results. Workers compensation, in particular, has operated with little or no coordination with other laws.

 

Three Critical Times Employers Should Seek Workers Compensation Advice

Work comp is a real time problem in progress. If you’re an employer, chances are you could use some, or much, advice. But advice often comes with an expiration date and, if not taken, will spoil faster than an open container of milk on July 4th weekend.

 

Employers Can Spot A Claim Months Before It Occurs

A witnessed, sudden, accident presents far fewer problems than a claim without a witness. Yet, many un-witnessed claims are quite real, stemming from long term degenerative conditions. Many of these claims are filed and flagged as highly suspicious.

 

3 Types of Medical Exams Employers Have Not Heard Of

Employers who are willing to make better use of claim tools already in existence around them can achieve precisely what they have been hoping, in vain, that their carriers will do for them. The tools are: Occupational Health and Safety Administration(OSHA) physical exam, Department of Transportation (DOT) medical exam, Americans with Disabilities Act (ADA) medical exams

 

The Employers Secret to Workers Comp Defense Lies in these Three Quotes

Three quotations are all an employer needs to understand handling difficult comp claims. Two are actual quotes, but the third – and best – was made up and appeared in a 1917 newspaper story.

 

Author: Attorney Theodore Ronca was a lawyer from Aquebogue, NY. He was a frequent writer and speaker, and represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years.

Cal/OSHA Cites Employer for Violating Stop-Work Order

Cal/OSHA recently issued citations to DP Investments after the employer violated a stop-work order that was placed on scaffolding at a Santa Barbara construction site to prevent employees from being injured.

 
DP Investments was also cited April 6 for failure to report a workplace injury as required by law.

 

Cal/OSHA’s Van Nuys office opened an inspection last October after receiving a complaint about the worksite at 1816 State Street, where the Fiesta Inn and Suites were undergoing renovation.

 

Cal/OSHA’s inspector notified the employer, Dario Pini, that the scaffolding on one building put workers in danger of serious injuries as it lacked a ladder for safe access, a guardrail to prevent falls, and base plates to provide a firm foundation on the ground. The employer was informed that no one would be permitted to use the scaffolding until the hazards were corrected and that the stop order could only be removed by Cal/OSHA. Pini was also advised that removal or defiance of the stop-work order is prohibited by law.

 

A follow-up inspection revealed that the stop-work order had been removed from the scaffolding without permission and that employees had resumed working on the structure without any safety modifications. During the course of the investigation, Cal/OSHA became aware of an unreported injury at the State Street renovation site from late August 2015.

 

Carpenter Injured in Fall

 
A carpenter suffered multiple fractures after falling 11.5 feet onto a cement walkway outside the building when a window grate bolt was removed and the window grating swung open.

 

Cal/OSHA cited DP Investments for 12 workplace safety violations, including one willful serious for removing the stop-work order, with a proposed penalty of $54,000. Two serious citations, with penalties of $5,400 each, were issued because rooftop workers were exposed to falls as high as 18 feet without personal fall protection equipment, and the scaffold was not assembled under the direction of a qualified person.

 

Additional citations penalized DP Investment for its failure to provide employees with safe workplace practice information and lack of training for supervisory employees. A serious violation is cited when there is a realistic possibility that death or serious harm could result from the actual hazardous condition.

 

A willful violation is cited when the employer is aware of the law and violates it nevertheless, or when the employer is aware of the hazardous condition and takes no reasonable steps to address it. Cal/OSHA investigators filed the case with the Santa Barbara District Attorney’s office, citing the removal of the stop-work order as a criminal offense.

 

In March, the District Attorney’s office announced that Dario Pini entered a plea of no contest and was sentenced to three years of probation.

 

 

 

 

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

Defense In Depth On Work Comp Claims: Attorney Ted Ronca Tribute

We recently learned some sad news that one of our long-time contributors to Workers’ Comp Roundup, Attorney Ted Ronca, has passed away due to health complications.  Ted was a wealth of knowledge in representing employers in workers’ compensation and a frequently used legal resource for questions and clarification by our primary blog writers, Michael Stack and Rebecca Shafer.

 

We pay a tribute to him with a compilation of some of this extensive writings. Because his library of articles is so large, and the information so valuable, we have broken it into 3 parts. Employers are recommended to use this information as a reference for workers’ compensation defense best practices.

 

Part 2 of 3:

 

Deny Work Comp Claims From Disallowed Unemployment

Can a worker who files a claim for unemployment and loses because of a justifiable dismissal then file for workers comp? Yes. And it happens all the time. The danger for employers is that the existence of the unemployment claim is not automatically known to the carrier or the New York Workers Comp board, causing many comp claims that could be defeated to be allowed at great expense, ultimately, to the employer.

 

Investigating Work Comp Fraud: Concealed Working Off The Books

If an employer has, say, a hundred or more workers who are semi-skilled, sooner or later there will be a comp claim in which suspicion grows that the worker has healed but is working off the books. This is a common problem in large metropolitan areas where activity is more easily concealed.

 

Injured Worker’s Personal Problems Lead To Dangerous Workers Comp Claims

There are classes of comp claims that start as ordinary reports of injury but quickly turn into claims nightmares. Among these is the younger worker claim in which an otherwise healthy person develops an inexplicably complicated claim. An explanation that needs to be considered is “trouble at home leads to trouble at work”.

 

‘See Attached’ Is Best Way To Complete First Report of Injury

The employer’s first report of a possible accident can be a dangerous trap when dubious claims are being reported. This is due to the fact that first injury forms are not designed to capture the information necessary to make decisions which are critical in the first days following an accident report. The decisions can be triaged into categories: there has been a clearly compensable accident, there has not been a work related accident, there has been a report which requires further investigation. (The second, there has been no compensable accident, also requires further investigation to document reasons for an objection.)

 

Defense In Depth On Work Comp Claims: The Employer’s Role

“Defense in depth” is a principal from conflict theory which promotes using several defenses in coordination instead of seeing them as separate defenses to be used one at a time. Sometimes, the phrase “mutually supporting” is used. In work comp hearings, defense issues often are identified and documented but they are not processed so that the use in hearings is enhanced.

 

 

Author: Attorney Theodore Ronca was a lawyer from Aquebogue, NY. He was a frequent writer and speaker, and represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years.

Florida Woman Arrested, Took Part in Comp Scheme

Florida Chief Financial Officer Jeff Atwater recently announced the arrest of Maira Chirinos, owner of Pompano Beach construction company Tocoa Builders Inc.

 
Chirinos is alleged to have misrepresented information regarding Tocoa Builder’s operations, employees and payroll when applying for a workers compensation policy. By doing so, Chirinos avoided at least $1.8 million in workers comp premium payments.

 
The Florida Department of Financial Services, which operates under the direction of CFO Atwater, began investigating Chirinos for violating a “stop work” order.

 

This initial investigation provided authorities with information that exposed Chirinos’ larger scheme of knowingly falsifying information to avoid paying for an adequate workers compensation policy. As a result, a second investigation was opened, led by the Department’s Bureau of Workers Compensation Compliance and Division of Insurance Fraud.

 

Defendant Lied in Obtaining Policy

 

Investigators discovered that Chirinos lied when obtaining a workers comp insurance policy from Madison Insurance Company to cover Tocoa Builders Inc. She did so by grossly under reporting the company’s payroll, number of employees, and day-to-day operations. During the dates represented on the policy paperwork, more than $11 million in payroll checkers were cashed, far more than the $76,000 that was reported.

 
Chirinos used a Broward County money service business to cash her company’s payroll checks; a common method of circumventing workers comp statutes. By misrepresenting the amount of Tocoa Builder’s payroll, employees and the businesses operations Chirinos was able to avoid more than $1.8 million in workers’ compensation premium dues.

 
Chirinos was arrested without incident and charged with workers comp premium fraud and grand theft, both of which are first degree felonies.
This case will be prosecuted by the Office of State Attorney Michael J. Satz of the 17th Judicial Circuit and if convicted, Chirinos faces up to 20 years in prison.

 

 

 

 

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

Honoring David Depaolo’s Legacy

depaolo

“We, as an industry responsible to society, have some soul searching to do” – David Depaolo – Wednesday, July 13, 2016.

 

This was a quote out of one of David’s blogs written just a few days before his shocking, and untimely death.  In a few words it speaks to his mission of education, leadership, and strong voice in the workers’ compensation industry.

 

He wrote often about doing right, holding organizations and individuals to a high standard of integrity, and calling out those who failed to meet this standard.  He was not afraid to absorb some criticism to bring awareness for the common good.

 

We, as an industry, have lost a great leader. My personal reaction is one of absolutely shock.  I heard the news yesterday morning and over 24 hours later I still don’t think it has really sunk in.  I just can’t believe it. Becki Shafer called to tell me and I told her she must have the name mistaken as I was right in the middle of writing three tribute blogs to another great loss and frequent writer on our Workers Comp Roundup, Attorney Ted Ronca.   Dave Depaolo, no, that’s not right I said.  It was just two days before that I had shared a panel with Dave at the CCWC Conference in Anaheim, where he spoke of the future of our workers’ compensation and attracting the next generation of talent, among other observations spoken with the good of the industry at heart.

 

Becki and I talked how she thought originally the news must have been a joke, speaking to his light-hearted personality, and the fact we were all going to be getting together in Orlando in a few weeks; so this was the start of the ribbing she thought, “Dave Depaolo Dies Laughing At Bob Wilson’s Mistake”.  Unfortunately the news was tragic and sad, the loss of a 20 year friend and colleague is just hard to accept.

 

Everyone copes with grief and loss differently.  For me, I try to find some meaning that could be part of a bigger plan, and how to honor the individual’s legacy.  Maybe the lesson is the soul searching that David referred to last Wednesday. We so often speak of the different sides that are at odds in workers’ compensation; injured workers, payers, claims handlers, attorney’s, etc.  David’s accident is a harsh reminder that there is really only one side, the human side, and that none of us are immune to being involved in a serious accident.  Each accident that occurs affects the lives of individuals and the circle of people they touch, we need to treat these individuals, and the process, with the proper level of care and respect.

 

David Depaolo was a great leader and he stood for what is right in workers’ compensation.  I believe we need to honor his legacy by acting on his lessons. RIP David, you will be missed.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

New Zealand Workplace Injury Leads to Employer Fines

New Zealand agricultural contracting company, John Austin Limited, has been fined $36,750 and ordered to pay reparations of $65,554 after a mechanic was crushed by a nine-ton truck hoist, leaving him with two severe breaks to his pelvis, deep bruising and nerve damage. It is unlikely he will regain full use of one leg and he spent several months in hospital recovering from his injuries. He also suffered from post-traumatic stress.

 
John Austin Limited pleaded guilty and was sentenced in the Te Awamutu District Court recently under the Health and Safety in Employment Act.

 

The company has a fleet of 80 heavy vehicles, some of which have hydraulic hoists.

 

On Feb. 18, 2015, the mechanic and another employee of John Austin Limited were fixing a truck at a farm in Morrinsville when they were asked to look at another of the company’s trucks with a broken hoist loaded with maize. Once they thought the problem was fixed, the truck was reversed onto a stack of maize and the hoist was lifted to dump its load. Halfway up, the hoist stopped.

 

Needing to get under the hoist to look at the hydraulic valves and hoses in the chassis, the mechanic wedged a railway sleeper into a hinge of the hoist. While he was under the hoist, a valve burst. The hoist came crashing down, crushing the wedged wood. As he couldn’t get out in time, the mechanic was hit by the hoist on the hip and between his ribcage and pelvis.

 

“An inadequately secured raised truck hoist is a significant hazard,” said WorkSafe Chief Inspector, Keith Stewart. “John Austin Limited should have had procedures in place for employees when they worked on a raised truck hoist and those steps should have been properly communicated. The employee should also have had training on repairing truck hydraulic systems so he knew how to work on them safely.”

 

 

 

 

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

Two Basic Rules To Solve Workers Compensation Problems: Attorney Ted Ronca Tribute

We recently learned some sad news that one of our long-time contributors to Workers’ Comp Roundup, Attorney Ted Ronca, has passed away due to health complications.  Ted was a wealth of knowledge in representing employers in workers’ compensation and a frequently used legal resource for questions and clarification by our primary blog writers, Michael Stack and Rebecca Shafer.

 

We pay a tribute to him with a compilation of some of this extensive writings. Because his library of articles is so large, and the information so valuable, we have broken it into 3 parts. Employers are recommended to use this information as a reference for workers’ compensation defense best practices.

 

Part 1 of 3:

 

What Your Employees Fear Most After A Work Comp Injury

Fear, silence, and uncertainty do more to drive workers’ compensation costs than is generally appreciated – and these factors are fairly simple to control through employer involvement. Attorneys in the field quickly learn that an unpaid medical bill is certain to drive a worker to a lawyer, but there are many other fears which will also do the same thing. Job security is perhaps the second greatest fear, but much else can cause dangerous anxiety. Your workers will quickly find themselves worrying about problems which don’t exist and can’t exist, but these problems will be very real unless someone communicates with them.

 

Two Basic Rules To Solve Workers Compensation Problems

Nearly all compensation problems are solved by employers if they follow two basic rules: 1. Communicate early, 2. Communicate thoroughly.

 

The Work Comp Claim Isn’t Over Until It’s Over

Yes, this article honors Yogi Berra, but not for the reason you might think. His now famous phrase, about a game (or a season) not being over until it’s over has become the archetype for a thought which is a) true, b) egregiously obvious and c) useless. But Yogi may well have the last laugh.

 

Warning For Employers: Social Security Problems & Consequences For Workers Comp

The trust funds for the Social Security disability benefits program are nearly exhausted and will be gone by 2016. What consequences are there for an employer’s workers compensation costs?

 

Pay Particular Attention To Work Comp Claims That Overlap With Other Laws

“Flexibility” when you’re involved in a claim of any kind, gives you options – and that means having several ways to deal with a problem. But flexibility can mean much more. It can also give an employer freedom of action; in addition all others involved in a claim do NOT have the same advantages that the employer has.

 

Author: Attorney Theodore Ronca was a lawyer from Aquebogue, NY. He was a frequent writer and speaker, and represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years.

 

Mass. Man Indicted in Comp Fraud Case

A Wilmington, Massachusetts man has been indicted in connection with allegedly failing to accurately report the nature of his company’s work in order to avoid $120,000 in insurance premiums, Attorney General Maura Healey announced recently.

 
Robert Foss, 54, was indicted by a Suffolk Grand Jury on charges of workers compensation fraud (four counts).

 

Authorities allege that between 2009 and 2012, Foss defrauded two insurance companies under three separate insurance policies by describing his Burlington business as a general contractor, when in reality, it was a roofing company. The Workers Compensation Ratings and Inspection Bureau (WCRIB) classifies roofing as a more dangerous occupation than general carpentry and places a higher premium on insurance.

 

“We allege that this defendant intentionally put the safety of his employees at risk by asking them to inaccurately disclose the nature of his business to insurance companies in order to avoid paying premiums,” said AG Healey. “Our office is committed to investigating and prosecuting those who engage in this type of fraud for their own benefit.”

 

The Insurance Fraud Bureau of Massachusetts (IFB) referred the case to the Attorney General’s Office in May 2013 after an investigation into allegations that the company was committing insurance fraud.

 

“Businesses that misrepresent their payrolls and type of business to lower their workers’ compensation premiums put honest businesses at a disadvantage, and are not providing proper coverage for their employees,” said IFB Executive Director Daniel Johnston. “The Insurance Fraud Bureau pursues these cases so that there can be a fair playing field for all businesses in the Commonwealth.”
WCRIB establishes different categories of insurance policy costs depending on the risk of injury associated with different types of jobs, and insurers apply those categories to a company’s payroll to calculate workers comp insurance premiums.

 

According to authorities, Foss also inaccurately described the nature of his business on an application for insurance through the Massachusetts Workers Compensation Assigned Risk Pool in 2011.

 

As a result of these alleged schemes, Foss put his insurance companies and his workers at risk by failing to cover injuries that could have occurred because of roofing work and in the process evaded paying $120,000 in workers comp insurance premiums.

 

 

 

 

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

6 Ways To Maximize Your Work Comp Adjuster Relationship

The best ways to reduce workers’ comp costs is to reduce claim costs. A major factor in the cost of claims is the quality of claims handling provided by the workers compensation adjuster.

 

There are at least six things an employer can do to improve the results the adjuster obtains for you:

 

 

  1. Get Your Own Adjuster

 

Too many employers allow the insurance company or the third party administrator (TPA) to chose their adjuster. If you have more than just a few open workers compensation claims at any one time, you soon to begin to evaluate the effectiveness of adjusters working on your claims. When you know who is the best adjuster or the best two adjusters are, ask the insurer or TPA to assign all your future claims to the adjuster you have selected. Express appreciation for the adjusters not selected, but put some emphasis on why you are requesting a certain adjuster, whether it is better overall results, quality communications or some other reason.

 

 

In the claims office, when an adjuster handles all the claims for a particular client, but also handles claims for other clients, the adjuster is referred to as the designated adjuster. If you have 100 plus claims in one claims office, ask for a dedicated adjuster who handles claims only for your company. Know the difference between these two types of adjusters. The benefits of having either a “designated” adjuster or a “dedicated” adjuster include:

 

  1. Becoming more important to the adjuster as the adjuster knows she/he will be dealing with you frequently.
  2. The adjuster learns what you as the employer considers essential and tailors their work to meet your needs or desires.
  3. The adjuster learns more about your company and knows who to contact with questions or to obtain information, making the claims process flow smoothly.

 

 

2. Create a Partnership

The quickest way to spoil the working relationship with your adjuster is to treat the adjuster as an inferior. Instead of trying to tell the adjuster what to do on the claims, ask the adjuster what would be the best approach for both yourself (the employer) and the adjuster. With your company and the adjuster striving together to move the claim forward, greater progress will be made.

 

 

3. Timely Communication is Key

You do not need to contact the adjuster daily on each file. The best time to contact the adjuster is immediately after you learn some new information the adjuster does not have. This includes everything from calling the adjuster to discuss the details of the accident – which should be done immediately after the employee leaves the accident scene and is going to the doctor – to keeping the adjuster informed about off-work slips. If you learn today that the employee needs a MRI or some other test, notify the adjuster today, not tomorrow or next week.

 

 

Communication goes both ways. Let the adjuster know you expect the same timely communications. If the adjuster receives a surprise letter of representation from a lawyer or a medical report obtaining significant new information, the adjuster should be sharing it with you. If the adjuster knows you expect to be kept in the loop on a timely basis, he/she will do so.

 

 

4. Know What is Needed

In addition to calling the adjuster whenever you have new information, provide the adjuster with all information at your disposal to assist the claim. If the employee is going to be off work longer than the state waiting period, know how many weeks of earnings history are needed, and provide it on the appropriate state form without the adjuster having to ask for it. If the adjuster will need a job description to assist in getting the employee back to work, forward it to the adjuster before the adjuster has to ask for it.

 

 

By providing the information the adjuster needs with the minimal of delay, the adjuster will began to think of you as their favorite client/employer/insured, and the good will results in your files getting the adjuster’s attention first.

 

 

5. A *Real* Return-to-Work Program

Adjusters understand better than anyone the sooner the employee returns to work, the easier it will be to resolve the claim. Plan ahead when you have an employee off work due to an injury. Ask for the return-to-work restrictions immediately after the employee’s first medical visit. If you can accommodate modified duty for the employee, do so. It will make the adjuster appreciate you and your company (and it will save your company a lot of money in the long run). If you cannot accommodate the first set of restrictions placed on the employee, keep in touch with the adjuster and as soon as the medical provider raises the restrictions to a level you can accommodate, do so.

 

 

6. The Magic Words – Please and Thank You

The job of the adjuster is one of the most unappreciated jobs in the universe. If you want to make your adjuster’s day, try a heart-felt thank you when the adjuster investigates the questionable claim, or continues to pursue a modified duty release from the medical provider, or does anything better than it was done before on your claims.  Also, when you do need to make a request, a “Would you please call the employee?” goes a lot further toward getting something done than a command of “Call the employee.”

 

 

The results of taking these approaches – in working with your adjuster – will be workers compensation claims that get settled quickly and cheaply. This will translates into lower workers compensation cost for your company.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de