Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.

 

 

Dara Duong, 53, of Lowell, pleaded guilty to charges of Workers Compensation Fraud (3 counts), and Larceny over $250 (2 counts). After the plea was entered, Superior Court Judge Kathe Tuttman sentenced Duong to two-and-a-half years in the House of Correction, suspended for three years and three years of probation.  Duong was further ordered to pay full restitution and perform 400 hours of community service at the Muscular Dystrophy Association in Beverly.

 

 

The AG’s Office began an investigation after the Massachusetts Insurance Fraud Bureau (IFB) finished its own investigation and referred the matter for prosecution. Duong was the owner of three companies based in Lowell: Middlesex Temporary Agency (Middlesex), Ankgor Staffing, Inc. (Ankgor), and General Labor Services (General Labor).  All three companies provided unskilled labor, such as factory workers, to several client companies.

 

 

Over a three-year period Duong intentionally underreported his companies’ payrolls, the total number of employees, and the number of clients his employees worked for. Duong also misrepresented job classifications as part of a scheme to avoid paying higher workers comp premiums to two insurance companies.  Investigators discovered that based on Duong’s false representations on his insurance policies, he avoided paying approximately $110,000 in workers comp premiums for a total of three policy periods.  (WCxKit)

 

A Middlesex Grand Jury returned indictments against Duong and he was arraigned on in Middlesex Superior Court where he originally pleaded not guilty.
 

 

 

 

 

 

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

A company that wants to implement a new workers compensation program or revamp an existing system will find this book helpful. Maybe your company has recently expanded and you realize the need to train a workers compensation manager or regional coordinators how to hold down compensation costs. Whatever your need, here is the answer: Workers Compensation Management Program: Reduce Workers’ Comp Costs 20%-50%.

 

 

Used by more than 150 firms across the country, this is THE book to help every employer develop a more effective workers compensation program to reduce workers compensation costs. It is based on field research and decades of experience in workers compensation from all aspects of the business. Best practices are described in detail for each person in the injury process.

 

 

This easy-to-read manual has been updated for 2012. It now includes:

 

An index for quick topic look-up so you can view a term or a procedure and see all relevant references.

 

Purpose of Workers Compensation

Who Pays for Workers Compensation?

Parties Involved in Workers Compensation

Benefits for the Employer

Independent Contractors

Benefits for the Employee

Injuries Covered

Types of Workers Compensation

How Losses are Categorized

How Losses are Reported

Calculating Your Premium

How Mod Effects Your Premium

Good/Bad Mod Example

Five Ways to Reduce Your Mod

 

Reasons Workers Compensation Costs are High

Who is in Charge?

Work Ability Form Properties

Who is Responsible for Managing Workers Compensation Claims?

Who is Responsible for Managing Workers Compensation Process?

Hidden (Indirect) Costs of Workers Compensation

Additional Costs

Calculating WC Costs

External Obstacles to Cost Control

Internal Obstacles to Cost Control

 

Account Handling Instructions

MD Participation

 

Critical Issues

Essential Intake Considerations

Nurse Triage

 

Occupational Health Clinics

Remote Health Services

Directing Medical Care in California

 

What to Include in a Transitional Duty Policy

Non-Profit, Volunteer or Charitable Positions

Employees Who Never Return to Work

Coordinating WC with Federal and State Leave Statutes

 

Telephonic Disability Intervention

 

URAC Certification

Mental Health RNs

Chronic Pain Programs

An Aging Workforce

At Home Recovery Services

Medical Fee Schedules

Fee Schedule Coding

ICD-9 and CPT Codes

 

Differences between Physical Rehabilitation Programs

Pharmacy Benefits Management Program

Authorized Drug Formulary

Toxicology Screening

 

Medical Terminology Used to Identify Malingering

Reviewing Investigation Reports and Videos

Avoid good Day/Bad Day Syndrome

 

Conditional Payment and Final Demand

Pharmacy Component of MSA

California Settlement Process

 

 

A 183-page guide covering how to assess your workers compensation program, design program materials, roll out a program to the organization, and monitor and manage the program once implemented.

 

 

Written by a national expert on workers compensation cost containment with over 25 years experience helping companies reduce their losses 20% to 50%.

 

 

T. Ronca, a workers’ compensation defense attorney from Long Island, NY, said the book is an invaluable desk reference. “It is one of the tools that should never be out of reach for a risk manager. Direct employer involvement with claims in the first weeks is the difference between success and failure. This manual will guide the conscientious employer through the pitfalls,” Ronca said.

 

 

What’s more, the book can be delivered with your company logo on the cover and a full-color ad for your company on the back cover. 

Take it out to the field. Text tabs are available to put on each chapter and it is ready to go as your company training manual. All you will have to do is customize the Training Agenda that is in Part I of the book.

 

 

Included in the manual are topics such as: Return to work and transitional duty, claim reporting, employee communications, controlling fraud and abuse, directing medical care, medical cost containment solutions, post injury response procedures, reporting procedures, working with your carrier and third party administrator. There is information about physical therapy, pharmacy benefits management programs, training supervisors and gaining management commitment. It also contains concepts of claim settlement and resolution as well as safety and loss control. New areas are identified above.

 

 

There are 5 sample worksheets in the manual to help organize an efficient workers’ compensation program. These include: timetable for implementation, the injury coordinator job description, and several sample roll-out letters. We recently received a terrific phone call from a third-party administration firm saying how the manual provided an organized way to train clients at loss prevention and has helped their clients put "layers of better WC management" in place. Everyone benefited.

 

 

One large distribution firm wrote to us to say the chapter on safety and loss control led to a company-wide safety change that only cost a few hundred dollars but prevented a specific type of injury that had been draining its budget, says Rebecca Shafer, Esq., President of Amaxx Risk Solution, Inc. who authors the book. Shafer is a national expert on workers’ compensation cost containment with more than 25 years of industry experience helping many companies reduce their losses 20-50%.

 

 

When you order your copy of Manage your Workers’ Compensation Program from Advisen at http://corner.advisen.com/wcbooks, the 183-page guidebook shows how to assess your program, design program materials, roll-out a program to the organization, and monitor and manage the program once implemented.

 

 

The workbook is also available with a customized front and back cover for bulk purchases. Discounted rates apply to bulk orders.

 

 

One company said, "After reading the manual, we took a look at past workers comp practices and saw that every department did things differently. Manage Your Workers’' Compensation Program 2012 gave us the guidance we needed to standardize our workers’ compensation programs across the country. It was like a pre-prepared lesson plan," according to the risk manager.

 

 

A regional hospital in North Dakota wrote that, "Our small company expanded rapidly and we actually didn’t have any official workers’ compensation program in place. This manual gave us step-by-step procedures from the first meetings with management to monitoring the final program. Buying and reading the book was almost like hiring another employee – one who was an expert in workers’ compensation."

 

 

Risk Managers and Workers’ Comp Managers find it useful learning about the cost containment niche and use it for themselves and to bringing new team members up to speed very quickly. The book becomes a “lesson plan” tool.

 

 

Safety Directors use the book to train supervisors in workers’ compensation claims management. They learn more about their area of responsibility — post loss cost containment — adding to their overall knowledge. They also learn what to do after an injury and what steps are supposed to take place during the first 24 hours.

 

 

Brokers use it for prospects, as well as, to learn about specific aspects of cost containment, passing their knowledge on to their clients. For example, when discussing how to develop a return-to-work program and a client asks about, “off-site return-to-work programs,” the broker quickly finds the relevant section in the book, reviews it and passes the answer on to the client, along with a copy of the cost containment book with the broker’s logo.

 

 

Adjusters use the book to gain a better understanding of the employer’s perspective. Adjusters also want to learn more about cost containment to add to their overall workers’ compensation knowledge in order to grow their careers and stay abreast of new services.

 

 

Account Producers give the book to prospects during formal presentations to illustrate their company is on top of the workers’ compensation industry. The book makes an excellent client gift.

 

 

Vendors such as doctors, physical therapy networks, occupational clinics and medical management firms learn how their service might fit into the workers’ compensation marketplace, what is important to employers, and what they look for in medical services to enable the vendors to enter the workers’ compensation marketplace.

 

 

The manual is a cost-cutting tool to learn more about systematic and operational techniques for reducing workers compensation costs.

 

 

 

 

 

 

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

The prosecution of Charles (Sandy) Blunt was, in our view, an outrageous and almost farcical event. It is, in the final analysis, a travesty that has damaged the national view of your state, hampered the operation of a State agency, and ruined the life of a good man wholly undeserving of such results. (WCxKit)

 

Sandy Blunt was Director of North Dakota's Workforce Safety & Insurance from May of 2004 until December of 2007. He was, as you are likely aware, prosecuted by state authorities for “misspending government funds”. Specifically, he was charged and convicted on two counts
 

1.     During his almost 4 year tenure his agency spent approximately $11,000 on employee incentive items, including flowers, trinkets, balloons, decorations and beverages for Workforce Safety and Insurance employee meetings, and on gift certificates and cards in small denominations for restaurants, stores and movie theaters. Blunt personally approved some of these expenditures. Others were made by managers as part of daily operations under his watch. Not a dime went into an employee’s pocket, nor did Blunt personally benefit from any expenditure.  

 

2.     His agency paid $8,000 to an employee, David Spencer, for sick pay when he was not apparently sick, and it also failed to collect $7,000 from Spencer when he left prior to the end of his employment agreement. The $7000 was for moving expenses incurred that prosecutors felt Spencer owed the state. Blunt’s position was that the agency was not entitled to collect these funds, since Spencer’s departure was not voluntary.
 

All told, the state prosecuted Sandy Blunt, and he is now a convicted felon for “misspending” $26,000 of government money.
 

No one has ever alleged that Blunt personally benefited from any of these expenditures. Blunt was acting like other capable, ethical North Dakota executives ‐ in the best interest of customers and of the mission of his employer. In our industry it is considered a best practice to provide employees and supervisors with incentives. It is not frivolous, it's necessary, and what every employer should do.
 

The first of these two charges would be, to many people, laughable if it were not for the damaging consequences associated with them. The notion that buying inexpensive incentive items for your employees could result in a felony conviction is simply stunning. This would not be elevated to a criminal status in most states in the nation. The fact that it is in North Dakota should have a chilling effect on businesses looking to move there.
 

The second and more serious charge, involving the sick pay and moving expenses of employee Spencer, has been fatally undermined by the revelation that the prosecutor in the matter, Cynthia Feland, withheld critical evidence from the defense – evidence that largely clears Blunt in this area. A disciplinary panel for the North Dakota Supreme Court has found on November 7, 2011 that
 

Withholding of evidence by prosecutors is one of the most serious acts of prosecutorial misconduct in North Dakota and all other states. In recognition of this, the panel recommended Ms Feland’s license to practice law be suspended. We urge that you read the entire report of the panel, including the penalties the board recommended be imposed on Ms. Feland. For the report, go here.
 

Had the prosecutor not withheld evidence, in all likelihood the case would never have come to trial, and the reputation of Blunt and the WSI would be free of taint. The evidence in question shows that WSI’s auditor’s own findings backed Blunt’s position on payments related with Spencer. However, those findings were not made available to the defense, and the prosecutor was found to have allowed testimony to be given at the trial that directly conflicted with information she had. As we indicated, Feland, now a judge in your state, has been recommended for suspension and a fine over these findings.

 

Yet Sandy Blunt remains a convicted felon. His crime? Buying balloons, trinkets and $5 gift cards – for his employees, not for himself. For that, Blunt, who is married with two children, has had to spend half a decade, and untold thousands of dollars trying to clear his name.

 

Some of us have known Sandy for quite a while. Some have come to know him while learning of his situation. Others of us have never met Sandy, but recognize the tenuous nature of his treatment. Collectively we speak to thousands within our industry every day. Our opinions have been clear; this situation needs the light of truth shone brightly upon it. The time and resources expended prosecuting a man on such questionable grounds should be more closely examined, by the business community, workers compensation professionals and the media in North Dakota. (WCxKit)

 

 

 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

 

 

The court sentenced Mikulenka to three years deferred adjudication and 100 hours of community service. Mikulenka was also ordered to pay $7,221 in restitution to Texas Mutual. (WCxKit)

 

 

Mikulenka reported a job-related injury while working as an electrician for IGC Construction, Inc. in Houston. He claimed he was unable to work as a result of the injury, and Texas Mutual began paying income benefits to him.

 

 

Meanwhile, Texas Mutual uncovered evidence that Mikulenka was working as a laborer while receiving income benefits.

 

 

Investigators call this type of scam double-dipping because claimants collect benefits for being too injured to work when, in fact, they are gainfully employed. Texas law requires claimants to contact their workers comp carrier when they return to work. (WCxKit)

 

 

Left unchecked, double-dipping and other workers comp fraud can lead to higher premiums for all Texas employers.

 

 

Maryland Woman Sentenced in Nevada Workers Comp Fraud Case 

A Maryland woman has been sentenced to 2 ½ years in a Nevada state prison for attempting to defraud her employer’s workers compensation insurer of $20,000 while at a professional conference at the Las Vegas Hilton, according to Nevada Attorney General Catherine Cortez Masto’s office.

 

 

Morale hazard is loosely defined as the presence of an outside item or system that affects typical behavior. I like to use an example of SUV-type vehicles. Because of added safety features and the enormity of the vehicle, drivers report feeling safer and often take more risks then when driving smaller, less-safe vehicles. For example, an SUV driver may be more aggressive during dangerous snowy conditions, or drive more aggressively in general simply because she feels safer.   WCxKit

 

 

To put this in a Workers Compensation context, the morale hazard is the comp system itself. The system’s rules and laws make people behave differently than if they were presented with the same injury and medical scenario outside of the work comp atmosphere. We further discuss these scenarios below:

Within the WC world, adjusters often complain about claimants overreacting to pain and complaining about the presence of pain with even the most trivial injury. This is thought to happen due to the nature of the claimant feeling that they have to prove their injury to the doctor and to the carrier. Even though, as adjusters, we understand injuries occur and most times they do indeed hurt, the need presents itself for the claimant to feel as if they have to be sure to state how unbearable this particular injury is, in order to make the injury seem more believable.

 

 

If you take WC  presence away, when a similar strain injury occurs, outside of the workplace, for example, the reaction may be wildly different. Claimants may shrug off the pain as “age-related” or due to overdoing it instead of feeling the need to play up the pain to their doctor, as is often the case in workers compensation claims. Adjusters will rely on physicians using the “Waddell’s signs” to evaluate pain behaviors in relation to the severity of injury. As you see, the mere presence of the work comp system can provide the means to making claimants overplay pain as much as possible to make their case more concrete or believable.

 

 

Minor strain injuries generally resolve with modified activity and time. But when a work comp case is present, some claimants feel the need to seek out certain types of medications, typically opiate in nature, to cement the legitimacy of their injury. The thought process is, “If I did not have a bad injury, why would I need these stronger medications? Therefore, my claim must be legitimate.”

 

 

One factor muddling this is physicians who are quick to prescribe opiate medication even when the clinical need is not present. Strain type injuries can heal with assistance from anti-inflammatory medication, not necessarily stronger opiate classifications of prescriptions. Many resolve with hot/cold compresses, several special deep knee bend type exercises, rest and 1-2 chiropractic treatments. I speak from experience.

 

 

Removing the comp system again can show the normal behavior. If a person injures themselves mowing their lawn, if they do not like going to the doctor in general, they may take over the counter medications and feel just as good the next day as if they did indeed take a stronger medication prescribed to them by their physician. So you see, drug-seeking behavior is rampant in work comp cases due to the need for the claimant to seek approval from their comp carrier for that injury.

 

 

If you have the capability for light duty at your factory, when claimants get injured and have work restrictions, proactive employers place them in lighter duty jobs until they get released by their doctor to full duty. A common situation in comp is the worker complaining even the light duty work makes their pain worse. This can happen even when it seems impossible the light work could cause pain. This is due to the presence of workers compensation. Had the worker not been injured, and you placed them in this light-duty job, it is doubtful they would be making the same complaints.

 

 

Similarly, employers may see an increase in work absences due to alleged pain complaints. Workers will say, no matter what job they do, they just cannot get out of bed and back to work due to injury pain. In the example of the lawn-mowing injury – when the comp system is removed, it is probable this worker will show up as scheduled and ready to work as if it were any other day. This again may be due to the claimant feeling the need to legitimize their claim to the carrier. True, sometimes it's not.

 

 

Sometimes outright avoidance becomes apparent. Missed phone calls, voicemails not returned, and an employee not bringing in medical slips to the HR department as instructed may start to happen. Remove the comp system and injury, and this wouldn’t happen. A responsible worker injured outside of work keeps the HR department up to date with medication restriction slips. Once you introduce the work comp system to this same scenario, avoidance behavior may come to fruition.  WCxKit

 

 

To review, morale hazard is the presence of a particular system or entity that can affect a person’s behavior negatively. This is made clear within the presence of workers compensation. Adjusters see these behaviors day in and day out. What the employer calls a “great, dependable employee” could be to the adjuster a claimant who exaggerates pain, has drug-seeking behavior, and exhibits typical avoidance maneuvers in general. This all negatively impacts the claim, and actually makes it more difficult in the long run. From the workers point of view, these behaviors make their claim more legit — just the opposite occurs.

 

 

 

 

 

 

 

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

 

The recently enacted Immigration Services Fraud Prevention Act, requested by the Attorney General’s Office, prohibits anyone from engaging in the unauthorized practice of law in an immigration matter, unless that person is a licensed attorney or is otherwise authorized to provide legal services under federal immigration law. (WCxKit)

 

 

Designed to protect consumers from deceptive business practices, the new law prohibits non-lawyers and unauthorized individuals from engaging in several other activities.

 

• Selecting or assisting another in selecting an immigration-related government form;
• Advising another as to his or her answers on an immigration-related government form;
• Soliciting to prepare documents for another for submission in a judicial or administrative immigration proceeding;
• Charging a fee for referring another to a person licensed to practice law;
• Drafting or completing legal documents affecting the rights of another in an immigration matter;
• Referring oneself as an “immigration assistant,” “immigration consultant,” “immigration specialist,” or any other term in any language (including the Spanish term notario publico), that conveys or implies that the person possesses professional legal skills in the area of immigration law

 

 

While the law does not prohibit the provision of translation services, the law does prohibit non-lawyers and other unauthorized persons from advising customers as to their answers on immigration forms.

 

 

As the new law goes into effect, the Attorney General’s Office warns consumers to be careful who they trust when it comes to immigrant assistance.

 

 

“In Washington and around the country, people advertising immigration services use the title notario publico on business cards and in their business dealings to deceive consumers into thinking that they have special legal training in immigration affairs,” said Attorney General Rob McKenna. “However, a notario publico is not a lawyer and is not authorized under state or federal law to provide you with legal assistance in your immigration case.”

 

 

In several Latin American countries, the term notario publico refers to an individual who has received extensive legal training over the course of several years.

 

 

In the United States, a “notary public” is an individual who has the authority to administer an oath or affirmation or witness the signing of papers. The title is relatively simple to obtain. (WCxKit)

 

 

Many people use this linguistic accident to deceive Spanish-speaking customers into thinking that they are experts in immigration law. Do not be deceived by a person described as a notario or notario publico. He or she is probably just a “notary public” with no legal skills whatsoever, according to McKenna.

 

 

 

 

But when there is a problem, it is a big problem. When the adjuster is working with a doctor that does not want to cooperate and respond to certain questions, that is a major issue.  This issue will affect the injured worker by affecting care and time off of work. It can cause the claim to go to litigation, etc.   So something as simple as going to the doctor for an injury can morph into a really big deal.  Here are some warning signs that a claim could be heading down the bumpy road. (WCxKit)

 

 

This one item frustrates adjusters more than any other.  If a person comes in with a hand laceration, and the doctor places them off of work for 4 weeks, how is that legitimate?  The worker has another hand that is perfectly fine.  Even if the workplace is a dirty environment it does not mean it is risky to be at work with a hand laceration to one hand.

 

 

Physicians familiar with workers comp know better.  They know if they place a worker totally off of work and do not address restrictions, the adjuster will call.  In the world of workers comp, if a worker is on total off work status that means the employee either just had surgery or sustained a major injury.

 

 

There are 2 roadblocks to return to work: (1) the employer does not cooperate with creating light duty work for the injured workers, and (2) the doctor totally disables the employee for no good reason. But it depends, if this injury is acute and very severe, then certainly some time off of work is warranted for rest.  But the doctor has to explain why.  There is nothing the adjuster hates more than to see a back injury, and the worker is totally disabled, but in physical therapy.  So the worker is good enough to go to therapy, but not good enough to go do some light desk work for the employer? 

 

 

Physicians have to explain the diagnosis and work restrictions, and they have to have good objective evidence to support the decisions.  The adjuster has the right to demand that the doctor answer specific questions, and if the doctor disregards that, then it can affect the benefits being paid out on the file.  So warning sign #1 if there is an off work slip with no real explanation as to why.

 

 

A doctor that is monitoring a condition on a comp claim knows the worker’s main goal is to get back to work.  So they closely monitor the situation.  They schedule to see the injured party at least once every week, if not sooner depending on the injury.  A warning sign for a complacent doc is a return visit in 4-6 weeks.  That is a long period of time to go without being evaluated.  If it is a surgical claim, and this worker is post-surgery, and starting rehab, then this may be ok.  But for early on in a comp claim, anything over 7-10 days I would raise an eyebrow.  He will drag out the claim costing the employer more money.

 

 

If the injured worker goes to Dr. Smith, and everyone knows Dr. Smith at the shop, and everyone treats with Dr. Smith both for personal medical issues and for workers comp injuries, I would be concerned.  Maybe Dr. Smith prescribes a lot of Vicodin for simple injuries.  Maybe Dr. Smith disables them from working for a longer time than anyplace else. It could be anything, but if this particular clinic is a place where 85% of your workplaces treat, something is awry.  It may not be “illegal” activity, but there is some trend that this doctor does that nobody else in town will do. And that is always cause for concern in an insurance claim.

 

 

This is perhaps the most popular trend these days.  I have observed countless claimants going to the doc for a simple strain and walk out of the clinic with a 30-day RX for Vicodin.  That is never a good sign.  I am not a physician.  I did not go to med school.  If Vicodin is needed for 3-5 days, that is warranted.  But for an initial visit, for a simple strain, that is not really all that severe, a 30 day supply is unnecessary. RX stands for "prescription."

 

The cost of the RX is determined by quantity and type of drug. If you look at the work slip and the doctor prescribed Vicodin and Percocet, Valium, and Motrin, that is not acceptable.  Not only did this doc over-prescribe by giving the worker 2 similar narcotic drugs (Vicodin, Percocet) but also prescribed Valium, which may or may not even be needed for this particular case.  Probably the only RX a simple strain needs is the Motrin.  All the other RX’s are warning signs that this doctor is happy to prescribe anything at will, and these medicines are not cheap, and some are not even necessary.

 

 

I recall a while back there was a large occupational clinic that would give anyone that walked in a script for physical therapy (PT).  You can have sprained your hand, and you were going to go for 4 weeks of PT. Back injuries, finger lacerations, elbow pain, the answer was PT. They were using PT as a stall tactic, not the way it should be used by reputable doctors.  Finally enough people must have stepped up and said “This is ridiculous!  You mean to tell me every person that walks in needs PT?” 

 

But this shows a crucial point. Some physicians are also financially tied in to therapy facilities as well as to other testing facilities.  So not only do they make money off office visits for evaluating the patient, but they make even more money billing for 12-16 PT visits.  Then they will probably see the patient again at the clinic for another evaluation.  And maybe more PT is needed.  And, before you know it, the cycle begins. In most states this is illegal and unethical. Excessive PT is an indicator that something fishy is going on, and you can use your tools, such as an IME, to deem if more PT is really reasonable and necessary treatment in your given claim. Employers can eliminate the risk of using the wrong PT facilities by using the services of a Physical Therapy Management Company instead of simply working with the least expensive PT network.  Physical therapy can be extremely effective in facilitating recovery and return to work when used appropriately. I know, I've been there, done that.

 

 

This is a warning sign because the physician wants to keep seeing the patient and wants to keep billing the carrier/TPA.  As soon as the patient goes to an ortho or other specialist, that patient no longer treats at this clinic.  So, the doc has incentive to keep that patient around for a longer period of time. Repeat business is what makes money, and if the patients are continually coming back, that is more money in someone's pocket.  So if it has been a few months and the injured party is no better, it is way beyond time to be evaluated by a specialist.  And if the treating doctor is not bringing this up, you may need to force the issue.

 

 

The adjuster will always want to see the doctor’s actual notes or transcribed dictation.  This is where the adjuster can see exactly what the patient said, what the doctor saw on examination, and what the doctor’s plans are for resolving this medical condition. 

 

 

If the adjuster requests the notes, and they consist of 1-2 sentences of barely visible hand written scribbles, this is not good.  Not only is it worthless to the adjuster, it is worthless in general.  There is no info about the patient, about the exam, or about the treatment plan.  These doctors are out there. An example of their medical note could consist of the items below.

 

 

 

As crazy as that seems, that sometimes is it.  And the bill was probably $100-$150 for that “exam.”  So beware of the doctor that does not dictate or does not have properly typed notes.  It does not mean the doctor is necessarily bad, it just means that if the worker continues to treat with this physician, it is going to be a struggle to get information and clarification the longer the claim goes on. Those issues are very important, and if you struggle getting that much needed information, the rest of the claim will be a struggle as well.

There are good doctors, and bad doctors.  There are doctors that care about their patients, and doctors that could care less.  There are doctors that write up fantastic notes, and some that jot down a sentence or 2.  Physicians are just like everyone else.  They all have a unique style.  They have good days and bad days.  Some have successful practices, and some do not. (WCxKit)

 

 

But the bottom line is if a doctor is going to treat the injured worker, in a workers comp situation, then they have to abide by the rules.  And if they choose not to do so, it is going to complicate the claim one way or another.  Use the above warning signs to evaluate current claims for rough roads ahead.

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.

 

 

According to court documents, Beard worked as a distribution and window clerk for the Postal Service in Groveland. For two plus years, Beard received federal workers comp benefits for an on-the-job injury. Because of her claimed injuries, restrictions were placed on Beard's physical activities: no reaching, no pushing, no pulling, no driving for more than 20 minutes, etc.

 

 

Yet, Beard performed various physical tasks, such as horseback riding, caring for horses, yard work, and driving all using the purportedly injured part of her body. Because of claims Beard made in routine Department of Labor questionnaires, she continued to receive workers comp benefits, all while not entitled to such benefits. (WCxKit)

 

At least once a year the U.S. Department of Labor’s Office of Workers Compensation Programs is required to ask every total disability benefit claimant whether the claimant has had any employment, earnings, or changes in their medical condition over the previous 15 months. In compliance with regulations, OWCP sends out a questionnaire to each claimant. Claimants reporting changes in employment, earnings, or their medical conditions on the questionnaire may experience a reduction or termination of benefits.

 

 

 

 

 

 

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Justice was served recently on a Glen Eden, New Zealand woman who evaded several previous Court appearances to face charges of defrauding the Accident Compensation Corporation (ACC).

 

According to a report from ACC, Emi Tuala, a 44-year-old solo mother, appeared in the Waitakere District Court and was convicted of nine charges under the Crimes Act, and two charges under the ACC Act. (WCxKit)
 

 

Tuala was sentenced to six months’ supervision, three months’ community detention and was ordered to pay reparation of $6,939.89. She must also complete a budgeting course, and observe a nightly curfew during the period of community detention.

 

The charges related to a seven-month period between 2003 and 2004, during which Tuala was paid weekly compensation on the basis that an injury prevented her from working. ACC investigations subsequently revealed that Tuala had worked full-time throughout this period.

 

Tuala was originally summoned to appear in Court in February 2005. After she failed to appear, a warrant for her arrest was issued. She failed to attend subsequent Court hearings and further arrest warrants were issued.