A worker has an accident on 5/8/07. The employer, in the C-2, reports not receiving notice of the accident until 9/12/07. Section 18 of the WCL states an injured worker must report an accident to the employer, in writing, within 30 days of date of occurrence. However, at the first hearing 6/4/08 when the worker testified, the carrier’s representative failed to raise the issue of late notice.
Eventually, after litigation, an appeal (when the claim was disallowed for late notice, and a request for full board review, the full board decided late notice was no longer an issue since it was not raised by the carrier or the employer at the first hearing in which all parties were present and the worker testified. Section 18 also provides late notice be waived if the carrier or employer does not raise it at the first hearing where all parties are present and the worker (claimant) testifies.
Each year dozens, if not hundreds, of claims that should properly be disallowed for late notice, are allowed for failure of the carrier to properly raise the issue. At the new rates, hundreds of thousands of dollars could be involved in a single such claim.
WHY, when the employer properly notified the carrier of the late notice did the carrier's rep not raise the issue in time? Comp claims are highly repetitive in many respects and a lawyer for a carrier might be handling more than 10 files on a single afternoon or morning. A note on a file to raise an issue may be overlooked or forgotten. (workersxzcompxzkit)
The employer might have a lawsuit against the carrier but there are better practices to employ to prevent the defense from being lost.
Tip from Ted: When an employer identifies a defense, especially late notice, it should call the carrier and make sure it knows of the defense. Then, the employer makes every effort to be present at the first few hearings (workers are not always present at the first hearing, nor do they always testify). The employer’s presence ensures that closer attention is paid to the file and that defenses are not lost.
Source: Citywide Central Insurance Program. New York WCB: 0074-9236.Full Board decision filed 2/25/10.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers' compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
Podcast/Webcast: Occupational Health Strategies
Click Here:
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
© 2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
Fraud Prevention Program Scores a Hit!
A
program targeting workers’ compensation insurance fraud resulted in 154 arrests in 2009 and $16.6 million in recoveries and estimated savings as reported by the New York State Insurance Fund (NYIF).
Since 1995, NYSIF cases accounted for 1,382 insurance fraud arrests, along with recoveries and estimated savings of $183.1 million. During that time, NYSIF established a national reputation for fighting workers’ comp fraud by working cooperatively with the New York State Insurance Department Frauds Bureau, the Workers’ Compensation Board Inspector General’s Office, local, state and federal law enforcement authorities, and district attorneys in many jurisdictions in and out of state.
“NYSIF has long been a leader in the fight against workers’ compensation fraud and our results this year again show we continue to lead the fight,” NYSIF Chief Deputy Director Francine James said.
“That’s a commitment we make as the state’s largest workers’ compensation insurance company to the people and all businesses of the state of New York . Workers’ compensation fraud is not a victimless crime, it is a felony and we vow to pursue it as such.”
Among anti-fraud special investigation units, NYSIF DCI ranks near the top nationally in annual arrests, and in cumulative fraud savings. In addition, NYSIF auditors have established a standard among insurance carriers for conducting premium audits that discourage improper payroll reporting and worker misclassification.
Recent significant cases resulting in millions of dollars in savings to NYISF have included claimants who receive benefits while operating businesses or remain employed in other capacities, the most prevalent type of workers’ comp fraud. (workersxzcompxzkit)
Other cases involve premium fraud, the most costly type, in construction, asbestos abatement and other contracting, including investigations in conjunction with the U.S. Department of Labor, the U.S. Postal Inspector, and local labor racketeering bureaus. Still other cases involve fraudulent provider billing.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
In litigation — especially the long processes of workers compensation, known to drag on for a decade or more — some procedures, normally making sense seem counterproductive. After all, why commit time and resources, both always so limited, to events which may not occur? Isn’t it better to save the efforts until they are needed?
That sounds sensible but it assumes everything else will remain the same until the right time comes along. In litigation and claims, however, evidence and witnesses slowly, but surely, fade away. Every year there will be less of each, unless measures are taken to preserve information which may be needed, in some cases many years later.
Often, in work comp, a claim may appear to be small and limited – and then, years later, the claim is reopened and becomes large indeed. The claims unit then must scramble to collect certain information only to discover much, most or all of it has been “purged,” i.e., lost forever. How much better it would be if basic information was kept, leading to recovering or preserving vital information.
Every employee workers’ compensation claim must keep certain basic information.
1. Date of hire.
2. Names and addresses of prior employers.
3. List of medical plans under which employee had coverage.
4. List of medical absences, however short, with dates of lost time.
5. Copies of medical absence certification by treating doctors.
6. Prior work comp or negligence claims, if known.
If it becomes necessary to reconstruct a worker’s medical history, the above information is used to locate information from a variety of sources.
1. A medical note purged from a doctor’s records may still exist in an old personnel file, even with a prior employer.
2. Rarely are group plan medical records purged beyond recovery.
3. Modern scanning and computer storage nearly guarantees records of surgery continue to exist somewhere, if the surgery was performed in the last 30 years.
4. The identity of an employer’s group medical plans is a public record, maintained by the United States Department of Labor.
Pulling together these types of information can save large sums, provided the name of the prior employer is preserved.
Who locates these records?
A very small, very specialized group in the field of “medical records archaeology” (yes, that term really exists) knows how to navigate the paths, assisted by attorneys with skills in subpoena and/or release of medical info.
However, the task takes a fraction of the time and expense, and produces multiples of results, if the employer provides a jump-start with the basic data. (workersxzcompxzkit)
Preserving the data, even after an employee leaves for a new job, is advisable. Old comp claims are frequently reopened for apportionment with a new claim.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers' compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
Workers’ compensation payments are periodic payments of money – but are they assets? Property? What rules apply to them in a family support or divorce matter?
When the New York Workers’ Comp Board makes awards, especially awards for “permanent” disability, or makes a final settlement award, many people come to think of the award as a common form of property. However, like much else in workers’ comp, the truth is far different.
First, “permanent” disability is not really permanent. The Board can change the award at any time under Sect 123 of the WCL and rule a permanently disabled worker is no longer disabled at all.
Second, even where awards continue to be paid they are not property the worker may dispose of at will. Section 33 of the WCL describes periodic payments as being generally free of liens and may not be transferred by the worker.
New York has recognized since 1935 that comp payments are for the support of a family, not just the worker. New York courts, since 1984, may issue orders of support, which become liens on comp payments under Sects. 5241 and 5242 of the CPLR.
What this means is during a divorce the parties may not agree to apportionment or assignment of compensation payments. There is continuing joint oversight of the payments by the compensation board. The Board rules on the amount of the payment. And, the Supreme Court, rules as to how the amount may be distributed.
The dark side of work comp and family support is many younger workers, seeing an extended comp claim as a chance to shed an old relationship and start anew, move, halt contact or otherwise try to conceal a settlement of a comp claim – often, currently, ones over $100,000. (workersxzcompxzkit)
An employer should not be surprised to receive phone calls from an angry estranged spouse if a former worker is now on continuing comp. The call, predictably, is about learning the amount of work comp and where it is being sent. Such calls should be referred to the WCB, which will direct a spouse or child to the proper people for assistance.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers' compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com
An international law firm with its primary office in New York City, allegedly violated federal age discrimination law through its compensation system, the U.S. Equal Employment Opportunity Commission (EEOC) charged in a recent lawsuit.
According to the EEOC’s suit, in the firms system, attorneys who practiced law after turning 70 years of age received dramatically reduced compensation compared to similarly productive younger attorneys solely because of their age. The EEOC further charged the law firm unlawfully retaliated against one of its attorney’s who practiced law at the firm for over 40 years, by further reducing his compensation after he complained about this discriminatory policy and filed a charge with the EEOC.
“Law firms that single out older attorneys for adverse treatment simply because of their age run great risk of violating the federal prohibition on age discrimination,” said EEOC Acting Chairman Stuart Ishimaru. “This lawsuit should serve as a wake-up call for law firms to examine their own practices to ensure they comport with federal law.”
The EEOC’s lawsuit, Civil Action No. 10- CV-0655, filed in U.S. District Court for the Southern District of New York, said the firm requires all partners to give up their ownership interest in the firm at the age of 70. If an attorney continues to work, his or her compensation consists of an annual "bonus" payment in an amount totally within the discretion of the firm's executive committee.
Since the claimant turned 70 in 2001, even though he previously earned a $1 million plus in fees annually routinely from his clients, his compensation was substantially less than the firm’s younger firm lawyers with similar productivity. Moreover, in 2008 and 2009, after the attorney complained internally about the age-based compensation system, ultimately resulting in his filing of an age discrimination charge with the EEOC, the firm reduced his bonus payment by two-thirds even though his productivity remained the same.
This alleged conduct violates the Age Discrimination in Employment Act (ADEA), prohibiting age-based employment discrimination against workers 40 and older. ADEA also bars employers from retaliating against those who complain about these unlawful practices. The EEOC filed suit only after attempting to reach a voluntary pre-litigation settlement.
“A law firm's compensation for its attorneys should be based on ability and productivity, not on age-based stereotypes about declining effectiveness,” said Elizabeth Grossman, regional attorney in the EEOC's New York office.
Spencer Lewis, Jr., director of the EEOC’s New York District Office, added, “More and more attorneys are effectively practicing law into their 70s and beyond. This is also seen by the fact that most current Justices on the U.S. Supreme Court are over 70 years old.” (workersxzcompxzkit)
In FY 2009, the EEOC received 22,778 age discrimination charge filings, the second highest level ever, accounting for 24% of its private sector caseload.
Author Robert Elliott
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Currently, 26 states have passed, or have pending, laws on medical use of marijuana. In New York, two bills, A.9016 and S. 4041-B, are pending which would permit medical prescriptions for marijuana.
The consequences for employers and workers’ compensation are far reaching. Some have said it is possible marijuana will be a substitute for the far more expensive and addictive Oxycontin – a substitution that might be welcomed by some carriers. However, there is a near certain potential for work comp claims being filed solely to obtain free marijuana.
The claims, most likely, will be “medical only” claims with little lost time. Such claims rarely receive much attention by the Workers’ Compensation Board – especially when the medical bills are minimal. The cost of adjudication is multiples of the underlying charges.
Senate bill, S. 4041-B, prohibits an employer from discriminating against an employee, or leased employee, for using medical marijuana. The bill also provides that medical marijuana may not be used publically or in any area where tobacco is prohibited.
The Senate bill permits prescribing for certain conditions, of which chronic pain is a qualified condition. This effectively means that a determined employee will certainly be able to find a facility willing to issue a prescription.
The social problem for the employer’s workplace will be the patient who may not openly use marijuana but is too open in boasting of its availability, free, to some employees. Added to that will be the protections against discrimination – which are quickly discovered by many people. (workersxzcompxzkit)
The chief problem for employers will be the legitimization of a practice formerly considered a crime and not protected by the Americans with Disabilities Act. There will be impacts upon drug-free workplace initiatives and a dilemma if a “patient” finds a way to obtain more marijuana than has been prescribed.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers' compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
A carpentry contractor was arrested for allegedly concealing payroll resulting in underpayment of thousands of dollars in workers’ compensation premium to New York State Insurance Fund according to NYSIF Chief Deputy Executive Director Francine James.
A joint investigation by NYSIF’s Division of Confidential Investigations, the New York State Insurance Department Frauds Bureau and the Suffolk County District Attorney’s Insurance Crimes Bureau led to the arrest of the individual. Authorities said NYSIF auditors found the man allegedly failed to disclose more than half a million dollars in receipts for carpentry work, resulting in an underpayment to NYSIF of $76,677 in premium for workers’ comp insurance.
Investigators said that during NYSIF’s audit, the suspect was found to have allegedly failed to disclose approximately $650,000 in payments he received for cabinet and framing work from another contractor between 2006 and 2008, and allegedly underreported his business payroll to NYSIF to obtain a lower premium for insurance.
He faces felony charges of fraudulent insurance practices in violation of the Workers’ Compensation Law.
Author Robert Elliott, Director.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Several changes in the work comp law in recent years have merged to create unexpected consequences for employers. First, permanent partial disability claims have new rules regarding what becomes of the reserves. Second, “caps” have been placed on permanent partial disability claims which limit the number of lifetime weeks of disability, based on the degree of loss of wage earning capacity. Third, the law regarding disposition of reserves does NOT apply to self-insured employers.
Henceforth, when a worker is found to be permanently partially disabled the reserves on the claim, instead of remaining with the carrier, must be transferred to the Aggregate Trust Fund. The reserves can be over $300,000. This can be avoided IF the carrier settles with the worker within the sixth months after a finding of permanency is made.
“Caps”, which limit the total number of weeks of benefits, seem to hold down reserves on smaller claims. But, they also result in far fewer settlements within the six month period – essentially creating a large fund for the state, not the carrier, since settlements would seldom be worth the effort of pursuing.
Finally, an employer can avoid the consequences of the new laws by becoming self-insured.
Past experience has shown that when the state has a financial interest in the outcome – as it does when it is the holder of substantial funds – judges tend to make decisions which gradually transfer more and more funds to control by the state. This was precisely the position taken by carriers in opposing the state borrowing reserves of the State Insurance Fund in 1982. And again, unsuccessfully, in a recent federal lawsuit to block the new rules.
But who pays? The reserves are taken from the carrier but the transfer will be passed on to the employer in the form of a higher experience modifier – unless. . . . Unless the employer is self-insured, in which case none of this applies. (workersxzcompxzkit)
It can be seen there will be a significant movement to self-insurance, either individually or through group self-insurance. Subjecting the self-insureds to the same rules is unlikely since all NY counties and nearly all towns, villages and school districts are self-insured.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers' compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Just when we here as Workers’ Comp Kit Blog think we’ve seen the most clever kind of fraud schemes, something new comes along to astonish us – and cause us to ask the question, “Why do they DO it?”
A doctor in New York doctor faces charges for alleged insurance fraud and fraudulent insurance practices for hiring a patient he was treating for a workers’ compensation disability.
Following a joint investigation by New York State Insurance Fund Division of Confidential Investigations and the New York State Insurance Department Frauds Bureau discovered the doctor allegedly hired the woman as a licensed professional nurse while she received workers’ comp benefits from NYSIF.
The doctor reported to NYSIF the woman was temporarily totally disabled as a result of her injury. However, he employed the woman as a LPN in his office during the time period she was collecting workers’ comp benefits. (workersxzcompxzkit)
The nurse joins her doctor/employer in being charged with insurance fraud and fraudulent practices in violation of the workers’ compensation law.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
A New York man is charged with wrongfully receiving nearly $47,000 in workers’ compensation benefits while working secretly as a disc jockey for a strip club, according to the New York State Insurance Fund.
Officials said they found the defendant was spinning music at the strip club for the past five years – the same time period he also collected work comp benefits from an accident 23 years ago.
The man was charged with third-degree felony insurance fraud and fraudulent practices, for alleged crimes taking place from January through December 2009. It is also alleged the individual not only misrepresented his return to work, but also his physical capabilities and condition.
Authorities say the man was injured in 1986 while working as a painter for a Central New York cheese company, and he previously denied in three separate written statements to the state Insurance Fund that he had returned to work. During an investigation, (by the state Insurance Fund’s Division of Confidential Investigations, Insurance Department’s Frauds Bureau and the Workers’ Compensation Board Inspector General’s Office) the man admitted he was working as a DJ at the club. On Dec. 14, Utica police took the man into custody on.
During this past year alone, the individual received nearly $3,600 in wage replacement benefits to which he was not entitled, officials said. The potential total for the benefits that he wrongfully received is estimated at $46,815. (workersxzcompxzkit)
“This case underscores an important element of what makes workers’ compensation fraud so expensive,” said Francine James, NYSIF chief deputy executive director. “This case has gone on for 23 years and could have continued for many more had our people not been vigilant.”
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
Podcast/Webcast: How To Prevent Fraudulent Workers’ Compensation Claims
http://www.workerscompkit.com/gallagher/podcast/Fraudulent_Workers_Compensation_Claims/index.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Posted in
