A California amusement park owner charged with workers comp fraud and tax evasion has entered into a plea agreement with the San Bernardino District Attorney’s Office.
Following a suspected fraudulent claim referral form from the insurance company, investigators from the San Bernardino County District Attorney’s Office, Workers Comp Fraud Unit, served a search warrant on various properties owned and/or controlled by Thomas, 58, and Sharie Davis, 54, both of Fontana. Thomas and Sharie Davis are the owners of Davis Enterprises, a carnival and amusement park business. This is all according to the DA's office.[WCx]
During the course of the investigation it was found that Davis had illegally operated at the Del Mar Fairgrounds in San Diego County and other carnivals in Los Angeles and San Bernardino counties. Following the investigation, it was determined that the Thomas and Sharie Davis underreported the amount of their company payroll in order to pay smaller premiums to the State Compensation Insurance Fund, said Deputy District Attorney Michael Chiriatti, Jr., who is assigned to the case.
In addition to the insurance fraud, Thomas and Sharie Davis also failed to pay payroll tax between April 2010 and March 2011.
According to the plea agreement, Davis agreed to pay $195,937 to the State Compensation Insurance Fund and $18,206 to Employment Development Department. In exchange for her pleas, the charges against her husband were dropped. [WCx]
“As of result of their fraud, Davis Enterprises illegally pocketed over $200,000 in taxes and insurance premiums,” said Chiriatti. “This is felony conduct, and I am happy that the defendant has been held responsible for her fraudulent behavior.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-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.
©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 Los Angeles Fire Department recently became the latest organization to sign on to Cal/OSHA’s confined space awareness campaign which is an effort to educate employers and employees about the dangers of working in confined spaces. The Oakland Fire Department is also participating.
Cal/OSHA launched the statewide campaign in February, citing seven confined space deaths and numerous injuries in the state in 2011 – all of which were preventable. Cal/OSHA says its comprehensive approach to preventing further confined space deaths and injuries includes: public education and media alerts, enforcement and consultation and ongoing partnerships to help increase awareness and compliance.[WCx]
California's Department of Industrial Relations Director, Christine Baker, points out that employers need to have an effective emergency response plan in place before a critical situation arises.
Confined spaces are enclosed spaces that can be entered by workers, but have limited openings for entry or exit, and are not designed for continuous worker occupancy. Common examples include tanks, silos, pipelines, sewers, storage bins, drain tunnels and vaults. Confined spaces can be found in many industries and also in non-industrial workplaces. The 2011 California deaths occurred in a wide range of industries including a Fortune 500 pharmaceutical facility, a winery, a paint manufacturing plant and a recycling center.
One of these incidents occurred last January at Baxter Biosciences, a pharmaceutical manufacturer in Los Angeles. A 33-year old technician entered a blood plasma tank to measure its contents when he collapsed in the oxygen deficient atmosphere. Two of his colleagues entered the tank in order to attempt a rescue and collapsed as well. All three workers were extricated from the tank by the Los Angeles Fire Department. The first worker died, the second remains unconscious, and the third was injured but recovered.
Last October, a similar scenario occurred at the Community Recycling & Recovery facility in Lamont, when a 16-year-old worker cleaning a drainage tunnel was overcome by hydrogen sulfide gas. Another worker, his brother, aged 22 was rushed in to save him and was also overcome. Both workers died. Last week, Cal/OSHA levied fines totaling $166,890 for multiple violations of confined space regulations against the employer. Cal/OSHA’s criminal investigation in this case is still ongoing.
It is even more tragic that in many cases, workers attempting to rescue their co-workers also fall victim,” said Cal/OSHA Chief Ellen Widess. “Confined spaces can be deceptively dangerous. Employers need to assess if they have such a hazard, identify and mark those spaces, provide employee and supervisor training and on-site rescue plans and equipment.”[WCx]
In the last year alone, we have responded to three confined space rescues,” said Los Angeles Fire Department Battalion Chief Jack Wise. “It is our experience that the victims, would-be rescuers and co-workers, either fail to adhere to their emergency plans or simply do not have a plan in place, with catastrophic results.”
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-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.
©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 California roofing contractor was sentenced recently to one year in jail and was ordered to pay $510,000 in restitution for failing to provide workers compensation insurance for an injured employee and failing to pay insurance premiums for unclaimed employees, who were paid in cash.
According to the Orange County District Attorney’s office, Michael Amzie Holley, 43, Murrieta, pleaded guilty to a court offer to two felony counts of perjury by declaration, two felony counts of recording false and forged instruments, one felony count of misrepresenting facts to the State Compensation Insurance Fund (SCIF), seven felony counts of making a fraudulent statement, one felony count of presenting a fraudulent material statement to obtain compensation, one felony count of making a false statement to discourage an injured worker from claiming benefits, one felony count of willfully failing to pay taxes, one felony count of failing to file a return with the intent to evade taxes, and a sentencing enhancement for aggravated white collar crime over $500,000. [WCx]
At the time of the crime, Holley was a roofing contractor and owner of So Cal Roofing. The defendant purchased a minimum workers compensation policy from SCIF and failed to state that he employed subcontractors, paid workers in cash, hired unlicensed employees, and leased employees from other companies. Holley paid his employees in cash to hide the fact that So Cal Roofing had workers. He received insurance based on his false declaration and entered into a contract requiring SCIF to cover all workers employed by Holley, even those employees unknown to the insurance company. Holley submitted inaccurate payroll reports to SCIF, resulting in underpayment of insurance premiums. To hide the fraud, Holley failed to file an accurate tax return to avoid paying taxes to the State on the cash payments made to his employees.
One of Holley’s employees was injured when he fell off a roof, and subsequently filed a workers comp insurance claim. Holley denied that the injured employee worked for him, thus denying the injured employee his workers comp insurance benefits. Subsequently, Holley fraudulently signed under penalty of perjury that he had no employees at So Cal Roofing and filed these documents with the California State Contractor’s Licensing Board to make him exempt from securing workers comp insurance.
California law requires that all employers maintain workers comp insurance for their employees. Payroll records showing the number of employees and their income must be submitted to both the workers comp insurance company and EDD, who oversee the collection of payroll taxes. [WCx]
Workers comp insurance rates are determined by a formula, which takes into consideration the number and type of employees and the company’s history of injury claims.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-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.
©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 Yolo County, California jury has convicted a West Sacramento resident and 25-year employee of The Sacramento Bee of workers compensation insurance fraud.
According to the Yolo County District Attorney's Office, Linda Vela, 58, was convicted of seven counts of workers comp fraud, three counts of presenting false statements concerning payment on an insurance policy and two counts of attempted perjury in connection with disability claims made over a two-year period. [WCx]
Vela, who was employed as a member of The Bee's finance department, left her position on disability and was diagnosed with bilateral carpal tunnel syndrome.
Vela, who had surgery on her right wrist, complained that she was still in pain after the surgery and that she could not go back to work despite the surgeon's recommendation that she return to work. Due to Vela's complaints of pain and her reported inability to use her hands, her physician kept her off work as "totally disabled."
As a result, Vela obtained workers comp benefits from The McClatchy Co., parent company of The Sacramento Bee, along with payment through Liberty Mutual Insurance Co.
Not long after starting to receive payments, Vela was nabbed on video doing many of the things that she told doctors she could not do.
An orthopedic surgeon who watched the surveillance video testified that Vela could go back to work with the restriction that she "avoids power gripping and torqueing." [WCx]
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.
©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 California Department of Industrial Relations’ Division of Occupational Safety and Health (DIR/DOSH), also known as Cal/OSHA, is reminding all employers that the annual summary of all work-related injuries and illnesses (Form 300A), must be posted at their place of business now through April 30.
The form (300A) is available on DIR’s Web site. The purpose of the form is to provide all employees the opportunity to review any and all injuries or illnesses that occurred at their place of work during the previous year. Former employees and their representatives also have a right to review the form. The form must be posted in a visible and easily-accessible area. (WCxKit)
“
Transparency and accountability are very important aspects of the employer-employee relationship,” said Cal/OSHA Chief Ellen Widess. “This form gives employees, former employees and their representatives’ access to worksite injury and illness data. Full and accurate reporting of injuries and illnesses is vital to understanding hazards in the workplace. It is also a good tool to determine where additional safety and health measures are needed.”
Employers are required to fill out and post the form every year, even if no workplace injuries occurred. Information that must be disclosed on the form includes total number of cases with days away from work, total number of days injured or sick employees spent away from work, and the different types of injury or illness suffered.
Employers who would like more information on their posting requirements or who would like more information on how to reduce workplace injuries and illnesses are encouraged to visit the DIR Web site at
www.dir.ca.gov/DOSH/EmployerInformation.htm. In addition, if an employer would like to speak with a Cal/OSHA consultant, free assessments are available by calling the Cal/OSHA Consultation Program 1-800-963-9424. (WCxKit)
Employees with work-related questions or complaints can call the California Workers Information Hotline at 1-866-924-9757.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-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.
©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.
Earlier this month the Los Angeles City Council passed an ordinance requiring condoms to be used in all permitted adult films shot within their city limits. It brings up many interesting workers compensation issues. After all, this requirement is for the health and safety of employees. Is it any different from requiring construction workers to wear a helmet? Road workers to wear a bright, orange vest?
In this commentary on Salon.com porn performer, writer and director Lorelei Lee calls the ordinance well intentioned but ineffectual. She notes that the new law requires adult film production companies to pay a fee with permit applications. “Currently, condoms are used in the mainstream gay adult film industry (which includes only gay male films), while the heterosexual industry (which includes both lesbian and straight films) has used mandatory STI (sexually transmitted infections) testing as a health and safety precaution since the early 2000s,” she writes.
Lee writes that until May of 2011, the Adult Industry Medical Center, founded by a retired performer, ran a nationwide STI testing service and database that certified heterosexual performers as STI-free previous to their working on any production whereas the new ordinance is in response to a San Francisco-based nonprofit AIDS Healthcare Foundation campaign along with other groups that have picked and boycotted companies which sell or show condom-free pornography.
One of the protest leaders called the testing service a “fig leaf” over the adult industry and backed the lawsuit that led to the organization’s financial insolvency and shutdown last year, which left a vacuum in health and safety protections in the industry, Lee writes. “(He) seemed to hope that leaving performers without any kind of health protection would force legislators to mandate condom use,” she writes.
Lee writes that she became a condom-only performer in 2010 but had worked for eight years previously relying only on the testing service. “But during my time as a non-condom performer, I never once contracted an STI on set that condoms would have prevented, and truthfully, I’m not sure that condoms actually keep me safer than testing alone,” she writes.
She writes that performers have a mix of opinions as to whether they mind actually using condoms on set and some are even strongly opposed to using condoms at work, believing that they may actually increase likelihood of STI transmission.
Lee says what she is most opposed to is regulating condom use in the industry through government regulation. “Many of the people attracted to this industry are still those who don’t care a lot about public opinion or about obeying authorities. In the case of a condom mandate tied to permits, many producers will simply shoot in Los Angeles without a permit. Others will move production outside of the city – to places like Las Vegas, San Francisco or Miami, where some companies are already established,” she writes, noting that perhaps that s what the city is after.
In effect, Lee writes, this legislation has made it more difficult for the industry to use the protections already in place with AIM’s testing program. “We’re also opposed to the squandering of AHF resources – resources that could be effectively used to help prevent and treat HIV and AIDS – on a political campaign against an industry whose health and safety regulations are already working. In the decade since AIM began the program of mandatory testing, six performers have tested positive for HIV, and only three of those have shown to be from on-set transmissions,” she writes. “That’s three transmissions during the course of filming tens (or perhaps hundreds) of thousands of scenes. There are no real statistics as to how this compares to transmission rates in the general population.”
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 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, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
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.
©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.
United States Attorney Benjamin Wagner announced that Chief United States District Judge Anthony Ishii sentenced 44 year-old Karina S. Beard of Turlock, California to one year in prison, to be followed by three years of supervised release, for four counts of mail fraud and two counts of federal workers compensation fraud. Beard was also ordered to pay $81,694 in restitution.
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.
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.
©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 Los Angeles area metal shredding facility accused of releasing toxic substances into the atmosphere has agreed to pay more than $2.93 million to comply with air pollution laws and to settle an environmental protection lawsuit, according to a report from the Los Angeles County District Attorney’s office.
Deputy District Attorney Daniel Wright of the Environmental Law Section said SA Recycling, LLC – an automobile and appliance shredding company – agreed to the settlement, which was signed by Los Superior Court Judge Debre K. Weintraub. The civil lawsuit and settlement were filed last week. (WCxKit)
The action alleged that SA Recycling violated air pollution laws when an explosion at its San Pedro facility at Terminal Island destroyed its air pollution control system in May 2007 and the company continued operating for weeks without proper equipment.
At the time of the violations, the company was operated by Hugo Neu Corp. SA Recycling purchased the company in September 2007.
The injunction permanently enjoins SA Recycling from operating its San Pedro shredder without a fully functioning air pollution control system.
Under the terms of the stipulated judgment, SA Recycling has agreed to install an air pollution control system to minimize emissions at its San Pedro location and two other sites in Orange and Kern counties. The company also has agreed to work closely with state and local regulators to address compliance issues related to its operations.
SA Recycling must additionally pay $260,000 in civil penalties and investigative costs to the Los Angeles County District Attorney’s Office and $430,000 to the California Department of Toxic Substances Control (DTSC) for investigative expenses and enforcement tools.
Among others who will benefit are the College of Engineering at the University of California, Davis, slated to receive $100,000 to support aerosol studies; the Coalition For A Safe Environment, which will receive $75,000 for select projects; and 11 San Pedro Bay marina owners and operators, who will share $165,000 to target water and sediment pollution sources. (WCxKit)
SA Recycling shreds and sorts recyclable metal materials. The process, ultimately, generates auto shredder residue (ASR) which is treated to reduce solubility of any remaining metals.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
United States Attorney Benjamin Wagner (California) recently announced that Karina S. Beard, 44, of Turlock, plead guilty to four counts of mail fraud and two counts of federal Workers Compensation fraud.
According to the plea agreement, from October 2006 through January 2009, Beard received federal workers comp benefits for an on-the-job injury she sustained in 2000 while working for the Postal Service. Because of her claimed injuries, restrictions were placed on her physical activities. According to the plea, Beard performed various physical tasks using the purportedly injured part of her body, such as horseback riding. (WCxKit)
According to court documents, Beard made false claims on a United States Department of Labor, Office of Workers Compensation Programs (OWCP) form. The OWCP is required to make an inquiry of every claimant who receives total disability benefits to ascertain 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 condition on the questionnaire may experience a reduction or termination of benefits.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.
Beard is scheduled to be sentenced by United States District Judge Anthony Ishii early next year. She faces a maximum sentence of 20 years in prison and a $250,000 fine for each count of mail fraud.
California allows the workers compensation insurers and self-insured employers to utilize a Medical Provider Network (MPN) for the treatment of on-the-job injuries and work-related illnesses. The MPN is an association or network of clinics, physicians, hospitals and other medical providers – under contract with the MPN – who treat workers compensation injuries and occupational illnesses. The advantage of the MPN to the employer is the employee is treated by a medical provider who specializes in work-related injuries.
Some practitioners have noted with criticism, however, that not all doctors in the network are well-qualified and further indicate that "almost any physician who is willing to take a discount" can get on the panel; therefore, it is important for employers to make sure that the doctors in their networks understand workers compensation, know how to bill at the OMFS (official medical fee schedule), know how to write reports and return injured workers to modified work. Physicians who are not experienced in the nuances of workers compensation may also not know how to close a case appropriately: Released as Cured; Pre-Injury or Permanent & Stationary / MMI.
California MPNs are designed to provide services throughout the state. It is customary for the MPN to offer:
1. A primary care physician within 15 miles or 30 minutes of the employee's residence or job site.
2. All other medical services within 30 miles or 60 minutes or the employee's residence or job site.
3. Emergency medical care services.
4. Medical care in rural areas (they have alternative distance and time standards and, in some situations, allow out-of-network medical providers or non-contract medical providers).
5. Medical care for the employee who is working or traveling outside of their home geographical area (but still within the State of California.) (WCxKit)
It should also be noted that all physicians in or out of the MPN must follow the California Treatment Guidelines / Medical Treatment Utilization Schedule Reg. 9710.
The employer has the opportunity to direct the care for 30 days with or without an MPN, but the requirements must be strictly followed or the injured workers regains the right and ability to self procure his own
medical provider at the end of 30 days; if the employer has followed the rules, they retain right to
direct care for the life of the claim. Stated another way, if an employer has an MPN and did not follow the procedures at time of hire and again at time of injury they lose the right of control. The employer can direct care for the first visit and
if they have complied with
requirements for providing the employee with MPN information and a list of providers at the time of hire and again at the time of injury
they have control for the life of the claim. If the employee is unhappy with the choice of a physician, they can elect to change doctors but must stay within the MPN.
If the employee is unhappy with the diagnosis or the treatment they receive for their injury, they have the right to ask for a second opinion from another physician within the MPN. The employee is required to make an appointment within 60 days of requesting a second opinion. If the employee is unhappy with both their original doctor's opinion and the second doctor's opinion, they are entitled to a third opinion in California.
If the employee is unhappy with the first opinion, second opinion, and third opinion, the employee may file a request for an Independent Medical Review (IMR) with the California Division of Workers Compensation administrative director. The administrative director will assign an independent medical reviewer. The independent medical reviewer will conduct either a physical examination or a medical-records review. If the independent medical reviewer agrees with the employee, the employee can select a physician who does not have to be a part of the MPN. In this case, the employer/insurer is responsible for the medical care cost. The injured worker can request a “QME” (Qualified Medical Examination) and will be provided a panel of 3 to choose from in a given specialty or specialties.
Most MPNs will offer medical management in which a nurse case manager will work with the employee, the employer, and medical providers to get the employee back to work as quickly as feasible. Some MPNs also offer a vocational specialist who works with the employee to retrain them for another occupation when they are physically unable to return to their prior job.
An insurance company or self-insured employer can create their own MPN or join one of the MPNs that have already been established. The benefits to the employer who joins a MPN include:
1. Lower
medical cost – The MPN contracts with the medical providers for the cost of the medical fees which are lower than the Medical Fee Schedule used in California. On average the medical fees are approximately 10 percent lower through a MPN.
2. Medical control throughout the claim – When an employer has a MPN and complied with the requirements, the employee must treat within the MPN throughout the life of the claim (with certain exceptions, see above) unless the employee has pre-designated their primary treating physician (the large majority do not). Employers need to make sure this information is provided to all new hires, at the time of hire. They need to be able to document compliance.
3. Elimination of chiropractors and acupuncturists: if the employer has a MPN, the employee can only pre-designate a medical doctor or doctor of osteopath. Without a MPN, the employee can pre-designate their chiropractor or acupuncturist. However, the injured worker can under 4601 request chiropractic care or acupuncture within the MPN. If the MPN has no panel chiropractors or acupuncturists within the given geographic distance they can choose one outside the MPN.
Medical Provider Networks provide medical cost control. The long term impact for the employer is lower overall cost of workers compensation insurance. We recommend for all California employers have a Medical Provider Network, or be affiliate with an insurance company that has one, and make sure you are in compliance with the rules.
Author Rebecca Shafer, JD, President of Amaxx Risks 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. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
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