A Lorry, Great Britain, driver whose career was ended after he badly broke his wrist in a workplace accident recently received compensation from his employers.
According to a report from Hazards Magazine, Peter Stocks, 63, from Newton Alfreton in Derbyshire is now unable to drive HGVs after an accident meant he had to have a pair of operations on his right wrist. He was told he will never be able to lift with the arm and that he will need a third operation in the future.
While making a delivery for manufacturer Recricel, based in Alfreton he was injured as he went to move 150 kilos (330 pounds) of foam from his lorry. When he pulled on string holding the foam together it snapped and he fell backwards landing heavily on his wrist.
Stocks was forced to take three months off work and though he has returned he can only drive smaller vehicles.
Following the accident he contacted his trade union, Unite, which instructed its lawyers to pursue a claim for compensation.
Lawyers argued that the foam should have been secured in a safer fashion. Recricel admitted liability and settled the claim out of court for £23,000 ($35,700).
"All my life I've driven large vehicles like HGVs or JCBs. It was quite a shock to never be able to do that again; it makes me worried about my employability in the future,” Stocks commented.
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, contactInfo@ReduceYourWorkersComp.com.
Everyone has opinions on what workers comp is. Some are correct, but most are misconceptions. The commercials seen on TV about people collecting hundreds of thousands of dollars are not true for the average claim. When looking at the bottom of the screen it indicates that the people on the commercial are actors, not even the real claimants. Most of the marketing material surrounds auto and liability accidents, where pain and suffering is translated into a certain dollar amount. This is not exactly true in workers comp. There is no pain and suffering payment. Insurance companies/TPAs are there to provide reasonable and necessary medical treatment, and wage loss. Some states even allow a permanent partial disability payment, or impairment rating, on top of wage loss, but that is it.
Below we discuss the top 5 misconceptions surrounding the mystery world of workers compensation. Not all of these will apply exactly to every jurisdiction but are general. Remember to discuss with the adjuster and counsel any exact questions surrounding certain details regarding. (WCxKit)
1. Workers Compensation is not Welfare
Compensation is not a free payment a worker is entitled. Just because you are injured at work, it does not mean a guaranteed payment or coverage for medical/wage benefits. There are a lot of criteria to meet in order for a claim to be compensable. Even if the claim is compensable, it also does not mean anything can be done. Claimants have to play by the rules, and do as they are told by the adjuster. The adjuster must make the effort and take the time to explain to each claimant what the rights are, and what they can and cannot do. The biggest issue is miscommunication between the carrier/TPA and the claimant, so having an open dialogue will end any misconceptions that a claimant may have in regards to what their rights are, and what is covered; if indeed the claim is determined to be compensable.
2. Nobody gets rich from Workers Compensation
Depending on the jurisdiction, employees give up the right to sue in civil court in exchange for what are essentially no-fault benefits. Workers compensation pays lost wages, medical care, and vocational rehabilitation. Pain and suffering as an additional payment is not available or applicable to a compensation claim. The amount of money a person receives is a percentage of average gross pay. There are typically no increases for inflation, and each state has a maximum limit that a person can get per week as workers comp payments.
Michigan, for example, has a maximum rate of $742 per week. Wisconsin has $820 per week. So even grossing $2000 per week as an average weekly wage, that amounts to $820 per week in Wisconsin. High-wage employees that fall into this criteria are usually not very happy when they find this out, but the rules are the rules. These statutes are set up within the workers compensation system, and they have to be followed by all parties. Even if a claim is settled for a certain amount of dollars, it is typically not a retirement jackpot. It may end the exposure for the carrier/TPA, but these claims that settle for very high amounts of money are the result of a very serious, extremely disabling injury. And even those are few and far between.
3. Workers compensation benefits will be stopped if the worker declines reasonable employment.
If the employer offers up a light duty job, within the injured employee's medical restrictions, a claimant cannot refuse it and still get paid wage loss benefits. This opens a Pandora ’s Box, because an issue will come up about whether this light duty job is something an injured worker is trained to do, or is the job offer seen as an insult to their professional skills, etc. If there is a welder sitting in a chair staring at a clock for a job, then maybe a case could be made that this work is not a benefit to the company. For light duty jobs, they have to be deemed something that the employer gets a “gain” from performing, and almost all jobs within an employment facility can fall within these parameters. Certainly if you provide a degrading job that is of no benefit, then you may get into legal trouble. But in all reality I do not think any employer would take a risk in stopping a compensable case by trying to make a person sit outside and stare into space.
The bottom line is any light duty job, that provides a service to the employer, must be performed if it is offered to the injured worker. If the worker declines, then wage benefits will cease.
4. Workers comp fraud is extremely low
I would venture to say that actual workers comp fraud is less then 10% of all claims. And that number may even be high; I would go as low as 5% or less. For a case to be deemed as fraudulent, it must meet a certain criteria within whatever state statutes are in the jurisdiction. That is hard to meet, and most cases will not even come close to being worth the pursuit of fraud in a legal court case. If a certain worker is claiming to be out of work, and you get surveillance of them outside roofing their house, this may not make the case actual “fraud,” it falls more within the injured worker not following their medical restrictions and going outside of their treatment plan as deemed appropriate by their treating doctor. This will provide the adjuster with the ammo to dispute ongoing benefits, but not exactly to pursue the case as overall fraud.
Workers comp fraud, as a whole, is not a major problem within the worker comp system. Sure there are a lot of people that do not follow their medical restrictions, or they may miss doctor appointments, or ignore physical therapy demands, but this provides only a dispute for ongoing medical benefits, not fraud. There is a difference between the two. If you think you have an actual fraud case, you need to discuss it right away with the carrier/TPA and counsel before taking any such action to pursue official fraud in a legal venue.
5. The vast majority of workers comp claims are paid, and do not go to court
Generally, most comp cases are accepted, the injured worker gets treatment, and eventually goes back to work. The idea that someone stays home and avoids work when they are able to actually work is not the norm. Sure, there are those people out there who try to do what they can to avoid going back to work, but after an IME is performed, or after some surveillance discovers them being active out and about running errands, they are quickly flushed out and denied ongoing benefits.
Typically after a denial, and wage loss payments stop, these workers get on the wagon and get their treatment, so they can return to work and have their comp case end. Some will run to plaintiff counsel and try to get what they feel they are entitled to, and they will file for mediations and hearings, but the litigation usually is settled before a case is tried in front of a judge. Doctors can disagree on the causal relation of an injury, and this can speed up the case to go into litigation, but these cases are typically settled within 2-6 months. A low percentage of claims will stay in the litigation system, and go on for months or years, but these cases are usually quite complex and can involve several defendants and several employers, and that contributes to the complexity and the duration of the litigation. For the most part, on the normal workers comp claim that gets disputed and goes into litigation, these cases resolve themselves in the early stages of litigation and the files eventually close. But even those cases are not the common ones. The common claims are legit injuries, where benefits are paid and the worker returns back to work at full duty within whatever timeframe is needed dependent upon the severity of injury. (WCxKit)
Summary
Everyone may have heard of someone that tried to get away with milking the comp system. Most of these people are caught through good investigation, and their cases get resolved. The stereotype of work comp being a total pain can be true in some cases, but for the most part, work comp claims are legit, paid, and the worker returns back to work. There are always some exceptions, but if all parties communicate, know what their rights are, and know what they can and cannot do, their claims are resolved as quickly as possible and everyone can move on with their respective lives.
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.
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.
Workers compensation is a type of insurance employers are required to have to provide benefits to employees who are injured on the job or become ill due to on the job exposures. Workers compensation (work comp) insurance provides the injured employee with medical benefits and partial wage replacement benefits. All 50 states, the District of Columbia, Guam, the Virgin Islands and Puerto Rico have workers compensation statutes. Each jurisdiction has their own unique provisions as to what their work comp laws provide.
Work comp provides benefits to the injured employee without regard as to whose fault the accident was. In return for the guaranteed benefits, the employee can not bring legal action against the employer if the employer was in someway negligent and caused the accident. The employee is not compensated for any pain and suffering that occurs as a result of the accident. (WCxKit)
Work comp has been referred to as a combination of health insurance, disability insurance and life insurance for employees. When the employee is injured or has an occupational disease, work comp pays the medical bills like health insurance does and provides partial wage replacement like disability insurance does. If the employee dies as a result of the injury or occupational disease, work comp will pay benefits to the dependents as a form of life insurance. Work comp does not pay any of these benefits if the employee injury occurs away from the job.
Employers in Ohio, North Dakota, Puerto Rico, the Virgin Islands, Washington State and Wyoming are required to purchase their workers compensation insurance from the state/territory government. In the other states, D.C and Guam, the employers can buy their work comp coverage from a private insurance company or in most states, self insure, if they are large enough to handle the financial risk. Some states allow smaller employers to join together to self insure. About a dozen states give the employer the option of buying the insurance from the state government. Texas is the only state that classifies work comp as voluntary insurance. If a Texas employer does not have work comp coverage, the injured employee can bring a lawsuit against the employer for their injuries.
In most jurisdictions there are four primary types of benefits available to the employee. They are medical benefits, disability benefits, vocational rehabilitation and death benefits. Medical benefits pay for all types of medical expenses including doctors,
hospitals, prescriptions, durable medical equipment and other medical providers (like nursing services, chiropractors, physical therapist, etc).
Indemnity benefits can be broken down into four primary types in most jurisdictions:
1. Temporary total disability
2. Temporary partial disability
3. Permanent partial disability
4. Permanent total disability
Temporary total disability benefits are the most common indemnity benefit. The injured worker receives on a weekly or a bi-weekly basis a portion (two-thirds in most jurisdictions) of their average weekly wage until they are able to return to work.
If the injured worker is able to return to work , but only for a part of the time, or at a reduced rate of pay, temporary partial disability benefits are provided to make up a portion of the lost income until the employee is able to return to work full time.
When the employee receives a permanent injury and will be partially disabled as a result of the injury, permanent partial disability is paid to the employee to compensate for their future loss of earning capacity due to the partial disability.
If the employee receives an injury that is very severe, and the employee will never be able to return to any type of work, the employee is paid permanent total disability benefits which can either be for a set of number of weeks (for example – 500 weeks) or is paid disability benefits for life, depending on the state law.
Vocational rehabilitation benefits are designed to assist the employee who is permanently partial disabled and is unable to return to work for the employer. The vocational rehabilitation benefits assist the employee in being trained for another job or obtaining the education needed to perform other work. (WCxKit)
Death benefits (usually in amount similar to the weekly disability benefits) are paid to the surviving spouse, dependent children or other dependents of an employee who is killed on the job or dies as a result of an occupational disease. Death benefits vary by jurisdiction, with some jurisdictions requiring death benefits be paid to the surviving spouse for life while other jurisdictions cap death benefits at a certain number of weeks (for example 400 weeks) or at a set dollar amount (for example ($250,000). Dependent children usually receive a portion of the death benefits until they are 18, or 22 if attending college. Surviving spouses normally lose the death benefit if they remarry.
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
The above title seems absurd. Why would anyone pay to be disabled? The answer is that far too many people see disability as an investment – especially for retirement or a lump-sum payment at the expense of employers and the workers compensation insurance system paid for by employers.
Disability is currently a vast industry. Workers comp, no-fault, Social Security, and long-term disability are disability programs that have experienced explosive growth in the past 40 years – and have established a firm presence on late night cable stations in the form of lawyer advertisements. (WCxKit)
Amazingly, many people who do not look, act, or feel disabled wish they did; at least in a submitted medical report, in hopes of getting “benefits.” Such reports are not free. They come at a price. Actually, two prices. One price is paid to the doctor for the report. The other price is paid by the patients in ways they never imagined.
Disability is not a hobby. It is a full time job. Furthermore, it is the most expensive job most people will ever have – and they, in the end, pay for these expenses. There simply is no free lunch. When you wish to present yourself as disabled your wish comes true. You begin to act, think, and finally BE disabled, although not entirely physically. One exchanges a full time job for activity of little purpose for less than half your former wages as an able person.
But what is the entry price for becoming disabled? Many doctors charge nearly $1,000 for an exam and a report. If the report is for a negligence claim it is far higher. And you need not fear the report will conclude you are healthy and in good shape. It won't.
Every workers comp lawyer has had a client at one time or another who was a convincing example of the ravages of injury and disability. However, at the time of the modest final settlement, the client will suddenly blurt, “If I had known this was all I would get, I would have gone back to work years ago!” See:
A “successful” disability claim ought never to be measured in weeks, months, years or decades of disability; the goal is return to the prior disability-free life. The monetary payments are a measure of losses, not gains. Consult with your spouse and children before you consider a career change to “disabled.” (WCxKit)
Author Attorney Theodore Ronca is a practicing lawyer from Aquebogue, New York. 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. Mr. Ronca has 21 years experience in searching and retrieving medical records and many other types of documents for defense of workers compensation claims. Contact
Attorney Ronca at 631-722-2100 or medsearch7@optonline.net.
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.
When a product – anything that is manufactured – fails to perform its intended function, and the failure of the product causes an injury, the person injured has a products liability claim against the manufacturer. When the product fails while being used by an employee causing a workers compensation claim, the workers compensation insurer can bring a subrogation claim (the right to recover) against the manufacturer.
To illustrate this, think of the Warner Bros. cartoon Road Runner where the main character, Wile E. Coyote, is always going about his job of catching the Road Runner. As Wile E. describes himself in some of the cartoons as “super genius”, he realizes he has a dangerous occupation, and therefore, even though he is self-employed, he has purchased workers compensation insurance. Wile E. often purchases products from the Acme Corporation (even though many of the products failed to perform as intended). One of his favorite tools in his business of trying to catch the Road Runner is the stick of dynamite. If Wile E. lights the fuse on the stick of dynamite, and Wile E. ends up in the wrong place at the wrong time, he gets a blacken face from the stick of dynamite. He has a work comp claim, but he does not have a products liability claim. On the other hand, if Wile E. is holding the stick of dynamite and the dynamite' fuse malfunctions blowing Wile E. up, he has both a workers' compensation claim and a products liability claim. (WCxKit)
The product that malfunctions, like Wile E's stick of dynamite, is the most common several types of products liability claim, but product malfunctions are not the only cause of product liability claims. In general, there are four types of product liability claims. They are:
1. Products that are defectively manufactured
2. Products that have a design flaw, also known as defective design.
3. If a defect cannot be designed out of a product, a "fail safe" safety guard must be installed.
4. Products that fail to provide adequate warnings of their danger if misused
The most common product liability claims that are also workers compensation claims is the manufacturing defect. In the construction industry employees are often working with various pieces of equipment that can malfunction, for example – ladders and scaffolding. If the employee is climbing the ladder and half way up one of the ladders rungs was installed incorrectly when the ladder was manufactured, resulting in the employee falling and being injured, the manufacturer of the ladder has a products liability claim to contend with. If the scaffolding's cross brace is not welded correctly, and the scaffolding collapses causing injury to the employee(s), the manufacture has a products liability claim. [As a side note: There were so many subrogation claims from work comp insurers in the 1970s and 1980s against ladder manufacturers and scaffolding manufacturers, that some went bankrupt, but others improved their product quality to a much higher level, resulting in much safer equipment]. Not to get too complicated, but the locking mechanisms on casters on the scaffolding can also fail; since these are typically manufactured by a different company than the scaffolding manufacturer, this would also result in a product liability claim.
Defective equipment can also lead to employee injuries. The most common example of this is the older hydraulic press or the hydraulic punch used in a factory. The hydraulic press would cut a form out of a flat sheet of metal or leather or other material. With the older equipment the employee pushed a button and the hydraulic press punched/cut the design in the material. After the press hits the material being cut, the employee reaches in and removes the cut-out piece. Combine this process with the employee being paid by the number of pieces produced and you end up with a lot of one-hand employees. While this is human error, it was also a design flaw that was easily fixed. The hydraulic presses manufactured today have two buttons, set wide apart, and both buttons must be pushed at the same time, forcing the employee to have both hands on the buttons, away from the hydraulic press, when press operates.
Some equipment has guards that can be removed for machine maintenance, or faster or easier operation. The machine should be manufactured "fail safe" so if the guard is removed the equipment will no longer function. In other words, if the guard fails, it fails safe. Failure to guard is a separate cause of action.
Almost all product liability claims now have a component for failure to adequately warn. There are workers compensation claims that arise out of the failure to warn by product manufacturers. For example, many janitorial cleaning supplies work great when utilized in accordance to the manufacture's recommendations. However, as most cleaning supplies contain chemicals, often they cannot safely be mixed with other cleaning chemicals. If the janitor mixes bleach with ammonia from two different cleaning products, a dangerous chloramines fume, which can be toxic or even fatal, is released. If the manufacturer of the bleach does not have a warning label on the bottle to not mix it with other cleaning products containing ammonia, the manufacturer of the bleach has a products liability claim and the workers compensation insurer that covers the janitor has a work comp claim with subrogation rights. (WCxKit)
The workers compensation adjuster (the employer, too) should always review the cause of injury to determine if there is subrogation – the right to recover – against the manufacturer of the product, item or equipment the employee was using at the time of the injury. If the product malfunctioned, was designed poorly, or, failed to warn about the potential hazards of using it, and the employee is injured, the insurer has a right to pursue the recovery of the cost of the claim from the products manufacturer. Now, I wonder if the insurer of Wile E. Coyote will pursue all the subrogation claims against the Acme Corporation.
As an employer, you must include a provision in your account instructions that all workers compensation claims involving products or premises of another person or company must be reviewed for subrogation potential. Don't rely totally on the insurance company (or TPA) to do this, your in-house counsel or litigation manager should take a look at these large claims to make sure the claim has been reviewed by a competent person at the insurance company and that you agree with their assessment of the potential to name a third party in an action to recover your payments — in other words, was another company more responsible for the injury than your company. In some states the damages are apportioned between responsible parties; however, in other states if the employer has ANY responsibility then there is no subrogation potential.
Although, it is much more complex than the discussion above, and involves numerous defenses, be aware that many workers compensation claims – particularly those that occur on machines and industrial equipment - have a component of product liability exposure under at least one of the four legal theories above. Your outside counsel or in-house legal department can provide more complete information about product liability claims.
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
The editorial staff at Amaxx Risk Solutions, Inc., the home of
LowerWC.com and
Workers Comp Kit was surprised yesterday morning (March 19, 2011) by a Hartford
Courant article citing our president, Rebecca Shafer, J.D., as “The Go-To Guru On Workers Comp.”
When I asked Becki how she “forgot” to mention this to us she said, as always, “You know, I prefer to call attention to our resource center and not myself personally.”
The Courant’s Q&A covered Becki’s professional experience and prominent clients she has worked with over the years noting the patented development of our web-based workers comp cost containment system, saying:
“She has patented an automated Web-based cost-containment system,
Workers Comp Kit, which includes a best-practice assessment and scoring system, and the ability to calculate benchmarks instantly using various data.”
The article resulted from her selection as a Lexis Nexis Notable Person and her work on
Lexis Nexis Workers Compensation Law Community Executive Committee with Attorneys Lex Larson, Tom Robinson, Robin Kobyashi, Stuart Colburn and Brad Bleakney.
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.
Reprinted with Permission of Risk Management Monitor.
Bloggin’ ain’t easy. Doing it well takes commitment, research, accuracy, and regular postings. And, of course, a knack for writing. The staff of Risk Management has a few favorite blogs that we visit on a regular basis for their insight, knowledge, and timeliness. The following are 10 of our favorite risk management and insurance blogs:
1. The Call: Foreign Policy magazine’s blog posts are authored by Ian Bremmer, president of the global risk research and consulting firm Eurasia Group. The blog uses political science to analyze the future of politics and the global economy. When it comes to industry blogs, this one is my personal favorite.
2. Terms + Conditions: The Insurance Information Institute’s blog covers current disasters, risks, laws, regulations and market conditions, among other topics. Claire Wilkinson, vice president for global issues at III, has done a great job of posting timely articles first thing in the morning, and it seems she’s been joined recently by James Lynch, a veteran insurance professional and blogger.
3. Clear Risk: The company itself works with organizations to help improve their risk management techniques and the blog, managed by Craig Rowe, covers the various aspects of risk management and insurance in a well-organized and easy to read manner.
4. Schneier on Security: Bruce Schneier, a security technologist and author, manages this blog, which focuses on security and security technology. He has testified on security before the United States Congress and has written articles for some of the world’s biggest publications. Schneier, an opinionated tech man, knows what he’s talking about — and it shows in every post.
5. Workers’ Comp Kit Blog: This blog covers (you guessed it) everything relating to the world of workers’ comp. It acts as a discussion forum for employers to learn about workers’ comp cost containment, techniques and strategies. The blog is managed by Rebecca Shafer, and attorney and risk consultant, and features posts by more than 30 other professionals. Though the format of the blog can be somewhat distracting (ads galore), the content is useful.
6. GC Capital Ideas: The website, a part of reinsurance intermediary Guy Carpenter, refers to itself as more of a platform from which it disseminates information that has been published through reports, briefings and bylined articles. I refer to it as a blog and its information is has proved valuable to our team on more than one occasion.
7. Calculated Risk: This blog offers a sophisticated analysis of economic data, from consumer sentiment to the mortgage and housing industry to the banking industry. Managed by Bill McBride, a full-time blogger with a background in finance and economics, Calculated Risk proves successful at turning complicated technical data into useful information for the masses. McBride publishes several posts per day.
8. Political Risk Explored: Brian Hasbrouck, a man with a serious interest in the international political economy, manages this blog. PRE’s short and sweet posts pull from other publications or reports that the blog’s readers may have never come across on their own. The blog’s simple format makes it easy to navigate and read and the Twitter feed embedded on the right-hand side is an added bonus.
9. Product Liability Monitor: This blog was created by attorneys in the Weil product liability practice and discusses key trends, developments, and events that have shaped and are shaping the product liability landscape. The blog’s clean format is something to be imitated.
10.The FCPA Blog: Its simple name leaves no guesses as to what it covers — news and views about the United States Foreign Corrupt Practices Act. Managed by Richard Cassin, the multiple daily posts gives readers a grim reminder of the oft-corrupt corporate world and analysis of the FCPA’s actions.
If you think we have left off an important blog related to the industry, please let us know in the comments section below.
Author: Emily Holbrook on
February 25, 2011.
The
Risk Management Monitor is the official blog of Risk Management magazine and provides daily stories, commentary, interviews, podcasts, and videos related to the world of risk management and insurance. The editors of the Risk Management Monitor are Jared Wade, Emily Holbrook, and Morgan O’Rourke. Learn more at: Risk Management Monitor.
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
An investigator for New Yorks Office of the Workers Compensation Board Fraud Inspector General knowingly fabricated entries in reports he filed with OFIG regarding investigations he had conducted, according to a report issued by the state Inspector Generals office.
According to the North County Gazette, Brian Codys employment with OFIG was terminated as of Nov. 7, 2008, based upon similar findings by OFIG. The Inspector General has referred these findings for prosecutorial review. (WCxKit)
On Oct. 27, 2008, Workers Compensation Board Fraud Inspector General William Gurin informed the Inspector General that, in September 2008, OFIG investigator Cody had admitted fabricating information in his investigative reports regarding allegations of fraud by employees, health care providers, and others.
Specifically, Cody had told colleagues that in order to close cases, they should do what he does and “make up” information. Based upon that remark, OFIG reviewed a sample of 41 of Codys closed cases from the prior year, and memorialized its findings in a report dated Sept. 29, 2008. The review determined that in eight cases Cody had manufactured details regarding his investigations in official reports.
Not long after informing the Inspector General of Codys fabrications, OFIG provided its Sept. 29, 2008 report of Codys false and inaccurate statements to the Inspector General, as well as an Oct. 29, 2008 memorandum memorializing an Oct. 24, 2008 conversation among OFIG employees Cody, Deputy Inspector General Robert Gabrielli, and Assistant Inspector General Scott Jaffer.
According to that memorandum, the conversation occurred not long after Cody was told that he would be fired from employment.
OFIG also determined that, in seven of the 41 cases, Cody had provided incorrect or misleading, though not materially false, information.
Cody acknowledged that he had “embellished” and fabricated interviews and personal visits but was adamant that none of his embellishments had result in to the effect [sic], “nobody innocent went to jail and nobody guilty got a free ride.” Cody stated that he “just wanted to make myself look smart” and that this practice had been long going [sic], including back to his service in the NYPD.
At one point, he allegedly turned to Jaffer, a former NYPD detective, and commented, “You know, it was just like we always used to do on the [NYPD form] DD5s.”
Gabrielli also noted that Cody “seemed not to grasp the seriousness of these ‘embellishments’” and stated that, “if he had to do all the things he had represented on [sic] his reports, he would not have the time to close any cases.” According to Gabriellis memorandum, Cody insisted several times that he had acted alone.
On or around December 2008, OFIG provided the Inspector General with 137 of Cody’s reports, a sample from his caseload encompassing the period January 2006 to August 2008. (WCxKit)
The Inspector General reviewed the documents in each case and, where appropriate, contacted the person or persons whom Cody alleged had provided material information which was used as a basis for ending the investigation.
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, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or www.LowerWC.com
©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.
As an employer you often hear the recommendation “stay involved in your workers compensation claims.” That is great advice, but way too often it’s where the discussion ends without any explanation as to what “staying involved” means. (WCxKit)
The employer's involvement in the workers comp claim begins before the injury occurs and ends when the employee is back at work, fully recovered from the injury. Let's first look at four phases of employer's involvement in the workers comp claim, then we will look at what the employer cannot do in regards to the workers comp claims. The four phases are:
1. Pre-injury process
2. The injury occurrence
3. The claim process
4. The claim settlement
If you have employees, sooner or later an employee is injured on the job. The following are some suggestions about what you can do prior to the injury occurring that will impact on the outcome of the workers comp claim. Make sure you have "touch points" for each phase of the claim. Here is an example of what was appropriate for one employer I work with:
1. Provide each new hire with an employee accident brochure outlining what the employee should do in case of an accidental injury.
2. Have a written transitional duty policy.
3. Provide each supervisor within the company a written guide on how they are to report and be involved in workers comp claims.
4. Post the injury procedure policy where all employees will see it.
5. Have a published returned to work policy.
6. Have a strong safety program and tie the manager's performance evaluation, raise, bonus or promotion to his or her safety record.
7. Award each month (or quarter) the department with the best safety record with recognition and prizes to the employees.
8. Have a medical provider network in place through your insurance company or join a medical provider network for self-insureds. Make sure all employees know about and use the network. This is called your "penetration" — you should have a penetration rate of > than 90%.
9. Prevent fraud by letting all employees know workers comp fraud takes money away from their raises and bonuses.
10. Put up posters reminding employee that workers comp fraud is a crime and will be fully prosecuted.
11. Post all the state required notices in a place convenient for all employees to see including workers comp laws, OSHA posters and anything else required in your state.
12. Post a list of the required medical providers (where allowed by state statute) or recommended medical facilities (in the states where the employee is allowed to select their own doctor). Consider using outcome-based network where providers with exemplary performance are included in the network. This cost more, but are worth more, so don't grumble about paying for what you get!
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.
Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
©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 area where a lot of employers, workers compensation claim adjusters and even some lawyers get confused is the requirements of
HIPAA – the Health Insurance Portability and Availability Act of 1996, which became fully functional in 2003. The law was written to protect the personal health information of individuals, and to keep the personal information as private as possible.
Like most federal regulations, it was written in code. Instead of saying the HIPAA law applies to doctors, hospitals, health care clinics, and other health service providers, the HIPAA law refers to “covered entities." An employer is not a “covered entity” unless the employer is also a provider of medical services, and then HIPAA does not apply to medical information in your employment records.(WCxKit)
The HIPAA law uses another two code phrase a lot – “personally-identifiable health information” (PHI), and “protected health information” (PHI) both meaning the same thing. [Yes, two phrases meaning the same thing, both using the same acronym – PHI]. By PHI the law is referring to:
1. Health care claim forms
2. Health claim attachments
3. Health care encounter information (like the doctor's or nurse's notes in the doctor's file)
4. Eligibility for a health plan
5. Enrollment in medical insurance – like Blue Cross or Aetna
6. Health plan premiums
7. Health care payments
8. Dis-enrollment from medical insurance
9. Health care claim status
10.Coordination of health care benefits
11.Medical referral authorizations and certifications
12.Last but not least – First Report of Injury
All the PHIs were referring to health insurance until the last one listed – the First Report of Injury which is the most often used workers' compensation form. Now this is where confusion about HIPAA arises for the employer. The First Report of Injury form you complete when the employee has a work comp claim is PHI when it is in the possession of the medical service provider. When it is in the employer's workers compensation file, it is not PHI and not subject to
HIPAA. (It may be subject to state privacy laws – more on that later).
The same guidelines for the employer's handling of the First Report of Injury apply to the work comp adjuster's handling of the First Report of Injury. When the adjuster requests the medical records for an injured employee, the medical provider can provide all of the PHIs listed above and not be in violation of HIPAA. The HIPAA law specifically excludes workers compensation from its far reaching tentacles.
Workers compensation insurance companies, employers who are self-insured for workers compensation, third party administrators, medical case managers and workers compensation boards/industrial commissions are allowedby HIPAA to obtain all necessary medical information for the purpose of processing workers compensation claims. State laws governing the obtaining of medical information for work comp claim handling still apply. As the state laws on workers compensation can vary tremendously from state to state, the employer needs to know and understand the work comp laws and privacy laws of the states where they do business.
Often when the employee's attorney does not want the work comp adjuster to know about the employee's preexisting double laminectomy, or some other preexisting medical issue, the attorney will try to throw-up a smoke screen telling the adjuster t they cannot have the employee's pre-injury medical records due to HIPAA. This is totally incorrect. HIPPA specifically allows in Title 45 of the Code for Federal Regulations (CFR) for disclosure of the employee's pre-injury medical history:
1. If the disclosure is authorized and to the extent necessary to comply with laws relating to workers' compensation………(to) provide benefits for work related injuries or illness {this info is in the statute – 45 C.F.R. Paragraph 164.512 (1)}
2. If the disclosure is required by state law, the disclosure is limited to whatever the law requires {45 C.F.R. Paragraph 164.512(a)}
3. If the disclosure is for the purpose of obtaining payment for health care provided to the employee { 45 C.F.R. Paragraph 164.502(a)(1)(ii)}
In most states the notification to the medical provider that the information is being requested for the purpose of processing a workers compensation claim is all the authorization needed for the medical provider to send the information to the work comp adjuster. In the few states requiringthe adjuster to obtain a medical authorization before obtaining the medical information from the medical provider, it is the state law that requires the medical authorization, not HIPAA.
In the situation noted above where the employee's attorney is trying to block the adjuster from having the information about the employee's preexisting medical condition, HIPPA does not stand in the way. The adjuster in most states will still need the medical authorization for medical records prior to the date of the employee's injury, but the adjuster can petition the work comp board to require the employee to provide the medical authorization if it is not freely provided. (WCxKit)
The employer should understand that HIPAA does not hinder the processing of work comp claims. Some states have passed their own versions of medical privacy laws that are more restrictive than HIPAA. Also, some of the states have other privacy laws limiting the information you can disclose about an employee. If you have any question about what your state requires, please consult with an employment law attorney. If you have any questions about HIPAA and its relationship with workers' compensation, please contact us.
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.
Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
©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.
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