What You Never Told The Comp Board Can Hurt You


Employer Files Contain Most Useful Information
A comp board, and carrier, can only deal with facts they know. What is not known is dealt with by presumptions, nearly always resolved in favor of a worker. The largest source of useful info is in the employer’s files – where it nearly always remains, silent and drawing no attention to itself.

Facts are totally impersonal and indifferent to whether or not they are invited to work comp hearings. If they are overlooked, ignored, unmentioned or regarded is irrelevant only the employer will pay if those approaches are wrong. A fortuitous discovery yesterday illustrates this.

Prior Unemployment Claims Are Common
Have you, as an employer, ever had an unemployment claim by a worker with a terminally anti-social attitude? Did you win the bitter, hard fought claim for unemployment benefits? Did you think that was the end of it, only to be faced with a claim for work comp? Many employers have.

But did you notify the comp board and the carrier, with supporting documentation, of the older UI claim and its outcome? If not, your performance has been typical. Few employers do, and few are asked about prior UI claims.

Yesterday, this writer was doing routine research of a 1985 NY comp decision through google. The name of the case, never mind what it was, unexpectedly produced not one, but THREE cases with the same name, one in 1985, but two in the early 1970s, which were not comp decisions, but UI.

The 1985 decision is useful for claims that require a worker’s signed release, especially where the worker refuses to provide one. The case involved a worker who, for undisclosed reasons, simply refused to provide a post-injury IRS return.

Yesterday, the two earlier UI decisions provided the answers. The worker had been, to put it politely, simply impossible to abide. His battles for UI, after being dismissed, did not change that impression. He lost…….and then filed a comp claim.

He won the comp claim, seemingly without much effort, but when the carrier tried to get documentation of post-injury earnings it met with a stone wall of unexplained resistance.

You Need To Ask
What is disturbing is that the decision strongly points to the fact that even at that point in the proceedings the carrier, the board, and later the court, were unaware of the prior two reported UI decisions. There is an old joke involving a 35 year old, believed to be a mute, who suddenly speaks. When relatives say, “We never knew you could speak”, he answers, “You never asked.”

Had the carrier known of the prior history, the outcome almost certainly would have prevented the claim from being allowed in the first place.

There are many, many claims which fit the above pattern. Wherever there is a claim in which there were prior applications for other benefits, or complaints such as harassment and/or discrimination, inform the board and carrier, and include a copy of any determinations. Do not be mute.

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. medsearch7@optonline.net  


Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.  


©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

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

How Winter Effects Disability Claims

Insurance Company's Group Benefits Division Warns of Disabling Illnesses and Accidents

"We are warning  workers about wintertime wellness risks and urging them to take steps now to protect their health and their wealth," said Glenn Shapiro, vice president of claims for The Hartford's Group Benefits Division. "In today's tough economy, a disability that lasts even a couple weeks could be a financial hardship for many Americans."  Winter is a wonderland for disabling illnesses and accidents. 

Claims due  to depression, respiratory illnesses and fractures jump in January but not before a spike in good cheer and a dip in claims around the holidays, according to an analysis of short-term disability claims by the United States seller of group disability insurance.

 The Hartford's  analysis of more than one million short-term disability claims over the past five years found claims are at their lowest level overall in November and December. The New Year then brings a flurry of disability claims related to depression.

"The holiday  season can be a stressful time of year. But studies show most Americans are happy when they're celebrating with family and friends," Shapiro said. "Our claims records back that up. Depression claims drop to their lowest point in December and then climb in January."

Employers  need to understand depression is a challenge workers need help in overcoming. Not only are workers trying to beat the blues in the dead of winter, they are struggling with sniffles and sneezes. Claims due to respiratory illnesses soar in January and peak in February.

"Everyone knows  wintertime is cold-and-flu season. But our research shows respiratory illnesses are not to be taken lightly. They keep many workers off the job, making this a major concern for the financial health of businesses, too," Shapiro said.

Overall,  accident-related disability claims peak in the summertime. However, there's another secondary spike in January of accident-related claims for workers in the Northeast and Midwest.

"Inclement weather  is a key factor making these two regions disability danger zones during the winter," Shapiro said. "Basic safety precautions can help prevent most of the accidents and injuries that can happen. We encourage residents in these two regions to exercise extreme caution while traveling during storms and use the appropriate protective gear for winter sports at all times, such as wearing a helmet when skiing."

Shapiro added  employers can lend a helping hand in keeping their workers happy and healthy and offers these tips for business owners:
1.  Don't let stress  drain productivity. Provide employees with coping techniques and tools, such as an Employee Assistance Program. You'll also find stress tips on The Hartford's Group Benefits Website such as staying active even during this frigid time of year.
2.  Avoid confusion  about absences. Ensure your team is familiar with key company policies on topics, such as storm closings and telecommuting. (workersxzcompxzkit) 3. 

Get ready
.  Arm your workforce with information about disability benefits, just in case they experience a disabling injury or illness this winter. The Hartford's research has found troubled economic times are a great time for employers to emphasize income protection. Workers can estimate their coverage needs at TheHartfordatwork.com, and employers can prepare by having plans to accommodate recuperating workers.

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.phpFREE

WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php 
WC Calculator:

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

Use Unemployment or Discrimination Claims to Detect Fraudulent Work Comp Claims

If a fraudulent claim is suspected, the employer should ask persons assisting the employer to review additional records. Prior employers listed in the records may have vital information about unemployment claims, prior workers’ compensation claims or discrimination claims which have been filed by the employee.


If an employee has simultaneously filed a workers’ compensation claim and an unemployment or discrimination claim, the employer should review this information. The easiest way to deal with fraud is to show that the employee has made contradictory claims to other agencies for the same injury.


Here are two actual examples of fraud detected by obtaining the records of other claims:


Example 1
The employee has filed a claim for workers comp alleging work stress and harsh physical demands leading to chronic back pain. Three years later, the employer learned the employee had alleged discrimination and harassment in a civil rights complaint which was taken to the Appellate Division where the employer won.


The employee had alleged that she was a good worker who was performing her work but that co-workers harassed her by leaving a dead body outside her security station. This story was bizarre and incredible. It led to the employer winning both the discrimination and workers’ compensation claims but only because diligent investigation discovered the earlier discrimination claim.


Example 2
A foreign born worker filed for unemployment benefits alleging that he had been fired for being late after he had driven through a thunderstorm. He had testified in English at the hearing and there was no interpreter.


After he lost the unemployment claim, the employee filed a workers’ compensation claim alleging he had told the employer he injured his back but the employer did not understand him because the employee did not speak English. The persons assisting the employer on the compensation claim were not told of the unemployment claim for over a year. Fortunately, the records were obtained and the employee’s own statements were used to defeat the compensation claim.


Inconsistent Statements – Few persons filing fraudulent claims are consistent with their statements, especially when they are made to different administrative workers’ compensation claims and communicate with the workers’ compensation board, valuable information will be lost unless the employer alerts those charged with the defense of the workers’ compensation claim. This is an excellent example of how an employer can actively participate in the defense of their workers’ comp claims.


This information was provided by Attorney Theodore Ronca, P.O. Box 980, Aquebogue, NY 11931. Attorney Ronca handles workers’ compensation and disability claims on behalf of employers. Phone: 631-772-2100 or medsearch7@optonline.net

For more cost-saving tips go to WC Cost Reduction Tips.
Show the REAL cost of workers’ comp with the Real Cost Calculator.

Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.

©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com


7 Ways Employees May Make More When Not Working

When executives at a major publishing company were pondering their skyrocketing workers' compensation costs last year, they found a convincing explanation. Employees who were receiving workers' compensation were effectively receiving one hundred ten percent of their salaries. That company is not alone.

Consider the following sources of income and why they might be a disincentive to return to work:

Double Dipping. Like many other employers, a national construction company had a group disability insurance policy provided by the company. One employee was receiving workers' compensation following back surgery and, after 26 weeks, began receiving disability payments too. This can happen with personal insurance policies. This double income meant the worker's at-home pay exceeded his at-work pay. When the company offered him a job with lighter duties at his full salary during his recuperation, he turned it down.

Unemployment In some states, employees on workers' compensation qualify for unemployment benefits under certain circumstances. To prevent this, companies should offer all injured workers transitional jobs they can perform even with their physical restrictions. Under the eligibility rules, workers who refuse such offers will likely not be deemed unemployed.

Lawsuits While workers' compensation statutes prevent workers injured on the job from suing their employers, they can still sue others. Someone hurt while emptying garbage into a dumpster, for example, can sue the dumpster owner and manufacturer.

If such a worker receives a court award or settlement, he gets paid twice for the same injury. Most states allow insurers or employers to seek reimbursement for sums spent on workers' compensation but I have seen many cases where this is not done. I have also seen many situations where the insurance company waives the company's liens – often without their consent.

Pension Pay Older workers who receive workers' compensation benefits may retire during their convalescence and can continue to receive workers' compensation benefits. The remedy is to revise pension plans that do not offset workers' compensation by retirement pay.

Grossing Up – Some employers offer "occupational injury supplements," which can raise workers' compensation benefits from two thirds of salary to full salary But, given that workers' compensation is tax fee and employees at home save on commuting and other work-related costs, a full salary is more lucrative for workers on leave than for workers at work. Thus, companies must carefully design any programs for supplemental pay to avoid any disincentives to working.

Motor Vehicle Accidents In some states, employees who are injured when driving a car on company business may receive both workers' compensation and medical benefits from their no-fault auto insurance policies. To prevent this redundancy, no-fault benefits should be deducted from workers' compensation benefits, where permitted by state law.

Additional Collateral Sources – Employers have many other policies that dampen the enthusiasm of those on workers' compensation to return to work. Open-ended transitional duty jobs and allowing employees on workers' compensation to accrue sick time can deter their desire to return to work.

The Solution Eliminate double dipping where possible. This requires advance planning so company-paid policies are structured to allow offsets. Have all departments (HR, WC, Labor, Safety) review benefits to make sure these perks and policies do not discourage employees from returning to work as soon as they are able.

Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.

©2008 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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