Tag Archives: workers’ compensation

Warning Signs for Employers Red Flags of Work Comp Fraud

6 Jun

There are several “red flags” that are common in workers’ compensation claim fraud. While none on its own is necessarily cause for alarm, the presence of two or more should raise suspicions and trigger an investigation.
1) Monday morning report of injury. The alleged injury occurs first thing on Monday morning, or the injury occurs late on Friday afternoon but is not reported until Monday.
2) Employment change. The reported accident occurs immediately before or after a strike, job termination, layoff, end of a big project, or the conclusion of seasonal work.
3) Suspicious providers. An employee’s medical providers or legal consultants have a history of handling suspicious claims, or the same doctors and lawyers are used by groups of claimants.
4) No witnesses. There are no witnesses to the accident and the employee’s own description does not logically support the cause of the injury.
5) Conflicting descriptions. The employee’s description of the accident conflicts with the medical history or injury report.
6) History of claims. The claimant has a history of a number of suspicious of litigated claims.
7) Treatment is refused. The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.
8) Late reporting. The employee delays reporting the claim without a reasonable explanation.
9) Claimant is hard to reach. The allegedly disabled claimant is hard to reach at home.
10) Changes. The claimant has a history of frequently changing physicians, addresses or jobs.
We believe that vigilant employers can nip most fraud in the bud with a tight workers comp management program that focuses on preventing injury, treating employers fairly and compassionately when injuries do occur and closely monitoring the recovery process until return-to-work on full or transitional duty. By actively demonstrating vigilance repeatedly, opportunistic fraudsters may think twice and sophisticated fraudsters may choose an easier target. Here are some best practices:
• Zero tolerance message. Educate employees about their rights and responsibilities under workers comp, and be clear that your intention is to care for anyone who is injured on the job, but that you aggressively prosecute fraud as a crime.
• Publicize your return-to-work program. Establish and reinforce a goal of recovery and return-to-work for any work-related injuries.
• Train supervisors. Your supervisors should understand workers comp and their role in the process. They should understand the employer/employee rights and responsibilities and what to do if an injury occurs. They should be alert for red flags.
• Aim for same-day injury reporting. Train employees to report injuries immediately when they occur.
• Conduct accident analyses. As soon as possible after a work injury or near miss, gather facts and witnesses while things are fresh. This will also set the stage for getting to the root cause and taking any remedial actions to prevent future occurrences.
• Set the tone at point of injury. Escort an injured worker to the treating physician in your network. Remind them of rights / responsibilities and that you will be monitoring their recovery.
• Keep in close touch with out-of-work injured employees. Let the employee know how important they are to the team. Have transitional work available that conforms with any restrictions and establish a return to work date.
• Work with your insurer. Be familiar with “red flags” and report any suspicious activity immediately.

State Fund Announces Work Comp Rate Increase for 4/1/15 – Some employers up to 17.5%

4 Feb

The State Compensation Insurance Fund in California is boosting its workers’ comp rates effective April 1st and it says insured employers will be paying based upon the overall average some 9% more under the modifications. Some employers however will be hit harder than others as State Fund is boosting tier A and B rates by 5%, dropping the 6% group discounts and increasing territorial surcharges in southern California 6.5% for Los Angeles and 4.8 for the rest of the area.
That means that effectively, a tier A or B account which is currently in a group and located in Los Angeles could see an increase of 17.5%. Accounts in Los Angeles not in a group will see increases of 11.5%.
State Fund, California’s market of last resort, is also increasing its requirements for schedule credits and debits to $25,000 and increasing minimum premiums by 25%.
All this is at a time when many employers are being hit hard by dramatic increases in their experience modifications, due to changes in the rating process in California.

Thanks to the Workers’ Compensation Executive for the news flash. http://www.wcexec.com

Why should an employer take care of a worker injured on the job? Because doing so saves money, and the data proves it!

15 Mar

Hard cold numbers prove the value of taking care of an employee injured on the job.  For California, if a work injury can be treated by workers’ compensation medical care only, the average cost of a claim is $1,156. (Data is based on the latest report for complete year statistics of the Workers’ Compensation Insurance Rating Bureau.)

However, if the employee can’t return to work the next day, and receives “temporary disability” payments, the average cost per claim jumps to $15,041. This increase in costs clearly shows the value of an aggressive return to work program, and a “day of injury” protocol in taking care of the physical and emotional needs of an injured employee.

If an injured employee experiences any, even minor, permanent disability, the average cost per claim triples to $41,313.  Major permanent disability claims average $140,021 per claim and permanent total disability claim costs soar to an average of $109,922,270 per claim – yes that is $109 million per claim on average.  Death claims only average a cost of $43 million each.  

Contact Don Dressler Consulting and CalWorkSafety for help in keeping injured workers on the job.  Our Nurse Consultant is doing great work in this area and our experience consulting staff can help with safety programs to prevent the injuries in the first place.

Visit our websites at www.DonDressler.com and www.CalWorkSafety.com

Even One Injury Can Raise Your Ex Mod

14 Apr

It is becoming increasingly clear in 2013 that recent changes in the California workers’ compensation experience modification process are severely hurting small employers, who have even 1 work injury reported. A single claim can push an employer’s experience mod up by 15 to 25 %, or more. Now that the first $7,000 of each claim are used in the “primary” loss portion of the experience modification, up from just $2,000 in past years, a single work injury can increase future workers’ compensation premiums by 3 to 4 times the dollar cost of the claim, according to UC Berkeley researcher Frank Neuhasuer and others.
And experience mods being reported in 2013 are showing this impact. The increases are so high that the Workers’ Compensation Insurance Rating Bureau has met recently to consider limiting the impact of one claim. The problem, however, is that many times, what appears to be multiple claims really is just an attorney for an injured worker taking advantage of filing two different claims, one for a “specific’ injury such as an injured shoulder, and a second claim for “cumulative trauma” over the work life of the employee. In truth, these are not two claims, but the lawyer’s effort to magnify injuries to obtain more money for himself and the worker.
Employers, in self-defense, need to consider “post offer pre employment physical exams”, immediate and through accident investigations, and full cooperation with their workers’ compensation claims personnel.

How to Save Money from the 2013 California Workers’ Compensation Reform

2 Apr

The California Legislature passed SB 863 in September of last year, with most of the provisions taking effect January 2013. “Permanent Disability” benefits were increased by 40% at a cost to employers of over $1.2 billion in new or added costs per year. There were a number of other changes, some good for employers, others very technical. One of the most effective tools employers were given to save money to offset the cost increases of the law are “return to work” programs. This means it pays for every injured worker, who is not in the hospital, to be back on the job doing something within the limits of their ability, the day after their injury. It might be better to call this a “stay at work” rather than a “return to work” policy.
California employers can save over $400 million a year in workers’ compensation cost by using this “stay at work” approach. But the savings are even larger in future premiums! When an injured worker is off duty due to a work injury, and he qualifies for “temporary disability benefits” under a workers’ compensation policy, he receives only 2/3rd of his pre-injury wage. BUT, this same temporary disability benefit costs almost all employers 2 times or more the lost wages – because these claim costs are used to set their “experience modification, not for one, but for 3 years in a row!. SO- the employee loses money by being off work and his employer pays more than twice as much as if the worker were to come back – even if the worker was just putting in time.
But of course a good return to work program is much more effective than just wasting an employee’s time. Every company I know has some work that they just have not gotten around to, but need to do “someday”. Such activities are always a place to look for “modified work” within the physical limits of a recovering employee.
If you would like to learn more about the return on investment or economic value of “stay at work” or “return to work” programs, just email me at DonDressler1@hotmail.com

The Most Important 2 days in Controlling Workers’ Compensation Costs

16 Mar

When an employee reports an injury, often that he or she is experiencing pain from lifting or a slip or fall, many employers direct the employee to a medical provider, file a report with their workers’ compensation insurer, and hope for the best. But they have wasted the 2 most important days they ever will have in controlling workers’ compensation costs.
Day 1- when the worker reports an injury- which may or may not even be an injury. Unless there is a medical emergency, bleeding, apparent broken bones, burns, etc. Take 15 seconds to do an assessment, just as any first responder would.-ABCD
A- Airways – is the person breathing
B- Bleeding –
C- Conscious-
D- Other apparent Disability
Treat the medical emergency with appropriate first aid with trained personnel, call for medical first response. After the emergency is handled, direct the employee to the appropriate medical care, if work related, provide workers’ compensation claims forms and notify your workers’ compensation claims office. All this SHOULD happen on Day 1. Case after case has shown that costs increase for every day of delay in any of these steps.

Day 2- and just a critical. If the employee involved returns to work, welcome them back, be supportive and ask how you can assist them. IF THEY DO NOT RETURN TO WORK their next assigned, day, they employer or someone on their behalf needs to immediately contact the worker, verify how they are doing, express support, answer questions, and urge them to return as soon as possible. Identify any work restrictions needed to accommodate their return to work.

The average cost of an injury of where the worker returns to work the next day is $700, and when the worker does not return is $13,000.

For help in managing your work injuries, contact Don Dressler Consulting at DonDressler1@hotmail.com

New Resource for California Employers – WCIRB.com Website Launched

23 Feb

The Workers’ Compensation Insurance Rating Bureau has launched a completely redesigned website to provide more in-depth information relevant to employers, insurers and agents, and anyone interested in learning more about the WCIRB and California’s workers’ compensation system. The website has a new online address: http://www.wcirb.com

What’s Available- Visitors to the website will find information and resources specifically tailored to their needs.

• Publications and Filings
Locate and access California manuals and plans, WCIRB Bulletins, regulatory filings and more.
• Research and Analysis
Search for and find current data, reports and analyses about the workers’ compensation system.
• Learning Center
Access online educational tools on a variety of topics including the standard classification system, payroll auditing, experience rating and more.
• About
Learn about the WCIRB Click: http://vimeo.com/60274101 for a video tour.

If you would like to learn about your own company’s experience modification or how to control it, please contact Don Dressler Consulting by our email: DonDressler1@hotmail.com or view our website at http://www.DonDressler.com