Managing claims is an important part of insureds and brokers alike. Both must need to be on top of all incidents and report them completely and correctly to get proper coverage from insurers.
Did you know that MOST workers comp challenges originate from the moment you send that offer of employment letter out?
If you didn’t, you are not alone. When you hire a new employee, you inherit their ENTIRE medical history! Your competition has turned this hiring process into their competitive advantage over you. Learn what tools you have to insulate yourself from your next Workers Comp claim and ensure you’re hiring folks that YOU KNOW can do the job…
This video takes you through the hiring process, the laws, regulations, and other small but important facets of hiring employees you may have not known before. Then, we’ll tell you how you can deal with these issues. Obviously, hiring a professionally trained team to teach, inform, and place different safety mechanisms within your hiring system is costly but the best option available. Metropolitan Risk is one of those teams. We deal with these issues on a standard basis, as it is one of our main points of business with small companies.
If you have questions about how to prevent hiring your next workers comp claim, you can contact one of our professional risk advisors at 914-357-8444. Or, you can click here to visit our website with more information and blogs.
There are 3 questions every organization should put to each level within their organization to get a sense for how aligned they are as it relates to managing employee injuries, near misses and workers comp claims in general. Doing so will open up plenty of different conversation with your employees regarding their answers. Hence, why these questions must be asked. The more you understand may be a hard pill to swallow, but it usually allows for progress within the company and potentially will help lower claims and in turn, lower premiums.
When it comes to insurance claims and workers comp injuries, Mark Twain’s famous quote jumps to the fore:
” It’s not what we don’t know that hurts us…it’s what we think we absolutely know that kills us.”
Executives, HR reps, and senior management are almost always shocked when they poll the employees of their company and ask these 3 crucial questions. Though fairly straightforward, the answers they receive usually are not. The video will go through the questions, what you might expect, what the answer usually is, and how you deal with this new batch of information.
This brief video should give you some pause. We suggest you poll your own employees as soon as possible. You might be shocked at what you discover from their answers.
Do you have questions about any of the content in the video? Contact one of our professional risk advisors at 914-357-8444. Or, visit our website for more information here. We are always here to help.
You’re probably looking online for an answer on “How to Spot Workers Compensation Claims”. Well, it’s probably the most often repeated refrain when we speak to folks whose companies are suffering under the high cost of employee injuries. They feel victimized by the system, mistreated by morally challenged employees, wronged by the insurance carriers who re-enforce the false perception that there is nothing they can do. Here’s the good news that perception is not only false but can be a huge competitive advantage for you.
It’s a competitive advantage because while your competition is playing the woe is me fiddle finger ; you put forth processes and protocols that won’t eliminate fraud, but will make you much less of a target in the future sending a strong message to the rest of your employees that you take employee injuries very seriously as long as they are legit. If they are not established, it may be considered fraud by the insurance carrier, which is a felony.
The tenor of this article is not to teach you how to build systems that lower the probability of fraud, that will come later another publication or posting. We want to help you identify the red flags that may show you might be getting deceived.
Here are six red flags of a possible and potentially fraudulent workers compensation claim.
Most workers compensation claims are reported Monday morning. The reason is that the injury potentially took place over the weekend. Maybe in a softball game, maybe doing yard work. Quite often these employee lack health insurance which is why they might use the workers comp system to obtain medical treatment. If your employee reports an injury first thing Monday morning, look for some of these other signs.
The injured individual refuses diagnostic procedures like an X-ray or MRI. This might be because they really don’t want the answer. If they are truly hurt, they would want the test done to receive the correct diagnosis and treatment to get back to being functional. Let the employee know there is no cost for the test so you take money out of the equation. If they still refuse recommended diagnostic tests in poker we call that a “tell”.
You can’t grasp a clear idea of what actually happened from those involved. Lack of clarity, conflicting stories should give you pause. Separate the injured employee from the witnesses and perhaps call in a professional to execute the accident investigation.
You’ve heard gossip about the employee’s injury. Careful with this as there could be different motivations in play. All this does is confirm that you need to take a deeper dive into the claim.
There are no witnesses to the injury event.
The claim is reported more than seven days after the injury occurred. This in of itself is not a red flag as most companies don’t have a solid on-boarding process whereby the employee knows when to report an incident or injury.
One of these flags is not a conclusive way to determine a workers compensation claim is false. But if there are three or more, it’s an indication to take a closer look through a really good accident investigation process. At Metropolitan Risk we have several tools available to our clients like our Digital Surveillance Pak which is a robust tool that tracks the employee on both the internet and the streets from our partners desktop.
Before re-affirming and acting upon your suspicions on a false workers compensation claim, consider these statistics and factors.
According to the Safety and Health magazine, newer employees are more susceptible to injury due to lack of their experience. Take into account the employee’s age and sufficiency in job training when judging the validity of the workers comp claim.
Experts in the industry estimate that only 1-2% of workers compensation claims are false. When you use this as a reference you only have a maximum 2% justification on your assumptions.
It takes a lot of effort and finances to train a new employee on safety and compliance.
When an employee submits a false workers compensation claim, there are crucial steps to take to protect your business. Upon uncovering a false claim, the employer must report their findings to their claims adjuster.
The issue is: employees stay out too long on workers compensation which could be considered border line fraud.We think there is a bigger opportunity there.
If you’ve noticed multiple red flags and continuously doubted the validity of the claims, give us a call at 914.357.8444. or request a free consultation with one of our RISK ADVISORS.
Do you have questions on the Guarantee Insurance Company Liquidation?
On November 27, 2017, Guarantee Insurance Company ordered into liquidation by the Second Judicial Circuit Court in Leon County, Florida. The Florida Department of Financial Services is the court-appointed Receiver of the company. The Florida Receiver began working to transition claim files and claim data to the New York Workers Compensation Security Fund. As of January 03, 2018, the Ancillary Receivership Order has not yet been approved. This has caused a delay in the transition as well as processing of open and new claims.
Employers insured through GIC began receiving notifications from the New York Liquidation Bureau (NYLB) on specific claims.
They advised the delayed transition and employers would be responsible for providing WC benefits. However, payments made by the employer may get reimbursed if the claim is subject to the WCB rates and covered.
This focuses on those unequipped on deciding which claims to pay, how much to pay, and what documentation is enough to seek reimbursement. To assist folks struggling, contact New York Liquidation Bureau for instructions on employer responsibilities pending the transition.
By January 25, 2017, we learned that the Ancillary Receivership Order expects to become approved by a judge at a hearing. The recommendation is that employers handle existing and also new claims as follows:
New claims should be reported through the normal channels to get the claim on record. If the employee is losing time from work the employer should seek medical documentation on the disability. If the disability exceeds 7 days, we recommend employers pay at the smallest rate of $150.00. You should do this until the transition takes place or until the Workers Compensation Board establishes the appropriate rate. Paying the least ensures payments made are timely to the injured worker but limits the risk of overpayment.
The injured worker already receiving compensation benefits will continue to get paid for a period of time on existing claims where benefits were being disbursed. It wasn’t specified who is making those payments, but it seems the employer doesn’t need to start disability payments on these claims.
It is possible some of these claims need investigations completed and a controversion filed (formal denial). To protect employers from potential fines/adverse consequences, it may be necessary to hire an independent adjuster to conduct a compensability investigation. If the investigation warrants a controversion, clients may need to hire an attorney to assist with filing the forms with the Workers Compensation Board. Contact your claims advocate for help. We can suggest an independent adjusting firm and law firm. We will ensure only necessary work is getting done however, still assisting with the assignment. Reimbursement for expenses is not clear once the transition takes place.
Our contact @ (NYLB) indicated employers are not expected to pay medical bills. Moreover, if the order becomes signed by late January as expected, medical bills will be processed by an assigned claims administrator.
Still want more info? Feel free to contact us if you have further questions or concerns by CLICKING HERE.
A false workers compensation claim is more common than you might think. The sooner you call the sooner we can help you work through it.
The workers’ compensation insurance system is a no-fault method, paying workers for medical expenses and wage losses from on-the-job injuries. Billions of dollars of false claims submitted each year, says The National Insurance Crime Bureau. In New York, insurance fraud looked at as a felony that most perpetrators aren’t aware of when deciding to game the system. Further, it’s the number issue most business owners raise with us when we are invited into their organization to check why their workers compensation insurance costs are so high. When business owners invite us into their organization to evaluate why their workers compensation insurance costs are so high, its typically the number issue.
Most employers face not only being vulnerable to workers compensation fraud but actually contributing to it as they don’t have the correct policies and procedures in place to help prevent fraud from starting in the first place. To help detect a possible false workers compensation claim, experience shows a claim may be fraudulent if two or more of the following factors are present:
Telltale Signs of a False Workers Compensation Claim:
Monday Morning: The alleged injury occurs either “first thing Monday morning,” or late on a Friday afternoon but not reported until Monday.
Employment Change: The reported accident occurs immediately before or after a strike, a layoff, the end of a big project or at the conclusion of seasonal work.
Workers Comp Fraud
Job Termination: If an employee files a post-termination claim:
Was this injury reported by the employee before being unemployed?
Did the employee exhaust his/her unemployment benefits prior to claiming workers’ compensation benefits?
History of Changes: The claimant has a history of frequently changing physicians, addresses and places of employment.
Medical History: The employee has a pre-existing medical condition that is similar to the alleged work injury.
No Witnesses: The accident has no witnesses, and the employee’s own description does not logically support the cause of injury.
Conflicting Descriptions: The employee’s description of the accident conflicts with the medical history or First Report of Injury.
History of Claims: The claimant has a history of numerous suspicious or litigated claims.
Treatment is Refused: The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.
Late Reporting: The employee delays reporting the claim without a reasonable explanation.
Hard to Reach: You have difficulty contacting a claimant at home, when he/she is allegedly disabled.
Moonlighting: Does the employee have another paying job or do volunteer work?
Unusual Coincidence: There is an unusual coincidence between the employee’s alleged date of injury and his/her need for personal time off.
Financial Problems: The employee has tried to borrow money from co-workers or the company, or requested pay advances.
Hobbies: The employee has a hobby that could cause an injury similar to the alleged work injury.
Suspicious about a claim possibly being an example of workers’ compensation fraud? Don’t hesitate to call us at (914) 357-8444 or CLICK HERE and run your challenge through one of our Risk Advisors. Our staff will perform digital surveillance on your case without having to spend big money on a potential stakeout.
Philip was driving to pick up a tool rental for a construction job his company was working on when another driver rear ended his car causing Philip to sustain serious back injuries. Ultimately the workers compensation insurance policy purchased by the construction company Philip was working for paid the hospital bills and lost wages. Since the bill was north of $100,000 the effect on the construction company’s workers compensation experience modification factor was significant. It doubled both their direct and indirect workers compensation costs which impaired their future bids. Further it drove their mod well past 1.2 precluding them from bidding Federal & State work which carries a requirement that all bidders achieve an experience modification factor of 1.2 or lower.
Not only is this not fair, but it’s also quite common. The problem is 4 fold:
In motor vehicle accidents like above workers compensation may be primary when an employee is injured in the course of employment.
If a third party is clearly negligent, even a little bit, you (and/or) your workers’ compensation insurance carrier can subrogate to recover the funds.
Few clients, and even fewer insurance brokers, track the progress of subrogation and make sure that the carrier or plaintiff does not compromise the client’s workers compensation policy.
When the carrier does receive subrogation funds reimbursing them for the client’s claims costs no one notifies the state workers’ compensation board to make sure the experience modification factor gets re-calculated in the client’s favor. In situations like these, we may have the ability to go back 5 years contingent on the date of claim and state. What’s a potential 10% credit on your workers’ compensation premium each year for 5 years’ worth?
The net result is the business owner or client ends up with an artificially high experience modification factor which not only significantly impacts their unit cost structure, but it may also impact their ability to bid new work as the artificially high workers compensation experience modification factor will knock them out of contention.
It’s no secret keeping your experience modification factor low is a solid strategy to better position your firm to compete harder in a challenging business environment. Owners know that when folks are reviewing RFP’s they are looking at this critical business statistic. Your experience modification factor not only distinguishes you from your competition it also is a major cost driver.
We suggest the client looks for a Risk Advisor or broker that employs a claims advocate that works on behalf of the client who will track all workers’ compensation claims until they are closed. By simply following up every few months and asking the right questions you can have a material and substantive impact on lowering claims and ultimately your costs. This is especially true when there are other negligent third parties involved that could contribute to or for the claim in it’s entirety.
A wise friend once told me sunshine is the best antiseptic, with respect to workers compensation claims clearly this is wise advice and protocol.
For more info on lowering your workers comp experience mod, CLICK HERE.
Last week Governor Cuomo imposed new emergency regulations on insurers. Doing so will aid hundreds of thousands of NY state residents whose properties were damaged or destroyed when Hurricane Sandy struck a month ago.
The New York Department of Financial Services made an emergency amendment to New York Insurance Regulation 64 (11 NYCRR Part 216) reducing from 15 business days to 6 business days the time for insurers “to commence” an investigation of certain types of claims “occurring from October 26, 2012 through November 15, 2012” in the 10 designated counties (Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk or Westchester) and, if they wish their investigation to include an inspection of the damaged or destroyed property, to conduct that inspection within that 6 day period;
The inclusion within that emergency regulation of a provision allowing claimants to commence certain repairs immediately and before the insurer has had an opportunity to inspect the damaged property “[w]here necessary to protect health or safety” and provided the claimant submits proof of loss documentation;
the issuance of Executive Order Number 82 temporarily suspending from today and until further notice the requirements of New York Insurance Law § 2108 so that the DFS may more easily issue temporary public adjuster licenses that authorize such temporary licensees to adjust property/casualty insurance claims in the counties of Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk and Westchester that are commenced during the period this executive order remains in effect; and
In addition the state’s insurance regulator will begin posting report cards on the performance of insurers to the agency’s website. This will ideally make the companies more accountable for their response to customers needing assistance following the storm.
While we applaud the intent by the governor, we question the enforceability of regulation 64. For example what does “commence” actually mean? Personally we think the decree has more political value than policyholder value.
We do like the Report Card idea as public relations is so important in this era driven by the power of social media. Insurance carriers should really think twice before they take the hard stance as consumers have far more power and voice than in storms past.
Lets get straight to the facts: business travel often causes travel-induced health problems that can eventually lead to workers’ compensation claims. You don’t want workers’ compensation claims.
The following are the three biggest factors that contribute to health risks in frequent business travelers:
Poor or minimal sleep
Fattening and salty restaurant food
Long work days and long periods of inactivity
Sound familiar? Long travel days of little sleep only interrupted by the Mcdonalds at the rest stop or airport is healthy right?
Those three factors often contribute to:
Obesity
Hypertension
Heart disease
Depression
In addition, long periods of sitting in cars, trains and planes increase circulatory problems and add stress to back and joint problems. The traveling lifestyles of many frequent business travelers actually equate to that of long-distance truckers. The down economy has created a push for expense cost control which only made it worse for travelers’ health. This may be from taking earlier/later flights, losing gym memberships, or not being compensated for bag fees.
Last year Columbia University researchers compared health risks for employees with different levels of business travel. The results? Rates of self-reported “less-than-good-health” increased with nights traveled. This is a “DUH” moment I hope. However, those “extensive travelers” were 260 percent more likely to rate their health as fair to poor, compared to the lighter travelers. That is a huge difference!
So what can you do to combat the issue you ask?
Implement some risk management techniques. More organizations need to recognize the necessity of assisting employees in finding ways to exercise, eat well and reduce stress during business travel. Some progressive organizations are already taking steps to help such as:
Making sure hotels have fitness facilities or walking trails
Providing in-room workout DVDs
Offering stress-management classes
Tying meal reimbursements to healthier food choices
Providing sample menus and calorie counts
Giving employees comp time to decompress after extensive travel
Remember, companies that assist their travelers to regain some semblance of control of diet and activity schedules, and manage health while on the road should see employees who meet both professional and personal targets without the workers compensation claims.
It’s good to have a local insurance agent when you have questions regarding liability insurance. New York workers compensation insurance, for instance, may or may not be needed depending on your specific situation. There may also be the option of much less expensive riders which you could add to your policy to fit the bill.
Those who have a business with full-time employees based out of home would most likely need a separate New York workers compensation insurance policy. Since this probably relates to only a small percentage of homeowners, this type of policy will not be needed in many domestic employees and homeworker situations.
One thing to consider with the help in an around the house is the number of hours worked. When the total number of hours worked in or around the home by a worker is less than 40 hours, you may be fine just adding a rider to your homeowner’s policy to cover him / her. However, you will need to be careful to make sure you have all your bases covered since there may be times you will want to make sure your hired helpers have their own insurance coverage. Your local agent is the one to guide you through the available options and concerns regarding New York workers compensation insurance and coverage for home help.
