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Workplace Safety Bulletin
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The Other Side of Fraud: Legal Bribes in Workers Comp
When you think of fraud in workers comp, it's common to think about employee fraudsters who are looking to cheat the company out of as much as possible. You might then extend that thought to the doctors who may be convinced to say the employee does indeed need continued treatment and cannot return to work. However, there's another side too that you may discount - the lawyers who handle these cases. They do not quite stand to benefit quite as much as those performing the long-term medical 'care,' but they can certainly be tempted into turning this into a business where the specialize in getting as many clients as possible who are willing to lie a little. We'll look at the case of Sean O'Keefe from San Diego who did just that.
Paying to Play
O'Keefe took on 9,000 cases, and he got many of those by paying a firm upfront for those who were sent his way. The firm he worked with needed his word that he would rack up a certain amount of expenses at the medical offices where his clients would go for treatment (e.g., MRIs, meds, etc.) This was a business that stood to benefit from clients being treated as dollar signs, and he's not the only running this scam. There are currently about a 100 people in San Diego who are looking at similar charges, and those are just the people who have been caught. It causes major concerns for just how easy it is was for them to set up an operation that functioned for years entirely under the radar.
Tightening Everything Up
Despite the fact that it doesn't look great that this happened at all, it is showing more interest in fraud than may have been shown in the past. This should cause a reevaluation of how claims are processed, how medical providers are reimbursed and how they submit their proof. This new information being brought to light should create more oversight which will bring the overall cost of workers compensation down. For O'Keefe's part, he was paid over a million for doing what he did, and he's agreed to cooperate in telling officials everything about the operation that they would want to know. In return for bringing down the people who were involved, he's hoping that his sentence will be deceased.
Fraud and You
This should concern you no matter where you live, and while you might feel helpless to stop it, it's not impossible to recognize signs of fraud. If you have a chance to check out the lawyers your employee uses, then it may not be a waste of your time either.
HMS Insurance Associates, Inc.
Mental Health and Workers Comp: What's Your Liability?
Workers compensation can feel like a minefield, especially when it seems like all the power rests with your employees. When people who don't follow directions or are goofing around during their breaks can be injured and then sue you for damages, you might feel helpless to safeguard yourself. The power you're looking for comes from being prepared when you walk into work in the morning, when you hire someone and how you interact with your employees. And you should be aware that mental health may play a significant role in workers comp. Even though it can feel like a subjective matter at times, it's good to know how it fits into the larger framework of taking care of your staff.
A Matter of Proof
There is a possibility you'll be held responsible for a person's mental health damages, but it will be up to the employee to prove that this mental illness would not have developed had they not been under a specific amount of stress at work. It would have to be classified as an abnormal working environment, which again, leaves a lot open for interpretation. When people attempt to prove this on their own without having hired a lawyer, the judge tends to err on the side of employers. Many lawyers won't actually touch these cases due to the fact that without any type of permanent physical injury, it can be difficult to show that a person is suffering from a sustained psychiatric state that is more or less expected to resolve itself once the stress of the job has gone away. They're likely only to be paid when they win, so it's just risky for the lawyers.
Despite your odds, that doesn't mean you should dismiss a mental health request, especially considering that mental health problems are increasingly more accepted as a reason for disability insurance by the federal government. With this type of validation, judges may start to give a bit more weight to these cases based on the right evidence. If you are approached by an employee for being under a great amount of stress, say if they have to work with unfriendly coworkers or are expected to deal with crises on a regular basis, then you may want to see if it's possible to lighten the load. Hopefully you've already implemented hiring practices that might weed out someone who would try to get out of doing his or her job at this point. Also, people are likely to win their case claiming mental health problems if they've also been physically injured as well - another warning for you to be as cautious as possible when dealing with workers comp issues.
HMS Insurance Associates, Inc.
Task Forces at Work: How a Florida Lobby is Taking Charge
With all the problems and injustices in the world, it can be difficult to know exactly where you should pick your battles. This is especially true for your professional world, because you may not get much leeway if you choose the wrong issues to focus on. However, when one group of people shows their passion through both talk and action, it can be one of the most powerful forces on the planet. That's what the Florida Workers' Compensation Strategic Task Force is hoping to do: effect change through systematic effort to help save businesses on potentially unnecessary costs of workers comp.
After town halls across Florida, the group said there needed to be more effort devoted to creating initiatives to improve the system. The call to action was brought upon due to the recent rulings in the state Supreme Court. One of those rulings denied a law that would place an expiration date on payments at more than two years after the worker was injured, and another denied the limitation of attorney fees for workers compensation. These two measures were meant to strip down some of the incentives that has made employee, legal and medical fraud as prevalent as it has been while creating a more sustainable plan for businesses who are trying to balance their expenses.
With another hearing coming up this month, insurance companies want to increase the rates for workers comp at close to 20%, a change that would take place on October 1. The looming court data spurred people into action to see if they couldn't get together to come up with other ways to curb the amount they're paying from month to month. Their platform is that businesses saddled with workers comp costs cannot grow, which cuts jobs for the people of the community. Without a stable means to support the community, it spells trouble for the economy at large. Their goal is to continue to come up with ideas until the best solutions are implemented to give Floridians a fairer outcome for both employees and company owners alike. This is about continued talks, not necessarily a one-off committee.
Whether you agree with the methods of the task force or not, this is a powerful lesson for those who do not agree with your own court rulings. It is always an option to increase your involvement in order to bring to light some of the more immediate potential dangers of paying too much for workers comp. Whether you've even been involved with an injured employee or not, precedents set in cases in your state can have a bigger influence on your bottom line than you think.
HMS Insurance Associates, Inc.
Falling Premiums in West Virginia and Illinois: A Look At Workers Comp Today
When you only hear about fraud and rising insurance rates, then it can be easy to assume that those are the trends that are here to stay. We encourage you to remember that there is change happening out there though for certain states. Concerned residents in Florida have already started a new task force, and people around the country are fighting their own battles for what they feel is best for their employees and their customers. We'll show you what's happening in Illinois and West Virginia today, so you can see workers comp is functioning in other areas of the US.
After seeing a reduction in workers compensation for the past 11 years, West Virginia continues their streak for another round of cutting costs in 2016 at almost 15%. This time around, employers in the state can expect to save about $36 million, which has made business owners a little happier and wondering what to do with the extra cash. While it's not been reported as to why exactly West Virginia has had such a good run regarding their workers compensation premiums, it is clear that the reduction gives businesses a sense of stability which can help relationships and growth flourish. The new change will take place the first day of November this year.
Illinois is not quite doing as well as West Virginia but their claims will fall by 12% this year, which is still a significant drop. While they still pay more than neighboring states, it's important to note that they do have one of the biggest cities in the country which is a clear indicator of why they would have higher rates. This fall is a good step in the right direction, but it may be for some disappointing reasons. Some of the jobs that used to be causes for injuries, like construction or manufacturing, have seen a decline in demand in the state. People claim that the high rates and special interest groups have stunted contract and projects moving forward due to the liability and cost concerns. As this year goes by, Illinois will be able to see if the reduction was the boost it needed to kickstart growth again or if it is still under too much strain by the debilitating cost of premiums.
No matter how you feel about either state, this is a good lesson that there can be change on the horizon for you. Illinois in particular will be getting an on-the-job lesson this year, so to speak. When insurance companies have the reason to do so though, they absolutely can work with state officials and businesses to start lowering the cost of workers compensation.
HMS Insurance Associates, Inc.
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