Workers Compensation Outlook
|
|
- Kevin Lamb
- 8 years ago
- Views:
Transcription
1 Reprinted with permission from, Volume 21, Number 8; May Copyright 2011, Standard Publishing Corp., Boston, MA. All rights reserved. Workers Compensation Outlook VOL. 21 NO. 8 May 2011 Fighting Workers Compensation Fraud This issue of examines dishonest activity by employees, health-care providers, and employers; explains how to identify red flags; discusses how states have cracked down on fraud; and suggests steps that employers can take to fight workers compensation fraud. Size and scope Workers compensation fraud undermines a 100-year old social system originally designed to assist injured workers and their families with medical bills and partial wage replacement for on-the-job accidents. The added strain associated with workers compensation fraud places substantial pressure on the system s infrastructure. When fraudsters cheat the system, the results are greater losses for employers and insurers, higher insurance premiums, lower revenues for insurers, depressed wages, and possibly fewer jobs for honest workers. The size and scope of workers compensation fraud is difficult to determine. The Insurance Information Institute estimates that property/casualty insurance fraud costs insurers $30 billion annually. The National Insurance Crime Bureau estimates that workers compensation fraud makes up approximately 25 percent of that amount, or $7.2 billion per year. The National Coalition Against Insurance Fraud reports a lesser estimate at $6 billion a year. Even the lowest of these estimates indicates that fraud is a serious problem and indicative of considerable strain on the workers compensation system. Types of fraud The most common way of classifying workers compensation fraud is by type. Generally, this includes employee fraud, provider fraud, and employer fraud. A better understanding of the types of fraud and what to look for will shed light on how best to combat this criminal behavior. Employee fraud Employee fraud tends to be the most highly publicized type of workers compensation fraud. Businesses that employ a high number of contract, temporary, or seasonal workers are particularly susceptible to this type of fraud. WORKERS COMPENSATION OUTLOOK: Editorial Director: Robert Montgomery, CPCU, AU; Editor: Katherine Allnutt Panikian, Esq.; Copy Editor: Lindsey Croteau; Production Coordinator: Nakeesha Warner; Marketing Manager: Susanne Edes Dillman; Circulation Manager: Kelly Cotter; Publisher: John C. Cross, Esq. WORKERS COMPENSATION OUTLOOK (ISSN # ) is published monthly by the John Liner Organization, a division of Standard Publishing Corporation, 155 Federal Street, Boston, MA Subscription price: $259 per year U.S. and U.S. possessions; $ in Canada and elsewhere. Periodicals postage paid at Boston, MA, and additional mailing offices. POSTMASTER: Send address changes to WORKERS COMPENSATION OUTLOOK, 155 Federal Street, Boston, MA
2 Employee fraud takes many forms. One of the more common occurs when malingering employees pretend their injuries or conditions are worse than they really are to receive more money or time off work. Sometimes, employees work a second job while they fraudulently collect disability for an injury on another job. In other instances, employees report an injury that never occurred. Additionally, employees fleece the system when they report nonwork-related injuries as having occurred on the job. These activities translate into greater financial losses, higher insurance premiums, and reduced revenues. Remaining workers are often forced to shoulder increased workloads. Supervisors spend time completing paperwork related to claims and training replacement workers. Consumers feel the impact at the cash register in terms of higher priced goods or services. While all claims should be treated as legitimate, managers should be trained to look carefully for suspicious signs of possible fraud. Managers should be alert for common characteristics that may suggest a claim is not legitimate. While these red flags do not confirm fraudulent activity, they can identify claims that warrant a closer look. Common red flags associated with fraudulent employee claims include the following: Injury is reported on Monday morning or after a vacation or holiday. Injury is reported about the same time every year. Injury is reported late. Claimant is a new, seasonal, or contract employee, or claimant has a history of short-term employment. Claimant has an attorney when injury is reported. Claimant demands quick settlement. Claimant is facing possible layoff or termination. Claimant s description of the accident and resulting injury are not consistent. Claimant goes to the emergency room for treatment for a nonemergency condition. Claimant refuses diagnostic procedures to confirm treatment. Claimant s address is a post office box or hotel address. Claimant is disgruntled. There are no witnesses to the accident. Provider fraud It is particularly disappointing when trusted health-care professionals commit workers compensation fraud. While these providers seek to pocket money they have not earned, they can also jeopardize the health of injured workers who have come to them for treatment and care. 2
3 Health-care provider fraud takes many forms. One of the more prevalent provider fraud schemes involves upcoding or inflating medical bills. In these instances, providers exaggerate injuries and then bill for unnecessary or unrelated treatments. Another way health-care providers defraud the system is by billing for treatments that never took place, including instances where doctors have billed for services provided to deceased patients. Some fraudulent health-care providers view workers compensation and group health insurance as an opportunity for double dipping. They bill the workers compensation insurer and the injured employee s group health insurer for the same procedure in hopes of being paid twice. Sometimes health-care providers team up with attorneys to take advantage of the system. For example, health-care providers will refer patients to attorneys in return for kickbacks. Another scam involves health-care providers and attorneys recruiting runners to bring injured workers in for treatment and consultation. They gamble that insurers would rather settle than fight a time-consuming and potentially expensive lawsuit. The more extreme cases of fraud involve organized crime rings and the establishment of medical mills. These groups may go so far as to set up bogus health-care clinics. These clinics rarely employ licensed medical physicians, contain little if any medical equipment, and provide virtually no medical treatment. Their sole purpose is to serve as a staging area for fraudulent claims, fabricating everything from fake credentials to medical bills. In some instances, these clinics will pay outsiders to participate in staged accidents. Fraudulent provider claims also have red flags. While they do not confirm fraud, one or several red flags may indicate the need for a more in-depth investigation. These red flags include the following: Provider bills for treatment the injured employee does not remember receiving. Provider does not change treatment regimen. Provider bills for dates of service on weekends or holidays for nonemergency procedures. Provider bills for evaluation and management procedure codes only. Provider bills multiple claims for injured worker. Provider bills for many drug-related and prescription charges. Provider continues to bill for services after injured worker has selected another physician for treatment. Provider bills for services that are not likely performed. Provider s medical reports read almost identical even though patients and conditions being treated are different. 3
4 The level and duration of treatment is inconsistent with the type and severity of injury reported. Injured worker shows no measurable improvement after extended period of time. The same doctors and attorneys are associated with the same types of questionable claims. There is a sudden and unexplained increase in provider billing. There are delays in receiving requested records. The doctor s office is far away from injured worker s home address. Employer fraud A third type of fraud, employer fraud, also has a significant negative impact on the workers compensation system and on the general economy. Those who cheat in paying workers compensation premiums can then undercut the prices of competitors. The result is an uneven playing field. Employers can defraud the workers compensation system in many ways. One of the more common is by underreporting payroll and number of employees. A variation of this tactic involves misclassifying payroll and job classifications. For example, a roofing contractor might underreport the number of workers it employs or indicate the type of work they perform is simply general carpentry. Both payroll and job classification determine the amount of workers compensation premium that an employer pays. Sometimes, employers attempt to cheat the system by keeping payroll off the books. They pay workers in cash, allowing them to keep payments off the books and deflate the payroll amount reported. Employee leasing arrangements should also be carefully monitored. Some employers have attempted to set up dummy companies with fake accounting and tax records. These companies become the source of their employees. Such an arrangement is also used to avoid the impact of a high experience modification factor that can increase standard premiums significantly. Some employers attempt to lower their overall costs by simply not purchasing workers compensation insurance. Underhanded employers may also attempt to deceive their employees by deducting premium dollars from workers pay or telling the workers that they are not eligible for workers compensation coverage until they have worked for the company for a minimum of six months. Many contract jobs require a certificate of insurance in order for the contractor to submit a bid. As a result, a black market offering fake insurance certificates for sale has emerged. In some cases, original certificates have been altered and photocopied so many times they appear grainy. 4
5 Like many other types of fraud, employer fraud carries its own set of red flags. Among the signs to look for are the following: The employer has multiple businesses operating from the same address. The employer refuses or delays access to records for audit. The employer s name is not consistent with the work performed. The employer has selected the lowest rated classification for its exposure. The employer has a high experience modification factor paired with a low premium exposure. The employer shows excessive use of independent contractor classifications. The employer s equipment and vehicles are not consistent with job classifications. The employer discourages employees from filing workers compensation claims. The employer displays a certificate of insurance with inaccurate data or the employer s certificate of coverage exceeds anticipated exposure. The employer makes a significant deposit premium in order to avoid audits. The employer requires new employees to complete a 1099 form declaring themselves as independent contractors. The employer reports significant payroll decreases even though revenues stay the same or increase. The employer s principal address is a post office box. The employer is unable to identify tax or unemployment reports. Strength in numbers The good news is that a number of businesses, insurance service providers, and governmental agencies have banded together to fight workers compensation fraud. Their efforts have been largely successful and hold considerable promise for the future. Governmental agencies The Washington State Department of Labor and Industries reported many successes and key developments in its 2010 Annual Fraud Report to the legislature. Among its achievements, the state accomplished the following: Completed a record 5,789 claimant investigations. This represented a 12 percent increase over the prior year. Completed a record 5,846 employer audits. This resulted in $26.4 million in assessments. 5
6 Collected $137.4 million in delinquent employer premiums, audit assessments, overpayments to workers and health-care and vocational providers, and fraud recovery orders. Referred 17 cases for criminal prosecution and maintained a 100 percent conviction rate. Created a blog called NAILED that features fraud fighting efforts around the country. The blog also shows surveillance videos from recently completed investigations and provides updates on the prosecution of major fraud cases. Similar fraud fighting efforts are taking place around the country. Almost every state has passed laws raising the level of insurance fraud from a misdemeanor to a felony. Some states provide immunity from civil liability to those who report suspected activity. Most states work hard to educate the public about the detriments of fraud through various outreach programs. Additionally, many states have created telephone hotlines for reporting fraud, and these have produced promising results. Insurance service providers Insurers, third party administrators, and other insurance service providers are also committed to fighting workers compensation fraud. Many have combined traditional fraud fighting techniques with today s technological advancements. One of these advanced approaches involves the use of predictive analytics. The insurance industry has learned to apply the same predictive modeling techniques used by retailers and credit card companies to detect patterns of behavior indicative of workers compensation fraud. Traditionally, claims examiners looked for red flags one claim at a time. Now they can use predictive modeling to analyze thousands of data elements simultaneously to detect subtle and complex patterns. By identifying high-risk claims early on, cases can be referred to highly trained examiners or special investigation units for proper follow-up. Moreover, predictive models give examiners an objective assessment of data patterns. The data are analyzed for outliers and aberrant activity with no predispositions. These models can be used to examine patterns related to employee behavior, healthcare provider billing, or employer payroll classifications. Traditional claims investigation has also been impacted by technology and patterns of social behavior. Social networking sites like Facebook, Twitter, LinkedIn, YouTube, and MySpace have proven to be tremendous assets in putting the brakes on fraud. What used to take investigators days to uncover is now readily posted by the claimants themselves for the world to see. Businesses Businesses are very capable of fighting fraud. Whether developing a new anti-fraud program or enhancing an existing one, the following steps are effective ways to prevent and contain costs associated with workers compensation fraud: 6
7 Establish a zero tolerance culture. Employers should not tolerate workers compensation fraud. To achieve a truly successful culture, accountability must rest at the top with senior management. Enforce a strong hiring program. An employer truly committed to zero tolerance will enforce strong hiring practices. Quality employees are both productive and less likely to engage in fraudulent activities. Promote the company s anti-fraud philosophy. Communication is important. An employer should convey that it will not tolerate workers compensation fraud and perpetrators will be prosecuted to the fullest extent of the law. Create a safe and positive workplace. Creating a safe and positive work environment is an excellent way to avoid fraudulent activity. Disgruntlement is a leading indicator of workers compensation fraud. Equip managers and supervisors. Teach managers and supervisors that every accident should be treated as legitimate and every employee should be treated with respect. However, they should also be able to recognize red flags commonly associated with fraudulent claims. Managers and supervisors should have clear procedures for reporting red flags. Enforce a return-to-work program. An effective return-towork program can be used to deter fraud. If employees know a modified duty position will be made available following an injury, they may be less inclined to stage an accident to obtain time off. Maintain current files. If fraud is suspected, an employee s file can aid the investigation process. Having the employee s current address, phone number, badge photo, and performance reviews available can be valuable. Establish strong relationships with claims adjusters. The claims adjuster is one of an employer s most valuable team members when it comes to fighting fraud. Establishing a strong partnership and ensuring the adjuster knows the company is very important. Investigate accidents immediately. Details begin to fade as time passes. Ensure managers and supervisors investigate accidents as quickly as circumstances allow. This includes inspecting the accident scene, taking employee statements, and interviewing witnesses. Know how to take and document statements. Train managers and supervisors how to record and document statements from injured employees and witnesses. Invite law enforcement or members of special investigations units to explain how to ask better questions and take more definitive statements. Use surveillance when appropriate. Surveillance involves monitoring a claimant s activities to determine if they contradict earlier statements or representations. While expen- 7
8 sive, it can be a valuable investigation tool. Prosecute fraud. Everyone pays a price for fraud. Once an employer s zero tolerance policy is communicated, businesses must take every action to expose and prosecute fraud. This can be a great deterrent to others in the workplace. Provide fraud hotline. Install a dedicated phone line that employees can use to report fraud. Employees should know how to report such activity and have assurance that their identity will be protected. Utilize outside resources. Keep track of new services available in the industry to fight fraud. Many insurers, third party administrators, and other service providers devote substantial resources to this campaign against fraud. Review and refine program continuously. Like any business initiative, a company s anti-fraud program should be periodically reviewed and refined. Make adjustments as needed. A final note Workers compensation fraud is a problem that plagues the entire system. This includes dishonest activity by employees, health-care providers, and employers. While not conclusive, red flags are valuable in knowing what to look for when fraud is suspected. The good news is governmental agencies, insurance services providers, and businesses have banded together to fight this threatening problem. Playing off their own strength in numbers, these entities are taking advantage of technology and other industry advancements to better identify and prosecute these criminals. Their recent successes hold much promise for the future. About the author Catherine D. Bennett, CPCU, ARM, is communications manager for Sedgwick Claims Management Services Inc., a leading North American provider of claims and productivity management solutions. Throughout her 25-year career in the risk management and insurance industry, Bennett has held various brokerage, consulting, and marketing positions. She is a frequent speaker at conferences and seminars, author of numerous articles within the industry, and the co-author of the book The Art of Self-Insurance. Bennett is a graduate of Vanderbilt University and the Owen Graduate School of Management. Copyright 2011 Standard Publishing Corporation. All rights reserved. workers compensation outlook is published monthly by the John Liner Organization, a division of Standard Publishing Corporation, 155 Federal Street, Boston, MA Quotation or reproduction of material, in whole or in part, only with permission of the publisher. Subscription price: $259 per year plus shipping and handling, United States and U.S. possessions; $ plus shipping and handling in Canada and elsewhere. To order your subscription, call (617) , toll-free (800) , or order@spcpub. com. is now available online through Vertafore ReferenceConnect. For customer service, k.cotter@spcpub.com; for editorial inquiries, k.allnutt@spcpub.com. Please visit our Web site, This publication is designed to provide authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other expert advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. 8
Fraud. Baldomero Gonzalez. Our reputation for excellence is no accident. TM
Fraud Baldomero Gonzalez Workers Compensation Fraud It is estimated that ten percent of all claims, nearly $31 billion dollars, is paid annually in fraudulent workers compensation claims. Workers compensation
More informationWorkers Compensation Claim Fraud
Workers Compensation Claim Fraud Small businesses don t have to be insurance experts to realize the many potential benefits associated with taking a strategic approach to workers compensation and risk
More informationNYSIF is leading the fight against workers compensation fraud. You can help.
NYSIF is leading the fight against workers compensation fraud. You can help. Red Flags of Claims Fraud Policy and Provider Fraud David A. Paterson Governor Robert H. Hurlbut Chairman Reporting Fraud to
More informationAnne M. Noonan, Commissioner, Vermont Department of Labor WORKERS COMPENSATION FRAUD STUDY AND REPORT
Memorandum To: From: House Committee on Commerce and Economic Development; Senate Economic Development, Housing and General Affairs Anne M. Noonan, Commissioner, Vermont Department of Labor Date: 1/15/2015
More informationWORKERS COMPENSATION FRAUD
WORKERS COMPENSATION FRAUD September 10, 2015 Dave Senott Special Investigations Unit Zurich Insurance Why Pursue a Fraudulent W/C Claim Financial savings for insurance company Estimated that 20% of W/C
More informationOASIS GROUP. Workers Compensation Claims Call Center. Workers Compensation Injury Reporting Guide
OASIS GROUP Workers Compensation Claims Call Center Workers Compensation Injury Reporting Guide Workers Compensation Injury Reporting Oasis Risk Department 2601 Cattlemen Road Suite 300 Sarasota, FL 34232
More informationThe Insurance Coverage Law Information Center
The following article is from National Underwriter s latest online resource, FC&S Legal: The Insurance Coverage Law Information Center. The Insurance Coverage Law Information Center EXPERIENCE, EXPERTISE,
More informationNYSIF is leading the fight against workers compensation fraud.
NEW YORK STATE INSURANCE FUND NYSIF is leading the fight against workers compensation fraud. You can help. Red Flags of Claims Fraud Policy and Provider Fraud Reporting Fraud to NYSIF nysif.com N E W Y
More informationThe state and challenges of insurance fraud
Grand Hotel Union 14. maj 2013 The state and challenges of insurance fraud James E. Whitaker Agenda 1. About ACFE 2. Statistics for insurance fraud 3. Insurance fraud schemes 4. Case study 5. Fight against
More informationStopping the Flow of Health Care Fraud with Technology, Data and Analytics
White Paper and New Ways to Fight It Stopping the Flow of Health Care Fraud with Technology, Data and Analytics January 2014 Health care costs are rising and everyone is being affected, including patients,
More informationWILLIAMSON COUNTY, TENNESSEE WORKERS COMPENSATION ANTI-FRAUD PLAN
WILLIAMSON COUNTY, TENNESSEE WORKERS COMPENSATION ANTI-FRAUD PLAN I. Provisions for the prevention, detection and investigation of workers compensation fraud. Williamson County Government will take all
More informationBUDGET & FISCAL AFFAIRS COMMITTEE
BUDGET & FISCAL AFFAIRS COMMITTEE WORKERS COMPENSATION PROGRAM COMPLIANCE REQUIREMENTS DIRECTOR, OMAR C. REID April 30, 2013 Workers Compensation Fraud Overview Our Philosophy Common Types of Fraud Employee
More informationManaging the Care and Return to Work of Injured Workers (and controlling your Workers Compensation Costs)
Managing the Care and Return to Work of Injured Workers (and controlling your Workers Compensation Costs) This Guide was developed to provide you with valuable information regarding our managed care program,
More informationWorkers Compensation Claim Fraud!
Handling & Reporting Suspected Workers Compensation Claim Fraud! Presenters: George Hickler, SCLA CIFI Director Special Investigation Unit Everest National Ins. Co. George.hickler@everestre.com Bill Randall,
More informationWorkers Compensation Fraud
Workers Compensation Fraud Martin Gonzalez Chief Investigator CA Department of Insurance Fraud Division 5999 E. Slauson Ave. Commerce, CA 90040 (323) 278-5000 1 State of California Department of Insurance
More informationEffective Injury Management Program AN EMPLOYER S GUIDE. Captain John Parker photo
Effective Injury Management Program AN EMPLOYER S GUIDE Captain John Parker photo How Well Does Your Company Manage Employee Injuries? Do you have procedures in place to assure prompt reporting of claims
More informationInsurancece.com is as easy as 1, 2, 3
All Wisconsin Agents may take online and self study continuing education. The Wisconsin Insurance Commissioners Office state on their website Self-study, correspondence and online courses can be approved
More informationWorkers Compensation Insurance Fraud
Don t Let Your Business Become a Victim! Fight Workers Compensation Insurance Fraud Ranney P. Pageler V.P., Fraud Investigations Department Copyright 2011 EMPLOYERS. All rights reserved. This presentation
More informationMoney Service Business Facilitated Workers Compensation Premium Fraud. OFR Discussion Item August 2, 2011
Money Service Business Facilitated Workers Compensation Premium Fraud Background: OFR Discussion Item August 2, 2011 A new form of workers compensation fraud has burgeoned within Florida s construction
More informationMay provide differing lists of damaged/stolen property regarding an insurable loss. May provide questionable proof of purchase for expensive items. May provide invoices or estimates that appear to be inflated
More informationWorkers Compensation Frequently Asked Questions
Workers Compensation Frequently Asked Questions Injured Workers Employers Adjusters/Attorneys/Insurers Vocational Rehabilitation Injured Workers What do I do if my employer has failed to file a claim?
More informationEmployer s Handbook. Workers Compensation
Employer s Handbook Workers Compensation Workers Compensation 101 Table of Contents Contact Information. 3 What is Workers Compensation?... 4-5 What is your role?... 6-7 Workers Compensation Benefits 8-9
More informationImportant Information
16 An Employee s Guide to the South Dakota Workers Compensation System Division of Labor and Management Phone: (605) 773-3681 www.sdjobs.org Department of Labor and Regulation 700 Governors Drive Pierre,
More informationZurich s Workers Compensation Claims Kit
Zurich s Workers Compensation Claims Kit A guide from a leader you can count on. With 50 state-specific workers compensation laws, a multitude of federal workers compensation laws and the provisions of
More informationWorkers Compensation Fraud
Workers Compensation Fraud Presentation to the EAIC 11/17/09 Ann Clayton Consultant to ERD Two Methods to Pursue Workers Compensation Fraud Criminal Prosecution this is generally up to the District Attorney
More informationEMPLOYEE FACTS IMPORTANT WORKERS COMPENSATION INFORMATION FOR FLORIDA S WORKERS
EMPLOYEE FACTS IMPORTANT WORKERS COMPENSATION INFORMATION FOR FLORIDA S WORKERS Please visit our website at www.fldfs.com/wc where you will find extensive information such as publications, a number of
More informationInvestigating Workers Compensation Claims and Complying with Wage and Hour Law
Investigating Workers Compensation Claims and Complying with Wage and Hour Law Noel C. Shepard 614-559-7223 nshepard@fbtlaw.com Adam R. Hanley 614-559-7238 ahanley@fbtlaw.com Investigating Workers Compensation
More informationMODULE 11: NEW YORK STATE SENIOR MEDICARE PATROL (SMP) HEALTH CARE FRAUD, WASTE AND ABUSE
MODULE 11: NEW YORK STATE SENIOR MEDICARE PATROL (SMP) HEALTH CARE FRAUD, WASTE AND ABUSE Project Goals Empowering Seniors to Prevent Healthcare Fraud. To raise awareness of and prevent Medicare and Medicaid
More informationINDUSTRIAL COMMISSION OF ARIZONA
INDUSTRIAL COMMISSION OF ARIZONA WORKERS COMPENSATION INFORMATION FOR THE INJURED WORKER Phoenix Office: Industrial Commission of Arizona 800 W. Washington Street Phoenix, Arizona 85007-2922 Claims Phone:
More informationTexas Mutual Insurance Company. The Employer s Guide to Workers Comp
Texas Mutual Insurance Company The Employer s Guide to Workers Comp 2013-2014 Table of Contents n Workers Comp: What Is It, and Why Do You Need it? 1 n Legal protection for you 1 n Medical and income benefits
More informationDriving Down Claim Costs With PREDICTIVE MODELING. December 2011. Sponsored by:
Driving Down Claim Costs With PREDICTIVE MODELING December 2011 Sponsored by: Driving Down Claim Costs With PREDICTIVE MODELING Executive Summary Tools based on predictive modeling are transforming claims
More informationFILING WORKERS COMPENSATION CLAIMS IN IDAHO
Claims contact information First Report of Injury forms ReportClaim@IdahoSIF.org General e-mail ClaimsIM@IdahoSIF.org FILING WORKERS COMPENSATION CLAIMS IN IDAHO Provider inquiries 208-332-2169 or 800-334-2370
More informationQuick Guide to Workers Compensation
Quick Guide to Workers Compensation What Is Workers Compensation Insurance? Workers compensation insurance covers businesses for their statutory and legal obligations for employee expenses that are a direct
More informationMedicare Advantage and Part D Fraud, Waste, and Abuse Training. October 2010
Medicare Advantage and Part D Fraud, Waste, and Abuse Training October 2010 Introduction 2008: United States spent $2.3 trillion on health care. Federal fiscal year 2010: Medicare expected to cover an
More informationPublic Advisory: Special Report on COUNTERFEIT CHECKS AND MONEY ORDERS
Public Advisory: Special Report on COUNTERFEIT CHECKS AND MONEY ORDERS Summary In recent years, law enforcement and regulatory authorities in Canada and the United States have seen a substantial increase
More informationThe Employers Guide to. Pennsylvania s Workers Compensation Law
The Employers Guide to Pennsylvania s Workers Compensation Law Table of Contents About this Guide. 3 The Pennsylvania Workers Compensation Act: An Overview for the Pennsylvania Employer....4 Your Duties
More informationOFFICE OF KANSAS ATTORNEY GENERAL DEREK SCHMIDT
OFFICE OF KANSAS ATTORNEY GENERAL DEREK SCHMIDT Attorney General Derek Schmidt BEING A SMART CONSUMER Jackie Williams, Assistant Attorney General Consumer Protection Division Duties of the Attorney General:
More informationRISK CONTROL. Workers compensation best practices risk management guide. Risk Management Guide
Risk Management Guide RISK CONTROL REDUCE RISK. PREVENT LOSS. SAVE LIVES. Workers compensation costs are escalating rapidly. In fact, statistics reveal that the direct cost of work place injuries in 1999
More informationTestimony on Behalf of the New York County District Attorney s Office Before the New York City Council Transportation Committee
Testimony on Behalf of the New York County District Attorney s Office Before the New York City Council Transportation Committee Daniel R. Alonso Chief Assistant District Attorney New York County January
More informationSmall Business Focus (SBF) Annual Revenues of $2,000,000 or less
Northwest Professional Center 227 US Hwy 206, Suite 302 Flanders, NJ 07836-9174 Tel: (973) 252-5141 / (800) 689-2550 Fax: (973) 252-5146 / (800) 689-2839 www.eriskservices.com email: application@eriskservices.com
More informationWorkers Compensation 101. Jess Baker, Workers Compensation Claims Consultant LMC Insurance & Risk Management 515-453-9369 jess.baker@lmcins.
Jess Baker, Workers Compensation Claims Consultant LMC Insurance & Risk Management 515-453-9369 jess.baker@lmcins.com Objectives Purpose of Workers Compensation Early Intervention Return to Work Programs
More informationFraud, Waste and Abuse Training. Protecting the Health Care Investment. Section Three
Fraud, Waste and Abuse Training Protecting the Health Care Investment Section Three Section 1.2: Purpose According to the National Health Care Anti-Fraud Association, the United States spends more than
More informationCHAPTER 1. Wyoming Workers Compensation. Workers Compensation Programs Benefit Injured Workers and Employers
CHAPTER 1 Wyoming Workers Compensation Workers Compensation Programs Benefit Injured Workers and Employers Injured workers receive medical and lost wage benefits, regardless of fault. Employers receive
More informationDELAWARE COUNTY. Supersedes June 15, 1988, March 22, 1999
DELAWARE COUNTY Subject Self- Program Effective June 28, 2004 Supersedes June 15, 1988, March 22, 1999 This Sheet 1 Total 5 Purpose To provide a written document explaining the Self- Program, preferred
More informationAn Analysis of Workers Compensation Outreach Materials. to combat insurance fraud
An Analysis of Workers Compensation Outreach Materials to combat insurance fraud April 1999 I N T R O D U C T I O N In 1997 the coalition s Workers Compensation Task Force made a series of recommendations
More informationMonetary Authority of Singapore INSURANCE BUSINESS - INSURANCE FRAUD RISK
Monetary Authority of Singapore INSURANCE BUSINESS November 2007 GUIDELINES ON RISK MANAGEMENT PRACTICES FOR INSURANCE BUSINESS MONETARY AUTHORITY OF SINGAPORE TABLE OF CONTENTS 1 INTRODUCTION AND FUNDAMENTALS
More informationHandling Real Property leasing exposures
Reprinted with permission from The John Liner Letter, Volume 44, Number 2; January 2007. Copyright 2007, Standard Publishing Corp., Boston, MA. All rights reserved. www.spcpub.com A MONTHLY BUSINESS INSURANCE
More informationAdmiral Insurance Company
Executive Liability Insurance Proposal Form for Employment Practices Liability CLAIMS MADE WARNING FOR APPLICATION: This Proposal Form is for a Claims Made and Reported Policy, relating to claims made
More informationQuick Guide to Workers Compensation for Small Business
Quick Guide to Workers Compensation for Small Business Do I Need Workers Compensation Coverage? Generally speaking, businesses must obtain workers compensation coverage if they have employees that are
More informationEIGHTEENTH STATEWIDE GRAND JURY Case No. SC 07-1128 SECOND INTERIM REPORT OF THE STATEWIDE GRAND JURY CHECK CASHERS: A CALL FOR ENFORCEMENT
EIGHTEENTH STATEWIDE GRAND JURY Case No. SC 07-1128 SECOND INTERIM REPORT OF THE STATEWIDE GRAND JURY CHECK CASHERS: A CALL FOR ENFORCEMENT March 2008 West Palm Beach, Florida FILED ~ I/~ J D ~ Thomas
More informationBreaking Down Work Comp Premium
3. 4. Missouri Employers Mutual Understand How it Can Add Up to Savings For more information: www.mem-ins.com 1.800.442.0593 These recommendations were developed from national standards and sources believed
More informationB. Prevent, detect, and respond to unacceptable legal risk and its financial implications. C. Route non-compliance issues to appropriate areas.
Policy Ashe Memorial Hospital (AMH) is committed to effective and efficient operations, reliable financial reporting and compliance with all applicable laws and regulations. It is the policy of AMH to
More informationBenefits Guide. Information for the Injured Worker
Benefits Guide Information for the Injured Worker The purpose of this benefits guide is to help you learn what to expect if you ever need workers compensation benefits. Recovering from a work injury can
More informationWORKER S COMPENSATION TREATMENT AUTHORIZATION FORM
FLORIDA TECH EMPLOYEE ACCIDENT/ INJURY REPORT Contact Financial Affairs @ 674-7297 OR 8885 IMMEDIATELY regarding an Employee's Injury. Employee AND Supervisor must complete this report. EMPLOYEE INFORMATION
More informationAN EMPLOYER S GUIDE TO WORKERS COMPENSATION IN NEW JERSEY
AN EMPLOYER S GUIDE TO WORKERS COMPENSATION IN NEW JERSEY I. WHAT IS WORKERS COMPENSATION?... 2 II. WORKERS COMPENSATION BENEFITS... 3 III. INSURANCE REQUIREMENTS... 4 Types of Coverage Definition of Employee
More informationThe Truth About Issue 2
The Truth About Issue 2 What will Issue 2 actually do? The Big Business coalition which supports Issue 2 has the money to air a slick ad campaign. The Big Business Campaign is founded on the belief that
More informationProvided By Touchstone Consulting Group Workers Compensation Employer Penalties
Provided By Touchstone Consulting Group Workers Compensation Employer New Jersey s workers compensation laws determine the benefits available to employees who are injured in the course and scope of employment.
More informationLIQUOR LIABILITY COVERAGE FORM
COMMERCIAL GENERAL LIABILITY CG 00 34 12 07 LIQUOR LIABILITY COVERAGE FORM THIS FORM PROVIDES CLAIMS-MADE COVERAGE. PLEASE READ THE ENTIRE FORM CAREFULLY. Various provisions in this policy restrict coverage.
More informationEXECUTIVE SUMMARY Compliance Program and False Claims Recovery
EXECUTIVE SUMMARY Compliance Program and False Claims Recovery INTRODUCTION: The Federal Deficit Reduction Act of 2005, also known as the DRA, requires that providers give their employees, medical staff,
More informationBenefits fraud: Shrink the risk Gain group plan sustainability
Benefits fraud: Shrink the risk Gain group plan sustainability Life s brighter under the sun Fraud: A real threat to group plan sustainability Fraud in group benefits has always existed, but never has
More informationWORKERS COMPENSATION CLAIM KIT. Workers Compensation That Works...With You and For You.
WORKERS COMPENSATION CLAIM KIT Workers Compensation That Works...With You and For You. CNA ASAP Now, One Phone Call, Fax or E-mail Can Get Results ASAP, 24 Hours a Day, Seven Days a Week Toll Free: 877-CNA-ASAP
More informationWho Administers the Workers Compensation Program and Related Responsibilities?
What is Workers Compensation? Who Administers the Workers Compensation Program and Related Responsibilities? Who is Eligible for Workers Compensation? What Coverage is Provided? What is a Compensable Injury?
More informationThe State of Insurance Fraud Technology. A study of insurer use, strategies and plans for anti-fraud technology
The State of Insurance Fraud Technology A study of insurer use, strategies and plans for anti-fraud technology September 2014 The State of Insurance Fraud Technology A study of insurer use, strategies
More information(404) 919-9756 david@davidbrauns.com www.davidbrauns.com
You are probably reading this guide because you were recently in an automobile accident. Now you are faced with some difficulties. The tasks of managing your care and your insurance claim can be confusing
More informationFraud, Waste and Abuse Prevention and Education Policy
Corporate Compliance Fraud, Waste and Abuse Prevention and Education Policy The Compliance Program at the Cortland Regional Medical Center (CRMC) demonstrates our commitment to uphold all federal and state
More informationHow To Get A Medical Bill Of Health From A Member Of A Health Care Provider
Neighborhood requires compliance with all laws applicable to the organization s business, including insistence on compliance with all applicable federal and state laws dealing with false claims and false
More informationVolunteer Return to Work
Volunteer Return to Work Volunteer Modified Duty Handbook Workers Compensation Fund toll-free: 1.800.446.2667 web: www.wcfgroup.com Although preventing injuries is the best way to control workers compensation
More informationWORKERS COMPENSATION GLOSSARY
WORKERS COMPENSATION GLOSSARY ACCIDENT An unplanned and unexpected event which occurs suddenly and at a definite place resulting in injury and/or damage. ACCIDENT FREQUENCY The rate of the occurrence of
More informationWorkers Compensation Optimal Claims Management
OVERALL OBJECTIVE - ECM seeks to provide a consultative relationship in which we work with our clients to influence and improve their Risk Management Process. Following are a few suggestions regarding
More informationDetecting, Preventing, and Reporting FRAUD
U.S. Department of Housing and Urban Development Office of Inspector General Office of Investigation Detecting, Preventing, and Reporting FRAUD Guidelines for Public Housing Authorities to Take Charge
More informationFree Legal Consumer Guide Series www.southernmarylandlaw.com
Free Legal Consumer Guide Series Brought To You By Meeting All Your Legal Needs For 50 Years 2 What You Need To Know About Workers Compensation HOW TO USE THIS GUIDE If you read this guide, you will discover
More informationGEORGIA STATE BOARD OF WORKERS COMPENSATION ENFORCEMENT DIVISION
GEORGIA STATE BOARD OF WORKERS COMPENSATION ENFORCEMENT DIVISION Doug Williams Criminal Fraud Investigator Enforcement Division State Board of Workers Compensation P.O. Box 217 Leslie, Georgia 31764 (229)
More informationApplication For ACE EXPRESS Non Profit Organization Management Indemnity Package
Application For ACE EXPRESS n Profit Organization Management Indemnity Package NOTICE: THE POLICY FOR WHICH APPLICATION IS MADE, SUBJECT TO ITS TERMS, APPLIES ONLY TO ANY CLAIM MADE AGAINST ANY OF THE
More informationFraud Waste and Abuse Training First Tier, Downstream and Related Entities. ONECare by Care1st Health Plan Arizona, Inc. (HMO) Revised: 10/2009
Fraud Waste and Abuse Training First Tier, Downstream and Related Entities ONECare by Care1st Health Plan Arizona, Inc. (HMO) Revised: 10/2009 Overview Purpose Care1st/ ONECare Compliance Program Definitions
More informationFighting Medicare Fraud More Bang for the Federal Buck
Fighting Medicare Fraud More Bang for the Federal Buck prepared for Taxpayers Against Fraud Education Fund by Jack A. Meyer President Economic and Social Research Institute APRIL 2005 Statement of Purpose
More informationPCI SPECIAL REPORT Oct. 27, 2011
PCI SPECIAL REPORT Oct. 27, 2011 Florida s Automobile No Fault Insurance: A System Under Siege by Fraud and Abuse Executive Summary Over the last several years, pervasive fraud in Florida s no fault auto
More informationIs What You Know About Injury Claims Accurate?
Is What You Know About Injury Claims Accurate? Presented by: Attorney Mark L. Krueger www.kh-law.net IS WHAT YOU KNOW ABOUT INJURY CLAIMS ACCURATE? Misconception No. 1 I have no claim if the responsible
More informationONTARIO TRIAL LAWYERS ASSOCIATION. OTLA s Response to the Anti-Fraud Task Force Status Update
ONTARIO TRIAL LAWYERS ASSOCIATION OTLA s Response to the Anti-Fraud Task Force Status Update 8/17/2012 The Ontario Trial Lawyers Association (OTLA) welcomes the opportunity to provide comment on the Ontario
More informationWhat is & what is not covered under workers compensation? Basically, what are the benefits... in plain language?
SEQUATCHIE VALLEY PLANNING & DEVELOPMENT AGENCY Employee Workers Compensation Handbook wchandbk.wpd Preface. Workers Compensation is a state-defined optional benefit that may be provided by Tennessee s
More informationINJURED AT WORK? WHAT DO I DO? Helpful tips for workers injured on the job. Toll Free: 1-800-603-4723 Direct: (816) 453-7764 Fax: (816) 455-6011
INJURED AT WORK? WHAT DO I DO? Helpful tips for workers injured on the job. Josh Perkins, Attorney at Law Spooner & Spooner, P.C. Toll Free: 1-800-603-4723 Direct: (816) 453-7764 Fax: (816) 455-6011 Email:
More informationI ve been hurt at work. What do I do / to whom must I give notice of my accident and by what date?
WORKER: I ve been hurt at work. What do I do / to whom must I give notice of my accident and by what date? In general, you must give your employer or your supervisor written notice within 15 days after
More informationUncovering More Insurance Fraud with Predictive Analytics Strategies for Improving Results and Reducing Losses
white paper Uncovering More Insurance Fraud with Predictive Analytics Strategies for Improving Results and Reducing Losses April 2012 Summary Predictive analytics are a powerful tool for detecting more
More informationInformation for Worker s Compensation Clients
Information for Worker s Compensation Clients Overview of the Worker s Compensation Act Indiana Worker s Compensation cases are governed by a State law known as the Worker s Compensation Act. The legislature
More informationRecognize it. Report it. Protect yourself.
Recognize it. Report it. Protect yourself. from YOUR A MESSAGE FROM YOUR INSURANCE COMMISSIONER Greetings, Insurance fraud in North Carolina is big business; in fact, sadly, it is a growing enterprise
More informationGlossary of Vehicle Insurance Fraud Terms
Glossary of Vehicle Insurance Fraud Terms Agent:A person or business that is empowered to act on behalf of others. Anti-Fraud Bureaus: Government operated agencies dedicated to detecting, investigating
More informationWorkers' Compensation in Oklahoma Employer s Rights & Responsibilities
Workers' Compensation in Oklahoma Employer s Rights & Responsibilities Workers Compensation Court Counselor Program 1915 N. Stiles Avenue, Oklahoma City, OK 73105 210 Kerr State Office Bldg, 440 S. Houston,
More informationWorkers' Compensation in Oklahoma Employer s Rights & Responsibilities
Workers' Compensation in Oklahoma Employer s Rights & Responsibilities The information provided in this pamphlet is general in nature and for informational purposes only. It is not intended to be a legal
More information2. Employees will receive regular pay for the hours scheduled on the day of injury.
SECTION 10.5 WORKERS COMPENSATION POLICY A. Statement of Purpose Jefferson County provides Workers' Compensation benefits for injuries or illnesses sustained in the course and scope of employment in accordance
More informationTexas State Board of Podiatric Medical Examiners HEALTHCARE FRAUD. 378.1(a) - CME 7/9/2013. 50 hrs of CME every 2 years
Donald R. Blum, DPM, JD TPMA ANNUAL MEETING Marble Falls June 28-30. 2013 Ethics in the Delivery of Health Care Services Topics on Healthcare Fraud Rules and Regulations pertaining to Podiatric Medicine
More informationInternet Insurance Fraud Rings
Page 1 of 5 Date: Regarding: Internet Insurance Fraud Rings - Florida 2010 For Dissemination to Member Company SIUs and Law Enforcement Prepared By: Kathy Novak, Field Information Analyst Internet Insurance
More informationINTRODUCTION GENERAL INFORMATION
Workers Compensation Benefits Summary For dates of injury occurring on or after July 1, 2013 through June 30, 2014 Employment Relations Division Department of Labor and Industry PO Box 8011 Helena, MT
More informationDriving Michigan: An Agenda To Reform Michigan s No-Fault system
Insurance Institute of Michigan Driving Michigan: An Agenda To Reform Michigan s No-Fault system No one has to lose anything if consumers are given more insurance coverage options. It s not a partisan
More informationWorkers' Compensation in Oklahoma Employee s Rights & Responsibilities
Workers' Compensation in Oklahoma Employee s Rights & Responsibilities Workers Compensation Court Counselor Program 1915 N. Stiles Avenue, Oklahoma City, OK 73105 210 Kerr State Office Bldg., 440 S. Houston,
More informationWorkers' Compensation in Oklahoma Employee s Rights & Responsibilities
Workers' Compensation in Oklahoma Employee s Rights & Responsibilities The information provided in this pamphlet is general in nature and for informational purposes only. It is not intended to be a legal
More informationOffice of Inspector General
Audit Report Office of Inspector General Workers Compensation Program July 2006 Office of Inspector General Montgomery County, Maryland This report is available to the public in printed or electronic format.
More informationUtah Labor Commission Industrial Accidents Division. Employers Guide to. Workers Compensation
2015 2016 Utah Labor Commission Industrial Accidents Division E m p l o y e r s G u i d e Employers Guide to Workers Compensation Utah Labor Commission Industrial Accidents Division Employers Guide to
More informationTestimony Submitted by Paul Trause, Washington State Employment Security Commissioner
Testimony Submitted to the U.S. Senate Committee on Finance Preserving Integrity, Preventing Overpayments and Eliminating Fraud in the Unemployment Insurance System Testimony Submitted by Paul Trause,
More informationFighting Insurance Fraud In Illinois: Insurers, Regulators and Consumers
Fighting Insurance Fraud In Illinois: Insurers, Regulators and Consumers Han B. Kang, Ph.D. Professor of Finance and Insurance 5480 Department of Finance, Insurance and Law Illinois State University Normal,
More informationThe New Reality of Synthetic ID Fraud How to Battle the Leading Identity Fraud Tactic in The Digital Age
How to Battle the Leading Identity Fraud Tactic in The Digital Age In the 15 years since synthetic identity fraud emerged as a significant threat, it has become the predominant tactic for fraudsters. The
More information