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Workers Comp and Structured Settlements

Posted by David Ross on Mon, Mar 21, 2016

Benefits of structured settlements in Workers Compensation Insurance claims. Serving Philadelphia, Reading, Allentown, Harrisburg, Lehigh Valley, Lancaster, PA and beyond.Employees who are injured on the job may be entitled to compensation for medical care and wage replacement through their employer’s Workers Compensation insurance. The insurance provides medical care, lost wages, and any rehabilitation needed to return to work. Sometimes an employee is permanently and totally disabled or disabled to the point that the employee cannot return to meaningful employment. These cases are usually complex and can be difficult to settle. If a lump-sum cash settlement does not resolve a case, a structured settlement may offer a solution.

What is a Workers Compensation Structured Settlement?

A structured settlement is a financial or insurance arrangement whereby a claimant agrees to resolve a personal injury claim by receiving periodic payments on an agreed schedule rather than as a lump sum. Structured settlements are often used to resolve workers’ compensation insurance cases in which the negotiations between the plaintiff’s attorney and the insurance company have reached an impasse. The responsibility of future payments to the plaintiff falls on an independent third party—usually a life insurance company from which an annuity has been purchased by the workers’ compensation insurer.

Congress has encouraged the use of these settlements through the federal tax code since 1983. Internal Revenue Code section 104 specifies the amount of each payment, and the earnings on payments are excluded from the settlement recipient’s income.

Not all payout schedules from a structured settlement are alike. There are three main forms of periodic payments from a structured settlement:

  • Deferred Lump-sum Payments: Payments are structured under a schedule of pre-determined dates. These payments are usually larger than regular periodic payments.
  • Flexible Settlement Plan: Payments in this plan consider the needs of the injured worker—important future events at different stages of life—while maintaining control of the costs for the employer and insurer.
  • Period Certain Annuity: The injured employee gets a larger settlement by agreeing to shorten the time period that the annuity will pay.

An initial lump-sum payment can be included in the settlement to cover such items as housing and transportation, and the settlement can also be structured to increase periodic payments at fixed dates in the future to account for inflation.

Advantages of Structured Workers Comp Insurance Settlements

Structured settlements are helpful for the injured worker in compensation cases. They can be set up to provide tax-free money for long-term and immediate needs, while eliminating the worry of managing a large amount of money. In most cases, a structured settlement will provide more money over the long term than the employee would realize from a cash settlement. The plan can be structured around age and life expectancy, thereby providing funds for maintaining medical treatment, future surgeries, and replacement of durable medical equipment.

The closure of the claim, expedited through a structured settlement, is a major benefit to the employer. It also avoids the uncertainty of litigation and all of the expenses that go with it. In the case of a disability that lasts a lifetime, all of the mortality and investment risk is transferred to the third-party insurer.

Insurers benefit because they free up money that would have been used for a lump-sum settlement and can now concentrate on other cases.

The employee’s lawyer has a satisfied client for whom he has provided financial stability.

A word of caution

A structured workers comp settlement is a flexible tool for resolving troublesome claims. Keep in mind, however, that each state has different laws with regard to settling workers’ compensation claims. Be sure to partner with a professional who can confirm the laws of your state.

Learn More About Workers Compensation Insurance

For more information and advice on workers compensation insurance, contact us online or give us a call at (800) 947-1270 or (610) 775-3848.

Tags: Workers Compensation Insurance, workers comp, workers comp insurance, PA Workers Compensation Insurance, workers comp costs, Commercial Insurance, Business Insurance

Cold Stress, Worker Safety & Workers Comp Insurance

Posted by David Ross on Tue, Feb 02, 2016

Avoidinging Workers Compensation Insurance Claims via Risk Awareness

Cold weather can increase risk of injuries and workers compensation insurance claims. Here are steps to take to reduce risk. Serving Philadelphia, Lancaster, Harrisburg, Reading, Allentown, Lehigh Valley, PA and beyond.For construction workers and others whose jobs require them to be outside, winter means a few months of extreme cold and challenging days, during which they will be susceptible to cold-related injuries.

In addition to injuries resulting from slips and falls as temperatures dip below freezing, there is also the risk of cold stress. Cold Stress is the result of skin temperature being lowered, ultimately resulting in a reduced core body temperature.

The human body’s natural reaction when exposed to cold environments is to maintain its core temperature. To do so, blood shifts away from less critical body parts--hands, feet, arms, legs and skin--to concentrate in the vital chest and abdomen areas. As a result of the blood shift, the body parts containing less blood face an increased risk of cold-related injuries. Under severe conditions, tissue damage and death may occur.

Cold stress and the risk of cold-related injury can be reduced by increasing management and worker awareness of the hazards. In order to ensure a safe working environment, mitigate risk and prevent workers' compensation insurance claims, it is important to understand the elements of cold stress. 

Types of cold stress facts you need to know

  • Hypothermia involves a severe loss of body heat, resulting in shivering, confusion, and loss of motor skills to an extent where workers cannot replenish their warmth.

  • Frostbite is the freezing of an area of the body, typically the nose, ears, cheeks, fingers or toes. Severe cases of frostbite may lead to amputation. Symptoms include numbness, hard skin, tingling or blisters.

  • Trench foot occurs when a worker's feet remain damp for a prolonged period of time. Although not directly tied to extreme cold (wet feet can contribute to the condition in warmer temperatures), it is a threat in winter with symptoms of red skin, numbness swelling, or bleeding.

Workers can help prevent cold stress

Workers will be able to monitor their own health and identify problems with colleagues if they understand the symptoms of cold stress. Following some simple guidelines will also help them to prevent cold stress injuries:

  • Dress in several loose-fitting layers and don’t forget boots, gloves, and a warm cap
  • Have at least one layer of waterproof clothing to protect at least some of their other clothing from getting wet
  • Take breaks to get warm. If possible, go indoors for a few minutes or at least get out of the elements
  • Stay hydrated. This is every bit as important in winter as it is in hot weather
  • Keep spare clothing nearby in case the clothing they’re wearing gets wet

What can employers do about cold stress?

A cooperative approach with employees is important. A cold stress prevention program, outlining steps to limit cold stress and reduce risk of injuries and illnesses, is a good start.

Another step you can take is a review of your scheduling. If at all possible, plan outdoor work, equipment repairs and other tasks when the weather is more favorable. While it is not always possible to prevent workers from operating outside at all times, especially in the construction industry with its deadline pressures, you can limit the length they have to spend in the coldest temperatures. 

Next, you must train your team. Review the symptoms of cold stress in a group meeting. Emphasize the safety measures that workers must take, and discuss the best emergency response methods and who to notify should an employee begin to show signs of cold stress.

Finally, you need to provide resources for your workers. These can include insulated clothing, a heated shelter, warm beverages or educational materials. Above all else, call attention to cold-weather safety this winter. These measures will help to keep your workers on the job and your workers compensation insurance costs low.

Control Your Workers Compensation Insurance Cost

Contact us to reduce PA workers comp insurance costs.Click here to contact us for more information about reducing the cost of workers compensation insurance, or give give us a call at (800) 947-1270 or (610) 775-3848.

Tags: Workers Compensation Insurance, workers comp, workers comp insurance, PA Workers Compensation Insurance, workers comp costs

Combat Data Breaches with Cyber Liability Insurance

Posted by David Ross on Wed, Jan 27, 2016

Affordable cyber insurance for Philadelphia, Allentown, Reading, Lancaster, Harrisburg, York, PA and beyond.Today’s businesses cannot operate without the aid of technology. Most companies do a significant portion of their business interactions online, and they are storing more sensitive information on their computers than ever before.

Even though technology has had a tremendously positive impact, it also comes with the inherent risk of data breaches.

As technology advances, these threats have become more difficult to resolve. Hence, the growing need for cyber liability insurance, also known as cyber insurance.

Data Breaches Affect Smaller Companies, Too

Data breaches at larger corporations-- Target and Neiman Marcus, for example—should not overshadow the more frequent security infringements that target smaller businesses. Many small business owners may not think they need cyber liability insurance; however, since half of all data breaches happen to small businesses, they are actually very vulnerable to security threats.

This should convince every enterprise, regardless of size, that cyber security and cyber insurance are worth considering. Whether it’s the theft of intellectual property or user data, a cyber breach can have unfavorable effects on your reputation, customer confidence and brand name.

The High Cost of Data Breaches

When criminals get access to your company’s databases, they become privy to a collection of information--Social Security and credit card numbers, addresses and other identifying data. Once they gain access to sensitive business data, they can use it to open and access accounts, steal money and destroy the affected individuals’ credit. And, of-course, a data breach can also cost the company that was breached thousands of dollars.

Some of these costs include:

  • Lost profits and opportunities: When your company closes its doors while the data breach is investigated, sales and profits stop. And negative publicity and diminished customer confidence can decrease your sales significantly

  • Updating or implementing your security system: New software, infrastructure and training in procedures and policies for your personnel can cost a great deal.

  • Concessions to customers: Many businesses affected by data breaches offer free credit monitoring services, discounts, and promotions to help regain customers’ trust and loyalty.

  • Bankruptcies and business closures: Stolen resources and the expense of responding to the breach can drain the limited resources of many small businesses.

Take Steps to Protect Your Business from Breaches

The best way to protect data is through a comprehensive cyber security policy. This will include keeping sensitive data on a "need to know" basis, employing network security and firewalls, and training employees on the proper care and control of customer data.

Employees need to understand the sensitivity and liability related to customers' financial and personally identifiable information. It is critical that you document your processes and conduct regular training sessions, as well as security audits, to ensure compliance.

Business owners should be aware that standard commercial insurance policies don’t offer the special protections afforded by cyber insurance, and in some cases, specifically exclude cyber threat coverage. Cyber insurance policies generally safeguard against viruses and hacking, and intervene if a breach does occur.

The Benefits of Cyber Insurance

If you run a small business, you may not have time to adequately manage your web security. Cyber threat policies can provide periodic reviews and assistance. Other benefits include:

  • Reimbursement for Fees and Penalties. Insurance benefits could reimburse you for additional staff you hire to recover from a cyber-attack, paperwork or filing fees, or other related costs.

  • Business Interruption Protection. The smaller your business, the more income you lose if you’re temporarily sidelined. Cyber insurance can offset losses.

  • Legal Help. If a data breach results in legal action, your plan could help find expert counsel, as well as cover legal fees and judgments against you

Regardless of a company’s size or industry, business owners must take preemptive action to secure their customers’ valuable data against the possibility of a cyber-attack. In addition, investing in cyber liability insurance protects your assets should such an event occur.

Learn More About Your Cyber Insurance Options

To learn more about cyber liability insurance options and cost, and to find the cyber insurance policy that's right for your business, click here to contact us, or call us at (800) 947-1270 or (610) 775-3848.

Denied Life Insurance? Take These 3 Steps!

Posted by David Ross on Thu, Jan 21, 2016

Being denied life insurance can be scary...

3 steps to take when your life insurance application has been denied. Serving Reading, Philadelphia, Lancaster, Lebanon, Harrisburg, Allentown, Lehigh Valley, PA and beyond with cost effective, high quality life insurace.Life insurance offers the peace of mind of knowing your family will have a financial safety net if you’re no longer there to provide one. While most people think obtaining coverage is as simple as filling out a few forms, that’s not always the case.

What should you do after you try to buy life insurance coverage but end up being denied? It can be a scary situation. You ask yourself why this happened and where you go from here. 

First of all, don’t get too upset. You’re not out of options. Begin by trying to find out why you weren’t approved. Next, take some steps toward a better outcome.

Reasons you may have been denied life insurance coverage

  • You have a specific health condition: If you have elevated cholesterol or glucose levels, or previously had a heart attack or cancer, you may be denied coverage.

  • You participate in high-risk activities: Sky diving, mountain climbing, and flying as a recreational pilot are considered risky hobbies that could get you turned down.

  • You’ve been caught driving under the influence: Most companies won’t insure you if you’ve had multiple DUI’s. If it’s only been once, you might be able to shop around and get insurance coverage.

  • You are overweight or obese: The red flag pops up for these conditions because they often lead to severe health complications, particularly cardiovascular issues.

  • You use drugs: Life insurance companies will want to know about any kind of drug use--both legal and illegal. Illegal drug use is an obvious reason for denial. But the regular use of legal medications may point to an underlying medical condition and could hurt your case as well.

This is not an exhaustive list, but it can give you an idea of some of the factors that are considered after a life insurer receives your application.

What to do if you’ve been denied life insurance coverage

  1. Learn why you were denied.  Before an insurance company denies an application, they collect lots of data from several sources to evaluate your risk. If the risk is high, you will be rated, postponed or denied. In any of these circumstances, you are encouraged to ask the life insurance company for the specific reason of denial for your application. A denial stemming from a current exam tends to be the most disturbing, since you may not have known about an illness or disease beforehand. But stay positive and be thankful that the issue was discovered, so that you can take steps to resolve it.

  2. Confirm the results. You signed an authorization for the underwriter to pull your medical records. If poor exam results were cited as the cause of denial, order these records and check with your doctor to verify their accuracy. Sometimes, mistakes are present in the medical records and need to be fixed. In other cases, you could be denied for recreational hazards, criminal records and even financial issues. If these records haven’t been updated or are lacking in detail, they can lead to postponement or denials because the underwriter simply can’t properly assess your risk profile. Make sure all of your records are accurate and notify the insurer if any discrepancies are discovered.

  3. Work with an independent life insurance agent. After you uncover the reason and fix the errors, you should work with an agent to find coverage. Every insurance company has its own criteria for assessing the risk of its applicants, and independent agents know which companies are more likely to approve you based on your health and your lifestyle.

Contact Our Independent Life Insurance Agents for Help

Trusted Choice Independent Life Insurance Agents near Reading PA, serving Philadelphia, Reading, Lancaster, Harrisburg, York, Allentown, Lehigh Valley, PA and beyond with qualiity life insurance.Knowledge is power, so find out why you were denied. Then, straighten out all of your records and work with an experienced independent life insurance agent to obtain the coverage you need.

Contact one of AIG’s experienced agents here or call us at at (800)  947-1270 or (610) 775-3848.

Tags: Life Insurance Berks Pa, Life Insurance Philadelphia Pa, Life Insurance Lancaster Pa, Life Insurance Reading PA, Life Insurance Allentown Pa, Life Insurance Harrisburg Pa, Life Insurance

Medicaid Recovery in Workers Comp Settlements

Posted by David Ross on Sat, Jan 16, 2016

Workers Compensation Insurance as a Third Party for Medicaid

Workers Compensation Insurance Claims and Medicaid: here's what you should know. We serve Phildelphia, Lancaster, Reading, Harrisburg, Allentown, Lehigh Valley, Erie, Pittsburgh, PA and beyond.Medicaid is an entitlement program, jointly funded at the state and federal levels, which provides healthcare--both medical and long-term custodial care--to the poorest population of the United States.  Not to be confused with Medicare, the federally funded program available to most U.S. citizens and permanent legal residents who are age 65 or older, eligibility for Medicaid is means-based, and the program has strict income eligibility requirements that vary from state to state.

However, Medicare and Medicaid are not mutually exclusive--it is possible to be on both of those programs at the same time.

It is not unusual for Medicaid recipients to have additional sources of coverage for health care services. Since federal law dictates that Medicaid is the “payer of last resort,” this means that if another insurer or program (a third party) has the legal responsibility for costs involving a Medicaid-eligible individual, that “third party” is normally required to pay all or part of the cost of the claim before Medicaid makes any payments. Workers compensation insurance is one such third party insurer.

The Expansion of Medicaid

In the past, it had been uncommon for workers’ compensation claimants to also be entitled to Medicaid. If you were employed, chances were that you had too much income to qualify. That changed with the Affordable Care Act of 2010. Obamacare, as it is often called, expanded Medicaid coverage and allowed more workers to qualify for the program. Today, all U.S. citizens and legal residents, including adults without dependent children and with income up to 133% of the published poverty threshold, qualify for coverage. 

Workers’ Compensation Insurance and Medicaid Recovery

When Medicaid has paid the costs of an employee's medical treatment that was due to an employment-related injury, the workers' compensation carrier may find itself in the position of reimbursing Medicaid. Even if the carrier is unaware of the employee's entitlement to Medicaid benefits, it may still be liable for payment of past or future medical bills.

In December of 2013, Congress passed The Bipartisan Budget Act of 2013 (“Budget Act”). The Budget Act included a Medicaid Secondary Payer provision, which gave state agencies the ability to recover costs from a beneficiary’s entire settlement, rather than only those settlement proceeds designated as compensation for medical expenses. The Medicaid Secondary Payer provision was initially set to be effective on October 1, 2014. However, on March 31, 2014, Congress passed a bill that delayed the effective date until October 1, 2016, giving Congress and the states two extra years to evaluate the impact of the Secondary Payer provision.

Consequently, it becomes particularly important for a workers comp insurance carrier to evaluate a number of considerations during the settlement stage of a claim. It is also important that claim management teams become proactive when dealing with Medicaid recovery issues:

  • Stay updated on any changes in Medicaid Secondary Payer recovery
  • Identify claims from those who are receiving Medicaid benefits at the time of the insurance claim or who could become beneficiaries in the future
  • Keep all parties that are involved in your settlements informed of Medicaid recovery efforts
  • Put all appropriate state agencies on notice of their intervention and recovery rights

There is considerable effort being made to protect Medicaid's interests--especially in cases where Medicaid has absorbed the costs of medical treatment for which another party is deemed responsible. And some states are already beginning to flex their enforcement and recovery muscles in anticipation of Medicaid Secondary Payer becoming effective in October of 2016.

Help With All Your Workers Compensation Insurance Needs

If you have questions about this constantly evolving issue or workers’ compensation insurance in general, or if you would like to consider changes to your worker's comp insurance coverage, then contact us at (800) 947-1270 or (610) 775-3848.

Tags: Workers Compensation Insurance, workers comp, PA Workers Compensation Insurance, workers comp costs

Workers Comp Insurance Claims: Documentation is Key

Posted by David Ross on Sat, Nov 21, 2015

Documenation is critical to lowering Workers Compensation Insurance Costs in Philadelphia, Reading, Lancaster, York, Allentown, Lehigh Valley, Harrisburg, Pittsburgh, Erie, PA and beyond.When one of your employees is injured on the job, it sets off a sequence of procedures that must be adhered to in order to protect your business. If a claim is filed--whether compensable or contested—it is imperative that you have the necessary documents on file. Documentation for workers compensation insurance becomes particularly crucial with contested claims, as these documents become the lynchpin for a solid defense.

Start Documenting Workers Comp Claims Immediately

Documentation begins as soon as the compensation claim is received. An early intervention process allows for a claims expert to properly document pertinent information associated with the accident while the critical details are still fresh in the minds of the injured employee and anyone else involved.

Early workers comp insurance documentation has another advantage: often, the employee is still working, which allows unrestricted access to the worker before representation. This can lead to evidence that would be harder to uncover once a lawyer is involved. 

Other reasons for early documentation include:

  • The injured worker and witnesses might change their stories if given the time
  • Physical evidence can change or disappear
  • Opportunities for research may be lost
  • Proof of fraud or malingering may be missed
  • Independent medical opinions may be jeopardized
  • Symptoms are often exaggerated after a lawyer enters the picture

In addition, late documentation can damage an employer’s credibility and will sometimes lead to additional claims including harassment and discrimination.

Be Thorough in Collecting Evidence for Workers Comp Insurance Claims

It is worth noting that documentation of non-industrial injuries, tardiness, warnings, write-ups, and other personnel actions help to show the injured employee in a different light prior to litigation. Employers should be vigilant about maintaining proper WC documentation in the employee’s personnel file. This can be helpful in constructing an accurate portrayal of the worker before and after the injury.

Other workers comp documents that must be on file include…

  • A comprehensive statement of the facts of the accident
  • Witness statements, taken as early as possible
  • Medical evidence obtained prior to litigation identifying the injury and body part
  • Past medical records that are pertinent to the claim
  • Independent medical examinations
  • Personal and physical background information on the claimant
  • Past claim records
  • Photos and videos of the accident site
  • Information procured from private investigators
  • Copies of training programs and the employee’s participation in them
  • Reports from professional experts and technical advisers
  • A record of all telephone discussions with anyone connected with the claim
  • A log of all employees’ functions from an up-to-date job description of all positions, especially modified duties

Medical Evidence is Key to a Workers Compensation Insuance Claim

While not every insurance claim will require this level of documentation, claim technicians will need many or all of these documents in some difficult cases. Many factors can affect the outcome of these cases. Experts seem to agree, however, that nothing is more important than medical evidence, procured prior to litigation, which identifies the injury or body part with a fair description of symptoms. Witness statements are also important, but witnesses have unreliable memories and are prone to leading questions. These factors lead back to the importance of early documentation.

Documenting a worker’s compensation claim is complex and time-consuming. But it is worth the hard work if it becomes necessary to defend a claim. Courts appreciate when complete and well organized paperwork is presented at a hearing.

Obtaining the Right Workers Compensation Insurance

Contact us for help in obtaining the best workers comp insurance in Philadelphia, Lancaster, York, Harrisburg, Allentown, Lehigh Valley, Pittsburgh, Erie, PA and beyond.Click here to contact us or give us a call at (800) 947-1270 or (610) 775-3848 to learn more about worker’s compensation and all of your insurance options. We'll help you choose the right policy and ensure you get a great deal because as indepenent agents we're free to shop among many competing workers comp insurance providers. Call or click today to get started.

Tags: Workers Compensation Insurance, workers comp, workers comp insurance, PA Workers Compensation Insurance, workers comp costs

Do You Need Utility Service Interruption Insurance?

Posted by David Ross on Tue, Nov 17, 2015

Here's how to determine if your business needs Utility Service Interruption Insurance. We provide insurance protection to Phildelphia, Allentown, Lehigh Valley, Pittsburgh, Erie, Harrisburg, Lancaster, York, Lebanon, PA and beyond.The storm was ferocious. Luckily, your buildings were spared damage from the high winds and heavy rains; however, a few miles away the storm brought down power lines that supply your business with electricity. While there is no physical damage to your property, you’re still out of business without power. Does your business insurance cover this? Do you have utility service interruption insurance?

Commercial Property Policies Exclude Utility Service Outages

You have a standard loss of business income insurance policy, and you may think that you are protected in the event of an outage. Unfortunately, most policies do not cover utility interruptions that originate away from your premises. While utility service exclusions may vary from one policy to another, they usually include the following:

  • Power supply services--electricity, gas and steam
  • Water supply services
  • Communications supply services--telephone, radio, microwave or television

Losing these services for an extended period can be financially devastating. To protect your business from any of these utility outages, you will need to purchase an endorsement that extends your insurance coverage to include utility services interruptions.

Utility Service Interruption Insurance Closes the Gaps

Storms are not the only threat to your business. A vehicle can snap off a utility pole, a fire can start several blocks away, or a tornado can touch down unexpectedly. None of these has caused damage to your facility, yet your business is on hold because one or more utilities that are vital to your operation have been interrupted.

Utility service interruption coverage is an endorsement that covers your losses due to lack of incoming electricity--or similar utility services--caused by damage to property away from your premises. (For instance, the utility generating station may have been damaged or transmission lines could be down.)

These endorsements vary widely as to what utility services are included and whether both Direct Damage and Time Element losses are covered. The following details explain these coverages:

Direct Damage Coverage

  • If a power surge occurs during power restoration, this coverage pays to repair or replace any items that have been damaged by the surge
  • You must have Personal Property insurance to purchase Direct Damage coverage. It is an extension of your Personal Property coverage
  • The deductible that applies to your Personal Property coverage will also apply to Direct Damage

Time Element Coverage

  • Time Element coverage extends standard business interruption coverage to include utility services interruptions
  • Time Element pays your profit plus continuing expenses, up to the limit you have chosen or until the utility comes back into service, whichever comes first
  • You must have Loss of Business Income coverage to buy the Time Element extension
  • The utility must be out due to a covered cause of loss 
  • If you have a deductible or waiting period on Loss of Business Income, it will be the same on your Time Element endorsement

Consider the Exposures to Your Business

The first step is to evaluate the exposures facing your company. Will the loss of power for hours or days adversely impact your operations and profits? If you determine that it will, your next step is to determine how your current insurance program would apply. This involves reviewing the policy language, evaluating the coverage and taking the appropriate action to change the policies or add endorsements.

A word of caution: many power outages are caused by downed transmission and distribution lines. These endorsements do not automatically extend coverage for loss caused by or resulting from the damaged lines. This coverage is available, but it must be specifically requested and added by endorsement.

We Can Help You Get the Right Utility Services Interruption Insurance Policy

Contact us to help in selecting a Utility Services Interruption Insurance Policy.The experienced agents at American Insuring Group can help you determine if Utility Services Interruption Insurance is a good idea for your business.

Click here to contact us or give us a call at (800) 947-1270 or (610) 775-3848. Our independent agents will compare insurance policies among many competing providers to find you the right insurance at the right price. Call or click today!

Tags: Commercial Insurance Allentown PA, Commercial Insurance Lancaster PA, Commercial Insurance Harrisburg PA, Commercial Insurance, Commercial Insurance Reading PA, Business Insurance, Commercial Insurance Philadelphia PA, Utility Service Interruption Insurance

Workers Compensation Insurance Fraud: What’s the BigDeal?

Posted by David Ross on Tue, Nov 10, 2015

Guard your business against costly Workers Compensation Insurance Fraud. We serve Philadelphia, Pittsburgh, Erie, Reading, Lancaster, Allentown, Lehigh Valley, Harrisburg, PA and beyond.Workers' compensation insurance allows employees who are injured on the job to receive payments for medical expenses, lost wages, and other expenses as they heal. It is usually paid by an insurance policy that has been taken out by the employer. Workers' compensation is required by law in most states, and receiving payment for workplace injuries may be an employee’s legal right.

But not everyone plays fair. Dishonest employees, employers, and health care providers are using fraudulent tactics to take money they do not deserve.

Fake Workers Comp Injury Claims by Employees

Most employees are honest, but the lure of free money, combined with the opportunity to bring in even more money at a second job, can be tempting. While only a small number of employees scam this coverage for personal profit, the damage can be substantial. Here are some of the ways dishonest employees can cheat the system:

  • Embellished injuries: A worker insists that a minor injury received on the job is much more serious and requires a longer time away from work.
  • Hurt off the job: Workers get injured elsewhere, but claim that they were hurt at work.
  • Faking an injury: Some workers simply invent injuries. Injuries such as muscle problems with the back and neck are hard to disprove and easier to get away with.
  • Previous injury: A worker with an old injury that never quite healed will claim he just got hurt on the job.
  • Malingering: Workers pretend they're still disabled, even though they've healed enough to return to work.

Workers Comp Premium Scams by Employers

Fake injury claims far outnumber premium scams, but most workers comp insurance premium scams are much larger. A worker's bogus injury claim normally costs $2,000-$50,000 total. Employers can illegally reduce the workers comp insurance premiums they owe, costing hundreds of thousands of dollars in unpaid premiums in one year. Some scams can last for several years, resulting in millions lost. These cons can be complex and are hard to discover. Here’s how they work:

  • Hiding employees: The company reports fewer employees or a lower payroll than it actually has. The owner might also falsely claim that some of the workers are independent contractors and don't count toward workers’ comp premiums.
  • Misclassifying employees: The dishonest employer tells the workers’ comp insurer that many employees work at safer jobs than they really do.
  • Avoiding coverage: The business doesn't buy state-required workers’ comp insurance, leaving workers dangerously exposed if they're injured.

Health Care and Lawyer Scams

Sometimes medical clinics and lawyers will team up to cheat workers’ compensation insurance. These are often well-organized and can steal millions of dollars a year. Here are some of the most common scams:

  • Inflated injuries: Clinics may overstate the seriousness of injuries to workers, and bill insurers for costly and worthless treatments or tests.
  • Phantom injuries: Clinics may bill insurance for treatment of injuries that never happened.
  • Bogus lawsuits: Disreputable lawyers working with crooked clinics encourage uninjured workers to seek useless treatment. The lawyers then may threaten to sue unless the insurance company settles the phony claim quickly.
  • Kickbacks: Dishonest clinics and lawyers hire recruiters to bring workers into the scams. The recruiters receive illegal kickbacks for referring patients to the lawyers or clinics.
  • Bogus clinics: Some clinics are fakes. There are no licensed doctors or useful medical equipment. The clinic is merely a staging ground for bogus workers’ comp claims.

Workers’ Comp Insurance Fraud IS a Big Deal!

Workers’ comp fraud is a large crime in America. Tens of billions of dollars in false claims and unpaid premiums are stolen every year. That makes it a very big deal! Insurers pass on higher premiums to businesses, while consumers pay higher prices for goods and services from businesses. Workers may have their pay reduced or their jobs eliminated, while those who remain employed may be at risk in businesses that illegally avoid buying insurance.

Call Us to Get the Right Workers Comp Insurance Policy for Your Business

Call us for help in avoiding workers comp fraud in in obtaining the best workers compensation insurance protection for your business.No businee is exempt from this problem.

Click here to contact us or give us a call at (800) 947-1270 or (610)775-3848 to get the right workers’ compensation insurance for your business.

Tags: Workers Compensation Insurance, workers comp, workers comp insurance, PA Workers Compensation Insurance, workers comp costs

CAUTION: Drones and Homeowners Insurance

Posted by David Ross on Tue, Nov 03, 2015

Your house insurance may not protect you against drone mishaps and  privacy issues. Contact us for more information. Serving Philadelphia, Pittsburgh, Erie, Harrisburg, Allentown, Lancaster, Reading, PA and beyond with drone insurance protection.Look! Up at the sky! It’s a bird! It’s a plane! No, it’s a drone! And it’s coming to a neighborhood near you. The Consumer Electronics Association estimates that consumer drone purchases this year will put 300,000 more recreational drones in the skies. And while many consumers are now eyeing these unmanned, remote-controlled aerial toys as one of their next purchases, they don’t necessarily want their neighbors to buy one. Furthermore, few consider whether their homeowners insurance will cover them for drone-related accidents.

Drone safety and privacy issues

With the possibility that a drone could crash-land into a car or injure a child or pet, there’s little wonder that a recent survey by a property-casualty insurer revealed a good deal of concern about hobby drones:

  • Three quarters of respondents were concerned that an unmanned drone could crash into their house.
  • Half believed that a drone was likely to injure someone
  • Half thought the aircraft might be able to hack into a wireless network
  • A full sixty percent feared that drones would take unauthorized photos of family members
  • And a third of them believed that drones could somehow steal their possessions

Check your homeowners insurance policy to be sure you’re protected

While the Federal Aviation Administration worries about the threat that personal drones pose to private and commercial aircraft, the insurance industry is concerned about their potential effect on home insurance. As more drones are sent skyward, there will be a commensurate increase in claims against their owners for accidents that cause personal injury and property damage. Many insurers worry that they will see a significant increase in recreational operators seeking coverage under existing homeowners' insurance policies. But will the drone operators’ homeowners’ insurance cover damages?

The quick answer: probably. While the standard homeowners' policy provides coverage for damages that the insured becomes legally obligated to pay for bodily injury or property damage, this coverage may be limited by policy exclusions. One of those exclusions is coverage for injuries or damage caused by the ownership, use, or maintenance of aircraft. “Aircraft” refers to any apparatus used or designed for flight, except model or hobby aircraft not used or designed to carry people or cargo. Many insurers, however, don’t make this exception for hobby aircraft. Since there are substantial differences in policy wording, one cannot assume coverage for drone use.

Business usage and intentional acts exclusions

Domino's is hoping to have drones deliver pizzas in the near future, and Amazon is testing them for deliveries as well. Agents are taking aerial photos for real estate listings, and home insurers are using drones for everything from underwriting to documenting damage from natural disasters. But keep in mind that none of these business applications will likely be covered under a personal homeowners’ policy, because those policies usually exclude business activities.

Homeowners’ insurance policies also often exclude coverage for intentional acts. And it can be difficult to separate the intentional from the accidental in drone incidents. If a local jurisdiction deems invasion of privacy to be an intentional act, any claims against you may not be paid if your policy specifically excludes intentional acts.

Drone operators need to look closely at the commercial-usage, "aircraft" and intentional-acts exclusions of their homeowners’ policy prior to liftoff. As with all insurance, the availability of coverage depends on the policy’s specific language – including the definitions, the exclusions, the exceptions to the exclusions and other conditions.

Questions about drones and homeowners insurance? Call us!

Call us to add drone insurance to your house insurance coverage.Before you send that new recreational drone on its maiden flight, contact American Insuring Group or call us at (800) 947-1270 or (610) 775-3848 to be sure that you are fully protected.

Our independent agents represent a multitude of competing insurance providers, so we're well equipped to find you the right insurance at the right price, so contact us today.

Tags: Homeowners Insurance Lancaster Pa, Homeowners Insurance Philadelphia Pa, Drone Insurance, House Insurance, Homeowners Insurance, Homeowners Insurance Allentown Pa, Homeowners Insurance Reading Pa, Homeowners Insurance Harrisburg PA, Homeowners Insurance York PA

Workers Compensation Insurance & Employee Wellness

Posted by David Ross on Tue, Oct 27, 2015

Do you have workers compensation insurance to cover your wellness program in Philadelphia, Lancaster, Reading, York, Harrisburg, Allentown, Lehigh Valley, Pittsburgh, Erie, PA or beyond? Here's what you should know.Today’s businesses are paying greater attention to their employees’ wellness. Some are even taking a more holistic approach in which “wellness” is being supplanted by “well-being.” Whether your business is providing employees with fitness programs, diets, and screenings or adding meditation and massages into the mix, your employees reap tangible benefits…and so do you.

A healthy employee is more productive, has less absenteeism, does higher quality work, and gets injured less often. Production and quality help a company to be profitable and competitive. Fewer injuries lower workers compensation rates.

Sounds great, right? Why doesn’t every employer do this for their employees?

Connecting Wellness Programs to Workers Comp Insurance

While all of these wellness initiatives play an important role in improving employee satisfaction--along with the company’s bottom line--it is worth noting that if an employee is injured during an activity that was encouraged by the employer, it may be compensable. That's where having the right level of workers compensation insurance can make a real difference.

An Injury at a Fitness Center

Recently, an employee of a New York business suffered a spinal cord injury while participating in an exercise class at a fitness center. His employer had made the center available for all employees during working hours. The employer had also offered to pay some of the employees’ cost of the center. A Workers’ Compensation Law Judge determined that the claimant’s injury arose out of and in the course of his employment, and ruled that the employee was entitled to compensation for his injury.

The New York Appellate Division agreed. The court reasoned that the employer encouraged the claimant to have a gym membership, and offered reimbursement to its employees for half of their center’s membership fees. The court also noted that the claimant’s position required him to develop contacts with clients, and the claimant stated that he advanced that objective by taking classes at the fitness center. Since the employer sponsored the fitness center activity in this manner, the claimant’s injuries were ruled to be compensable.

A Lunch-time Basketball Game

In Pennsylvania, a Commonwealth Court found that an employee, injured while playing basketball on his lunch hour, was entitled to workers’ comp insurance benefits. The Court found that the employer had encouraged employees to engage in physical activities to improve their health, relieve stress, and to give them a better mental attitude at work. The employer encouraged such activities with postings on a bulletin board and by allowing its employees to use company facilities, including their gymnasium. Based on these facts, the Court found that the claimant was furthering the business interests of his employer when he was injured.

The Implied Requirement and the Need for Workers Comp Insurance

The South Carolina Supreme Court recently ruled that a man who organized a voluntary kickball game for fellow employees and shattered his leg during the game must be covered under workers’ compensation. In its decision, the court cited the testimony of the man’s supervisor, who said that while attendance at the game was not mandatory, he would have been “surprised and shocked” if the employee had not attended after organizing the event.

The case turned on the court’s view that the man was “impliedly required” to attend the event because of his role in organizing it. The decision doesn’t necessarily apply to other employees who are injured at an event where employees are encouraged--but not required--to attend. It does suggest, however, that employers should be aware that encouraging attendance may be regarded as an implied requirement.

Getting the Right Level of Workers Compensation Insurance Protection

For most employers, the benefits of promoting workforce wellness far outweigh the potential liability. But if your company is considering a wellness initiative, or continuing an existing one, it would be wise to seek the advice of an attorney in order to develop initiatives that promote the goals of the program while minimizing the risk of legal exposure.

Also, click here to contact us or give us a call at (800) 947-1270 or (610) 775-3848 to ensure that you have the right level of worker's compensation insurance to properly protect both your business and your employees.

Tags: Workers Compensation Insurance, workers comp, workers comp insurance, PA Workers Compensation Insurance