Insurance Savings and News You Can Use
Join the Conversation!

How to Prevent Repeated Workers Comp Insurance Claims

Posted by David Ross on Sun, Mar 31, 2019

Prevent repeated workers comp insurance claimsYou often hear horror stories about fraudulent workers compensation insurance claims, but fortunately, most employees that make WC claims are honest, hard-working individuals.

Occasionally, you’ll run across an employee who seems to be a repeat WC claim offender. Some are legitimate claims, and some are not, but repeated WC claims can be annoying, time-consuming, and costly.

Here are steps you can take to determine if workers are trying to take advantage of the system, and ways to stop them from making repeated false claims or from incurring repeated injuries:

 

1 - Don’t Antagonize - Give Injured Employees the Benefit of the Doubt

Your first step is to remember that both you and the injured employee are human, and as humans, we all have emotions and make errors. Injured employees need to be treated with respect, or you may inadvertently antagonize the employee and make matters worse, or you may be dealing with a worker with a legitimate claim.

For example, an employee who is willing to do whatever it takes to get a job done may do things that increase their risk of injury. An employee may be naturally clumsy, or they may not be aware of the right way to get a job done safely.

If you encounter an employee who has multiple WC claims, you need to investigate it, so you know what steps to take to reduce the number of claims. It’s vital that you go into the investigation with an open mind. Start the investigation by giving the injured employee the benefit of the doubt until or unless you find a reason not to.

2 - Investigate the Injury

Investigations are essential with any WC claim but especially with an employee with repeated claims. Gather statements from the employee, supervisor, any witnesses, and the treating physician, so you can understand the extent of the injury and how the injury occurred. If you don’t think the treating physician is being honest or is not providing the best information or treatment, it’s okay to get a second opinion.

You also need to figure out the actual cause of the accident. A cause may seem obvious but upon a more in-depth inspection may prove to be a secondary cause – or not the cause at all. Review studies conducted on similar injuries; look at all potential factors; consider other factors such as previous injuries and comorbid conditions such as obesity, mental health issues, substance abuse, etc.; consider the validity of testimonies; and with all that information, make a conclusion.

3 - Talk to the Injured Worker

As mentioned earlier, injured workers are human and have emotions. Like everyone, some of those emotions are logical, and some are not. Having an open, non-confrontational conversation with the injured employee can reveal things such as personal challenges at home, psychosocial issues, or problems with a supervisor or with your company.

4 - Take Steps to Avoid Future Claims

Once you understand the reasons for the repeated WC claims – whether they’re legitimate or not – you can take steps to avoid future claims. If it turns out they don’t know how to perform their job safely, provide additional training and education. If you determine that they are physically unable to do their job effectively, consider transferring them to another job that they can perform safely.

However, if they’re trying to take advantage of the system, be respectful, but let them know that you will be watching them and will take appropriate action if abuse of the system is found, up to and including termination.

Protecting Your Bottom Line

Repeated workers’ compensation claims affect your bottom line while potentially harming productivity and employee morale.

You know what else affects your bottom line? Paying more than you need to for workers comp insurance!

To get a GREAT deal on your WC insurance, give the independent agents at American Insuring Group a call at (800) 947-1270 or (610) 775-3848 or find us online. As independent agents, we’re free to shop and compare rates among competing insurance carriers to make sure that you are getting the best WC insurance at the best possible price!

Call or click today to get started.

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

Warning Signs of Workers Comp Insurance Fraud

Posted by David Ross on Sun, Mar 10, 2019

Use these warning signs to reduce the risk of workers comp insurance fraud, and then save on WC insurance in Philadelphia, Reading, Allentown, Lancaster, Pittsburgh, Erie, PA and elsewhere.The majority of employees are honest, and the majority of workers compensation insurance claims are legitimate.

Unfortunately, there is a small group of people who commit workers compensation fraud, and they cost companies billions of dollars every year in rising insurance premiums, production delays, and training costs. 


What is EMPLOYEE Workers Comp Insurance Fraud?

Workers Compensation fraud occurs when a WC claim is filed that is not entirely truthful to get money or extended time off. Fraudulent claims include faking or exaggerating an injury, claiming an injury that occurred off the job, or claiming an old injury that didn’t heal.

Workers comp fraud is a serious crime, and one of the fastest growing types of insurance fraud in the U.S. Estimates place the cost of WC fraud to companies at $6 to $7 billion every year.

The good news is that there are steps you can take to minimize WC fraud by both employees and providers.

One of the first steps is to recognize common warning signs.

 

13 Warning Signs of EMPLOYEE Workers Comp Fraud

Protect your business from WC insurance fraud by recognizing the warning signs of fraudulent claims:

  1. No witnesses
  2. An injured employee refusing treatment
  3. Delayed reporting of injury
  4. Conflicting or inconsistent report of the incident
  5. An employee with a history of making WC claims
  6. An employee with a history of frequently changing addresses, jobs, or physicians
  7. Suspicious medical providers or legal consultants
  8. An injury that occurs just before or after a weekend or holiday
  9. An injury that occurs right before or after job termination, layoff, end of seasonal work, a strike, or the end of a project
  10. An injured employee working a side job
  11. An injured employee doing activities that would not be possible with the claimed injury
  12. An injured employee who is difficult to get in touch with
  13. An injured employee who hires an attorney and tries to get a quick settlement

Never accuse an employee of fraud. If you see two or more of these warning signs, notify your insurance company immediately, but remember these are just potential signs that there could be an issue. It doesn’t mean that every workplace injury that occurs with no witnesses is fraudulent or that every injured employee who is hard to get in touch with is lying. They are just indicators that there may be a problem. 

How to Minimize Employee WC Fraud

  • Follow a screening process for all new employees by conducting thorough background checks of all applicants, contacting references, and watching for red flags such as a spotty work record or a criminal record
  • Create clear WC policies and establish a zero-tolerance policy on WC fraud
  • Clearly communicate these policies with new hires and provide WC fraud training
  • Create a culture of safety to reduce opportunities for fraudulent claims
  • Install video surveillance
  • Consider establishing ways that employees can report suspicious or fraudulent claims anonymously
  • If you suspect fraud, notify your insurance carrier immediately and provide supporting documentation.



What is PROVIDER Workers Comp Insurance Fraud?

Unfortunately, it isn’t just employees who commit WC fraud; providers of WC benefits such as medical and legal professionals sometimes take advantage of WC programs with unnecessary billing, fake clinics, kickback schemes, and inflated worker injuries or service costs

8 Warning Signs of Provider WC Fraud

  1. Billing for services never received
  2. Billing for equipment never used
  3. Billing for treatment that was never performed
  4. Duplicate billing
  5. Higher than usual bills for services performed
  6. Billing for procedures that don’t make sense for the reported injury
  7. Increasing visits
  8. Ongoing medical services that don’t improve injury

WC fraud can cause a ripple effect that touches everyone. Fraudulent claims create additional costs for insurance companies, which can turn into higher insurance premiums for employers. Increasing business costs can cause an increase in prices customers pay, a decrease in employee benefits, or even job cuts.

 

How to Get a Great Deal on Workers Comp Insurance

Our Trusted Choice independent workers comp insurance agents will help you save on the best workers comp insurance for your business. Call today.To learn more about preventing and recognizing WC Fraud and ways to save on Workers’ Compensation Insurance, contact the WC specialists at American Insuring Group at (800) 947-1270 or (610) 775-3848 or find us online.

Our Trusted Choice independent agents will work hard to analyze and compare plans from competing WC insurance carriers, so you’ll get the best price on quality protection.

Call or click today to get started!

Tags: Workers Compensation Insurance, workers comp costs, Commercial Insurance, Workers Compensation Insurance Fraud

10 Red Flags For Workers Comp Insurance

Posted by David Ross on Sun, Mar 04, 2018

Watch out for these red flags signaling possible workers compensation insurance abuse. It’s your responsibility as an employer, to pay close attention to your workers compensation insurance claims. The majority will be legitimate claims that your employees are entitled to. But even one fraudulent claim can adversely impact your bottom line.

There are important red flags you can watch for to identify possible workers compensation fraud. Here are ten red flags. Seeing just one red flag probably isn’t cause for alarm, but if you see multiple red flags on one workers’ compensation claim, it’s a good idea to bring it to your adjuster’s attention.

Ten Workers Compensation Fraud Red Flags

#1. Questionable Incident Description

An injured employee should be able to describe the incident – what happened, how, and when - with a fair amount of detail and clarity. The details should be consistent and not change as you ask questions or when the employee describes the incident to someone else (doctor, adjuster, employer). If there’s more than one medical report, the details of the event should be the same, and the nature of the injury should be consistent with the type of work the employee performs.

#2. Lack of Witness Corroboration

If the employee usually works around others, there should be a witness, and the witness account of the accident should match the employee’s description of the accident. If the witnesses are all close friends of the employee making a claim or if the employee’s co-workers express uncertainty that the accident occurred, it may be a red flag.

#3. Delayed Reporting

Injured employees usually report their injury immediately – not days or even weeks later.

#4. Disgruntled Employee

Is the employee unhappy with his job or employer? When a workers’ compensation insurance claim is made, check if the employee was recently demoted or passed over for a promotion, if his evaluations are less than stellar and he’s in danger of termination, or if he is scheduled to be laid off. An incident immediately before a strike, plant closing, or end of seasonal employment may be a red flag.

#5. Early Morning Claims

If the employee reports an incident that occurred over the weekend or very early in the morning before the supervisor and other employees have arrived, it could be a red flag.

#6. Inability to reach the injured employee

The employee should provide his address – not a PO Box and not a friend’s address – and you should be able to contact the injured employee. If you find they aren’t home during regular working hours or if you’re always told he’s sleeping or can’t be disturbed, it could be a red flag.

#7. Shaky Finances

If an employee is having financial issues, he may see a workers’ compensation claim as a way out. Find out if the employee has financial problems, is nearing retirement, is in the middle of a divorce, or if they took a lot of time off just before the injury. Check if the spouse is working or receiving any of these payments: workers’ comp benefits, disability, welfare, or unemployment. If the employee asks about a settlement early into the process or applies for social security benefits before the incident occurred, that could be a red flag.

#8. Medical Care

Watch out for subjective injuries - such as soft-tissue and emotional - or injuries that seem to move from one body part to another; frequent changes in physicians or inconsistencies between employee and physicians’ reports; or missed doctors’ appointments or refusal of diagnostic testing. Carefully examine the medical reports to make sure there aren’t any whiteouts, and it doesn’t look like it’s been photocopied multiple times. Most employees don’t have extensive knowledge of the medical or insurance field. If he does, it may be a red flag.

#9. Inconsistent Physically Ability

An injured employee who is out of work on workers’ compensation should not be able to do similar activities to what he was doing at work. So look for evidence that he is performing those activities outside of work such as callused or grimy hands, medical reports that use adjectives like “muscular” or “tanned.”

#10. Over-eager

If the employee is pushy to settle the claim or has an attorney letter of representation dated the day of (or even before) the injury, it could be a red flag.

Final Advice: Don't Assume Insurance Fraud, But ... 

Don’t go into every workers compensation claim assuming there’s fraud. The majority of claims are legitimate. But at the same time, don’t be blind to the red flags that may indicate fraud. If you see multiple red flags, let your adjuster know. It may just help you save on your workers’ compensation costs.

 

Remember the Easy Way to Save on Workers Comp Insurance!

To learn more about workers compensation insurance, call the American Insuring at (800) 947-1270 or (610) 775-3848, or contact us online.

And remember, the easiest way to save on workers comp insurance is to buy it from an independent agent like those at American Insuring Group! We shop competing insurance providers, matching their policies to your needs, and identifying the best value for your particular situation. Get the right coverage at a great price. Call or click today to get started!

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