In the early 1990’s when many states began passing workers compensation insurance acts, there was a prerequisite that any compensable injury had to have a physical impact. That has changed over the years.

Today most states accept that mental injuries can occur and, therefore, can be classified as a compensable injury. Mental injury workers comp claims can be expensive to defend, and expensive if found to be compensable.

3 Types of Mental Injury Cases Affecting Workers Compensation Insurance 

Pennsylvania workers compensation law distinguishes between three (3) types of mental injury cases:

• Mental / Physical
  A work-related mental or emotional experience causes physical consequences. Sometimes a heart attack or cardiac condition can qualify as a compensable event under this standard. In this case, most courts apply a two-part test. The first part is the need for an accumulation of workplace stress beyond the ordinary day-to-day stress employees are exposed to. The second part is the need for legal causation between the stress and the alleged work injury.
  
  
• Physical / Mental
  A physical stimulus causes a mental injury. A good example of a “physical/mental” case involves an amputation or orthopedic injury of sufficient severity to necessitate later psychological counseling or psychiatric treatment for a condition such as depression or PTSD. Although the physical injury need not be the only cause of the mental injury, the element of “contact” is required.
  
  
• Mental / Mental
  A mental or emotional stimulus causes purely emotional sequela (an aftereffect of a disease, condition, or injury).  There is no physical impact or harm. This applies to any employee that is subjected to “abnormal working conditions.” Typically a verbally abusive boss is not sufficient grounds, but a store clerk who has been robbed at gunpoint, is traumatized by the event, and can no longer function normally may be.

The categorization determines the burden of proof.  In physical/mental and mental/physical cases, the claimant needs to provide evidence that establishes that his or her injuries arose in the course and scope of employment.  Mental/mental injuries require a higher burden of proof. The Claimant needs to demonstrate the presence of “abnormal working conditions.”

Proper Handling of Workers Compensation Insurance Claims

In addition to understanding the laws in your state regarding mental injury workers’ compensation claims, you also need to learn how to work with medical experts. Here are three tips when choosing and working with medical experts.

1. Prior to the independent medical/psychological evaluation by your medical expert, provide a complete set of medical records  - including review of all pre- and post- injury medical records related to the employee’s conditions - if you want your expert’s opinions to be accepted.
   
   
2. You never know how a court may respond to a medical expert. It may accept your expert’s opinions based on a rational explanation that the employee’s condition is affecting their recovery or they may be more receptive to the medical expert’s opinion when the report is detailed and supported by deposition testimony. Therefore, provide a detailed and logical explanation for an expert’s opinions to help prove your theory or position.
   
   
3. Accurate and concise reporting is essential when it comes to the acceptance of an expert’s opinions. If your expert makes the slightest error or omission, all of his opinion could be disregarded.

Learn More About Your Workers' Compensation Insurance Options

To learn more about saving on workers’ compensation insurance costs and all your workers comp insurance options,  click here to contact American Insuring Group or call us at (800) 947-1270 or (610) 775-3848.

All businesses are at risk for some type of damage, liability or loss, and need to ensure that they have the right commercial insurance to protect themselves, their business, and their employees from those risks. 

Food service businesses – whether it’s a café, diner, or gourmet restaurant - are no different and actually present some unique risks that need to be addressed.

Often the most cost-effective way to protect a restaurant is with a Business Owners Policy (BOP) that is tailored specifically to the needs of the restaurant business. That's what we mean by  restaurant insurance.

Here are the Three Main Categories of Business Insurance for Your Restaurant

Restaurant Insurance Category #1: Property Insurance

Property insurance protects… well… property. That could include the actual building that your restaurant is located in if you own the property and all of the property within the building (whether you rent or own), such as equipment, dishes, food, and furniture. In the event of a fire, flood or other damaging event, property insurance allows you to replace those items so that you can resume business.

Many BOPs also include Business Interruption Insurance and Business Income Insurance. Interruption insurance helps you recover as quickly as possible by paying extra expenses caused by the interruption in your business —such as rent for temporary quarters.    Business Income Insurance helps pay for ongoing expenses – such as rent - incurred while your business is closed. 

As a food service business, you carry the added risk that your food could cause food poisoning or transmit a communicable disease, which makes a Food Contamination Endorsement Insurance a good idea for many restaurant owners. Typically, this endorsement helps pay for lost income if the business is shut down by a government authority, clean up expenses, food replacement, and additional advertising expenses required to restore your restaurant’s reputation.

Other property insurance coverages you may want to consider as a food service business owner include…

• Spoilage
• Mechanical Breakdown
• Outdoor Signs
• Burglary and Robbery
• Employee Dishonesty

Restaurant Insurance Category #2: Business Liability Insurance  

Commercial liability insurance helps protect your business against lawsuits – from someone breaking their leg walking up your steps to claims of libel or slander. We live in a very litigious society, and you never know what your restaurant could be liable for. Remember the woman who sued and won the lawsuit against McDonalds because she spilled hot coffee on herself? Even if you win the lawsuit, the cost of defending yourself can seriously affect your bottom line. Liability insurance helps protect you and your business.

If your restaurant has a liquor license, you should also include a Liquor Liability Endorsement to help cover the cost of your defense in the event of a lawsuit and any damages awarded if you are found liable.

Restaurant Insurance Category #3: Workers Compensation Insurance

Worker’s Compensation Insurance is a type of small business insurance that is mandatory in most states and covers employees for work-related injuries. A typical "workers comp" insurance policy pays an employee lost wages and medical expenses incurred due to a work-related accident, while also protecting the employer against accident-related lawsuits. 

Need Better Restaurant Insurance?
We Can Help! 

Whether you own a sandwich shop or an elegant restaurant, the independent insurance agents at American Insuring Group can help find the right insurance at the right price for your food service business. Because we're independent, we're free to shop around for the best deal among many competing providers of restaurant insurance based on your particular needs.

So give us a call at (800) 947-1270 or (610) 775-3848, or click here to Contact Us today.

Changing your Workers’ Compensation Insurance provider will cost money and time.  Not only will you need to spend time researching your options, but you will also probably end up spending more time answering employees’ questions. One way to save money on Workers’ Compensation expenses is to develop a strong long-term relationship with your third-party administrator (TPA).

A competent TPA can help lower your worker's comp insurance cost

The best TPAs have strong medical management skills that allow them to control the medical cost of your claims and work in conjunction with workers’ compensation adjusters.

Before hiring a TPA, ask which of the following techniques they use to control medical costs:

• Telephonic nurse case mangers (TCM) or Field nurse case managers (FCM) – experienced nurses help coordinate and manage the medical care of an injured employee, including consulting with physicians; providing frequent updates to the adjuster; and facilitating communicate between the employee, employer, and physician.
• Senior nurse reviews – a highly experienced nurse who provides continuous oversight of medical care, identifying recovery obstacles early in the claim.
• Utilization reviews – provides an independent confirmation that medical services are necessary with a pre-certification review, a concurrent review, and/or a retrospective review.
• Medical bill reviews – reviews and verifies the accuracy of the diagnostic codes and charges.
• Prescription management – helps ensure the best prices and the prevention of overutilization of drugs.
• Physician review – If an injured worker isn’t responding to medical care within the normal recovery time, a specialist can evaluate and document the past, current , and future medical treatments.
• On-site clinics – a medical clinic located on an employers’ worksite can reduce the cost of medical care for both personal and work-related injuries and illnesses.
• Injury triage – a triage nurse evaluates the injured employee’s needs and directs them to the most appropriate medical providers within the network.
• Wellness programs – a company sponsored wellness program lowers the cost of health insurance and the cost of workers’ compensation costs, lowers absenteeism, and increases productivity.
• Preferred provider networks – a network of doctors, hospitals, diagnostic facilities, and other medical providers that have agreed to provide medical services at a reduced cost to injured employees covered by workers’ compensation insurance. 

Get educated and lower your Workers Comp costs!

• Become more informed about the services offered by your claims administrator. Ask for samples of reports and deliverability’s. Read through their brochures and ask lots of questions.
• Visit one or two of their claims offices and learn their processes. Find out if adjusters have backup or clerical assistance. Watch the process as a medical bill enters the system through to the time that it is paid. You’ll have a better understanding and appreciation of how they work and how you can work with them more efficiently.
• Educate your adjusters on your business. Invite them to come in and see what your business does, the kinds of jobs and skills your employees have. This will help them understand better how an injury can occur. This may also allow them to offer more possible transitional duties for injured workers.

Need help finding a good TPA?

Amercian Insuring Group can help you find the right TPA for your organization. We can also help you find the best Workers Compensation Insurance coverage. That's because as independent agents, we're free to shop among competing insurance providers to find the best workers comp insurance to meet your unique needs at the best price.

Give us a call at (800)947-1270 or (610)775-3848 or click here to contact us. 

Workers Compensation Premium Audits - a necessary evil (some would say) for any employer - determines the final cost of your workers compensation insurance premiums. Sometimes the results of these audits can significantly change your premium compared to the estimated insurance premium originally used in the policy – and not always in a positive way. These audits can be stressful, disruptive and time-consuming for you.

Don’t wait until you receive a notice that you are about to be audited to begin collecting data.  Sometimes you only know a few weeks ahead of time, and you don’t want to scramble around for information, which can cause incorrect, missing or inadequate information. 

Here are a few tips to make a workers comp insurance audit as painless as possible:

Before the Workers Comp Audit:

• Review your original workers compensation insurance policy to see how the initial estimated premium was determined – including classification codes, rates, and payrolls.
• Look at your last audit report to see what information was required and what errors were made.  If this is your first workers comp audit, ask the auditor for a list of documents and information that they will be requesting.
• Review all job descriptions and ensure that the correct NCCI class code descriptions are applied to each job.
• Review all of your payroll records and check that employees are on the correct corporate payroll.  Make sure that any outside contract employees are kept separate from corporate employees and have copies of other insurance provisions for these contracted employees, such as hold harmless agreements or insurance certificates that show the employer as also insured on the contracted employees’ insurance policy.
• If there are unusual situations, such as an unexpected project that required additional over-time, make sure that you understand and are able to explain the situation.
• Place documents and physical evidence in chronological order.
• Ensure that information on your website or any other places a workers compensation insurance auditor would have access to is up-to-date, correct and not misleading
• Secure a private and comfortable room for the auditor(s) and ensure that internet is available in that space.

During the Workers Compensation Insurance Audit:

• Be professional and friendly
• Make sure that the workers comp insurance auditor is comfortable and knows where everything is (coffee, restrooms, photocopiers, etc.)
• Assign a primary contact person from senior management who will act as a liaison between the company and the auditor.   This person should be very familiar with all the work done within each department and by each employee, audit procedures, and the materials prepared for the audit.
• Do not lose your temper.  Be cooperative and answer all questions accurately and to the best of your abilitiy.  Keep your answers short, direct, and to the point.
• Do not invite auditors to lunch or dinner or offer any other items that could be interpreted as a bribe.
• You should have the opportunity to meet with the workers compensation insurance auditor(s) before they leave the premises to go over his or her findings and make corrections if needed.   This wrap-up meeting should be held in a private location.

After the Workers Comp Audit:

If you do not reach an agreement on the published report at the wrap up meeting, immediately prepare a written document along with all the necessary documents to support your position and request that any adverse premium changes be held until the challenge is resolved.  Legal assistance may be required.

Premium audits are a part of being an employer.  In order to see the best results, be prepared and cooperative, and be ready to provide any information the auditor requires. 

Get the Right Workers Compensation Insurance

For more information about premium audits or how to get the best deal on workers compensation insurance, contact an American Insuring Group independent agent at (800) 947-1270 or (610) 775-3848. As independent agents, we're free to find you the best insurance at the best price, selecting from among competing insurance carriers. We serve Phildelphia, Lancaster, Harrisburg, Allentown, Reading, Pittsburgh, Erie, PA and beyond. Call today.

You’re about to become an employer.  Maybe you’ve been in business for a while, but now you’re ready to hire your first employee.  You’re excited; this means your business is growing.  Or, maybe you’re just starting a business and you need employees to help run that business. 

Either way, being an employer comes with many responsibilities, including ensuring that you purchase the right business insurance.  You may be asking yourself, “What insurance is required by law and what is optional?  What’s in the best interest of both my business and my employees?” 

There are four primary types of insurance every employer should take a look at – Workers Compensation Insurance, Unemployment Insurance Tax, Disability Insurance, and Health Insurance.

Workers’ Compensation Insurance

Workers Compensation Insurance coverage ensures medical and wage-loss benefits to employees who are injured on the job. Plus, it helps protect employers against lawsuits filed by injured workers. Worker’s Comp insurance requirements vary by state.  In Pennsylvania, if you employ one or more employees - whether they’re part-time or full-time (including family members) workers’ compensation insurance coverage is mandatory.

If you are a sole proprietor, Workers' compensation insurance is not required by law, which can save you money; however, if you’re ever injured on the job, workers’ compensation insurance can help pay medical bills and supplement lost wages until you’re able to go back to work.

Click here for information about workers compensation insurance requirements in other states.

Unemployment Insurance Tax

Unemployment Insurance (UI) is a joint state and federal program financed through federal and state employer payroll taxes. It provides temporary payments to individuals who are unemployed through no fault of their own.  Each state has its own unemployment insurance program, which includes additional eligibility requirements, but they all follow guidelines established by the federal government.

Most employers must pay federal employer payroll taxes if they pay employee wages of $1,500, or more, in a quarter or if they have at least one employee during 20 weeks in a calendar year.  Most employers are also required to pay state unemployment taxes. In Pennsylvania, all employers providing employment to one or more workers must register Form PA-100 with the Office of UC Tax Services.

Employment that is not covered under the UC law includes the following:

• An individual employed by his or her son, daughter or spouse
• A child under the age of 18 who is employed by his or her parent
• A student in the employ of an organized camp that did not operate more than seven months in the preceding calendar year

Disability Insurance

Some states require that employers provide partial wage replacement insurance coverage to their eligible employees for non-work related sickness or injury. Currently, if your employees are located in any of the following states, you are required to purchase disability insurance:

• California
• Hawaii
• New Jersey
• New York
• Puerto Rico
• Rhode Island

In Pennsylvania, there are two types of disability insurance available if you decide to purchase it for your employees: short-term and long-term.

Again, if you are a sole proprietor, Disability Insurance is not required in Pennsylvania; however, if your family relies on your income, you may want to consider disability insurance for yourself to help pay medical bills and supplement lost wages if you become sick or injured.

Health Insurance

If you have more than 50 employees you are required to provide health insurance benefits to your full-time employees.  If you have more than 50 employees and don’t offer health benefits, you may be subject to a penalty call the shared responsibility payment.  96% of employers in Pennsylvania are exempt from the shared responsibility requirement. 

Contact Us for All Your Business Insurance Needs

If you’re an employer, contact American Insuring Group at (800) 947-1270 or (610) 775-3848 for more information about required and recommended business insurance, including health insurance, disability insurance, workers compensation insurance, or any other insurance your business may need. We've been helping businesses like yours acquire affordable, high-quality insurance for over 25 years.

Safety and Lower Workers Compensation Insurance Costs Go Hand in Hand

Creating a safe working environment for your employees is one of the best things you can do to help control the cost of Workers’ Compensation Insurance.  Whether you run an office, a warehouse, or a manufacturing facility, there are certain steps that apply to the main structure of any successful safety program.  Here are a few:

Set the Standard

Create an atmosphere and culture of safety; it will spread to your workers.  This can be as simple as carpeting that is free of rips and holes, clearly marked hazards, clean floors, and machines with real guards in place.  If you set the right standard, everything will follow.  

Create an Emergency Response Team

Your workforce may be the most efficient and responsive team during the course of regular business, and you may assume that they would react the same way in an emergency, but too often that efficiency and responsiveness turns to confusion and chaos during an emergency situation.  Employees need to know ahead of time what their responsibilities are in the event of an emergency, so they can react quickly like a group of well-trained marines rather than the bumbling Stooges. 

First, create a team that is a mix of serious-minded workers, supervisors, and management that understand that – in the event of an emergency -  lives may depend on them.  Make sure every employee knows who those team members are and how to reach them.  Consider creating a special code for emergencies or maybe a special name tag for members of this team.  Then, establish protocol for reporting an injury along with the chain of command.  Everyone on that team needs to understand what his or her responsibility is – whether that’s calling 911, applying CPR, or alerting other staff.

Finally, stage a few “accidents” for practice drills.  Don’t let employees know ahead of time and start easy, working your way up to accidents with increasing severity.

Communicate!

Your goal with Workers’ Compensation is to report zero claims, but if you do find yourself filing a claim, make sure your adjuster and carrier are good at communicating with the injured worker.  Set standards and make sure they are followed.  An injured worker should receive a call from a triage nurse or the adjuster within 24 hours.  The injured worker’s manager should call him or her once a week to check in on them.  Let the employee know that he or she matters and that you care about their welfare.

Lack of communication has been the down-fall of many marriages and statistically, it’s one of the biggest complaints of insurance claimants.  Too often, injured workers don’t know what is going on, what doctor they can and can’t go to, etc.   Effective communication decreases litigation, gets workers back to work more quickly, and keeps the claim moving forward to a resolution.

Get Upper Management Involved

My dad used to say to me, “Do as I say, not as I do.”  How do you think that went?  Not very well.  Good leaders lead by example.  If upper management repeatedly breaks the rules, you’ll lose whatever cooperation you’ve achieved with your employees.  Safety standards need to apply to everyone, even if that means writing up someone in senior management for a safety violation.  Your safety program needs to be enforced 100 percent of the time.

We Can Help You Save on Workers Comp Insurance

To find out more ways to save on workers’ compensation insurance, contact American Insuring Group at (800) 947-1270 or (610) 775-3848.

You say you have good business insurance, and that you've taken the time to obtain the right workers compensation insurance protection for your employees and your business. Good for you!

But, have you taken all the proper precautions to protect your construction workers or other employees from asbestos exposure? Doing so is the right thing to do for their protection, and over time it could also lower your workers compensation insurance costs.

What is Asbestos?

Asbestos is a naturally occurring mineral-based material that is widely used in many building products because it is resistant to heat and corrosive chemicals and does not conduct electricity. Asbestos fibers are very fine and can remain suspended in the air for hours. Asbestos comes in all shapes, sizes, and colors, and it’s extremely difficult to see. 

Asbestos that is in good condition and undisturbed is safe, but scientists have confirmed that when asbestos materials start to rot or are disturbed by cutting, scraping, drilling, or sanding, toxic fibers are released into the air.  Once breathed in, these tiny fibers (1,200 times thinner than a human hair) can get trapped in the lungs and remain there for a long time.  As these fibers accumulate, they cause scarring and inflammation, which can affect breathing and cause significant health problems.

Asbestos has been classified as a carcinogen (cancer-causing substance).  Continued exposure to asbestos can cause mesothelioma (a cancer that affects the membranes lining the lungs and abdomen), asbestosis (scarring of the lungs, which causes a loss of lung function that often progresses to disability and death), lung cancer, pleural plaques, and cancers of the esophagus, stomach, colon, and rectum. 

Often, the symptoms don’t appear until many years after the first exposure (20-50 years is the average gap).  Even short-term exposure to a significant amount of asbestos can lead to breathing problems, coughing, and shortness of breath.  And, there is evidence that family members of workers heavily exposed to asbestos face an increased risk of developing mesothelioma, as a result of exposure to asbestos fibers brought into the home on the shoes, clothing, skin, and hair of workers. According to the World Health Organization, 43,000 people die annually from asbestos (10,000 Americans).

Banned in 55 Counties

Asbestos has been banned in 55 countries.  Its use is restricted in the U.S. (asbestos must account for less than 1 percent of the product.), but it has not been banned.  Two million metric tons of the substance are produced every year worldwide. Many U.S. companies have phased out most products that contain asbestos; however, asbestos building materials still exist at many jobsites – especially homes and commercial buildings built before the 1970’s.  In 1989, the U.S. Environmental Protection Agency (EPA) banned all new uses of asbestos; however, uses developed before 1989 are still allowed.  

Why Construction Workers are at Risk:

Everyone is exposed to asbestos at some time during their life.  Low levels of asbestos are present in the air, water, and soil.  However, most people don’t become ill from their exposure.  People who become ill from asbestos are usually those who are exposed to it on a regular basis. 

Throughout the twentieth century, asbestos was incorporated into thousands of construction products, including fire retardant coatings, concrete and cement, bricks, pipes, gaskets, insulations, drywall, flooring, roofing, joint compound, paints, and sealants. Asbestos is a serious risk for construction workers of any trade.  Demolition workers who unsafely dispose of asbestos experience some of the highest risks.  Roofers, electricians, drywall workers, painters, plumbers, and laborers all face regular exposures, but anyone working on an older structure should be cautious of asbestos.

According the National Institute for Occupational Safety and Health, nearly one-quarter of worker deaths caused by asbestosis between the years 1990-1999 were in the construction trades, by far the most dangerous industry in terms of asbestos exposure.

If your employees perform any of the following tasks, they are at risk of breathing asbestos fibers:

• Cut, drill, sand, or otherwise disturb textured wall/ceiling material or drywall that contains asbestos
• Collect asbestos samples for laboratory analysis
• Remove or repair pipe insulation that contains asbestos
• Strip electrical wiring that contains asbestos insulation
• Remove ceiling tiles that contain asbestos
• Drag cable or wiring through asbestos-containing vermiculite insulation or ceiling tiles, or through asbestos-cement conduit
• Remove vinyl floor tiles or linoleum that contains asbestos
• Demolish concrete block that contains asbestos-containing vermiculite insulation
• Remove asbestos-containing asphalt roofing materials

How Can You Protect Your Employees from Asbestos?

• Read and understand the U.S. Occupational Safety and Health Administration (OSHA) regulations covering asbestos exposure in general industry and construction www.osha.gov/SLTC/asbestos
• Train employees who will be working with and around asbestos, including
  • How to recognize asbestos-containing materials http://www.hse.gov.uk/asbestos/gallery.htm
  • Awareness of the health hazards of asbestos
  • Proper use of personal protective equipment
  • Proper handling, removal, and disposal of asbestos
  • Develop and implement an exposure control plan for asbestos work
  • Have qualified people conduct risk assessments for any asbestos-containing materials that might be disturbed
  • Ventilate workspaces
  • Monitor employees for asbestos exposure levels
  • Keep warning signs and instructions in areas where asbestos-related work is performed
  • Require protective clothing, such as overall, gloves, foot coverings, face shields, and goggles.
  • Use protective equipment , such as respirators
  • Supply shower facilities and other post-exposure precautions
  • Require medical examinations for workers who are exposed to high levels of asbestos

Having the Right Health Insurance and Worker's Comp Insurance Pays Off

If one of your employees still becomes ill from exposure to asbestos while working for you, the right insurance – both liability, health, and workers’ compensation insurance – will help ensure the best care with the least financial impact. 

We're Here to Help

To determine your business insurance needs, contact American Insuring Group at (800)947-1270 or (610)775-3848.  We're independent insurance agents who offer insurance from over 25 competing brands. We’ll make sure you have the right coverage for your business at the right price. Contact us today.

The inability to get the right care, from the right provider, at the right time is one of the leading causes of increasing medical costs. 

Every business should complete its due diligence by taking the time to set up a network of medical providers and develop strong relationships with pharmacies to deliver quality care at reasonable prices to its employees. 

But if their employees aren’t taking advantage of those relationships, much of the opportunity for cost savings is lost. 

Better Communication = Lower Workers Comp Costs

This is especially true of employees who are injured on the job and utilizing workers’ compensation.  Too often, medical information is not being communicated properly, which can result in delays of medical treatment, increased absenteeism, duplication of medical services, and other inefficiencies, causing higher workers’ compensation costs for employers.  As medical costs - and nearly every other expense - continue to rise, it’s more important than ever to direct employees to preferred provider networks that provide the highest-quality and most cost-effective care.

Using Web-Based Communication Platforms to Reduce Workers Compensation Costs

One solution is to use a web-based communication platform such as the the Health Ticket. Such systems can include a virtual ID card that transmits all the relevant information – such as employer and employee names, date of injury, nature of injury, and the name of ancillary network vendors and contact information - to medical providers. Helpful information can be provided to the injured employee, such as participating pharmacies, phone numbers for additional medical providers, and network identification numbers.

The patient is able to access all the medical information he needs to find a provider via smart phone.  He can also print out a single page that details his health benefits, co-payments and deductibles.  He is also alerted if he is seeking care from a provider outside his plan’s provider network and how that will affect him financially.

Systems like The Health Ticket can communicate critical information while reducing costs. By providing real-time, accurate information about complex healthcare transactions, the Health Ticket helps guide injured workers through the preferred pathway of care.

What Can Web Based Communication Platforms Do For Your Business?

• Increase PPO network penetration

• Reduce claim costs by avoiding unnecessary or duplicate medical treatments.

• Maintain compliance with ever-changing regulatory environments and PPO contracts. 

• Contain costs by reducing billing errors, administrative costs, and out-of-network usage. 

• Improve the quality of care coordination and employee satisfaction.

• Reduce confusion over benefits and claims.

Contact Us for Workers Compensation Insurance Assistance

For more information about saving on workers compensation insurance, contact American Insuring Group at (800)947-1270 or (610)775-3848.

Fraud, waste, and abuse continue to drive up the cost of administering workers’ compensation programs. Workers’ compensation fraud, which accounts for approximately one-quarter of all insurance fraud, comes in all forms: injury while off work, multiple claims, injury concurrent with termination, and many more. 

Workers comp insurance fraud is a crime. Tens of billions of dollars in false claims and unpaid premiums are stolen every year.  Scams are increasing the cost of insurance premiums — draining business profits and costing honest workers their pay and their jobs.  In addition, these increasing costs are being passed on to you as a consumer with higher prices at the cash register.

Medical Records Investigations: Cost Effective Sleuthing to Cut Workers Comp Insurance Costs

Aggressive pursuit and investigation of fraud can help lower the financial impact of workers’ compensation on businesses. If you’re willing to do a little sleuthing, there is one interesting method of reducing workers’ compensation fraud in your business - the use of medical records for investigation.  This method is often more cost-effective and less expensive than many of the more formal investigative tools.

Where should you look?

There are a few things to consider if you decide to use medical records to investigate a workers’ compensation insurance claim. 

1. Start at the beginning. Using this investigative technique at the onset of a claim allows you to better monitor treatment trends and develop a better understanding of the case.  It’s important that you get ahead of the case before it becomes too complicated.
    
2. Start with primary care providers.  Records from a primary care provider will often provide a good overview of a person’s health, including yearly physicals. 
    
3. Don’t overlook urgent care clinics.  In addition to checking the records of your local emergency rooms, you should also take a look at urgent care facilities in the vicinity of where the claimant both lives and works.  Urgent care facilities are on the rise.  They provide a more affordable option to health care for people who don’t have medical insurance, and they offer access to medical treatment for injuries that occur after hours or on the weekend.
    
4. Look at other medical facilities.  In today’s health care environment, proper treatment often requires a visit to a specialist.  Specialists can also provide information about underlying conditions.

What should you look for?

Here are a few of the “red flags” you should look for in an investigation of medical records:

1. If a claimant receives medical care and/or treatment at more than one facility in one day.
    
2. If a claimant sought medical treatment on a Monday morning or after a holiday, it could indicate that an injury took place over the weekend or during a holiday – and not in the workplace.
    
3. If a claimant received treatment and/or referrals from providers that share common waiting rooms or are located in adjoining buildings.
    
4. If a claimant has a medical appointment while he or she is out of town or on vacation.
    
5. If a claimant receives medical care on a weekend, holiday, or during inclement weather.
    
6. Look for evidence that the medical records have been changed or altered, or if they aren’t consistent with what the primary doctor is recommending. 

Be Proactive and Increase the Odds of Cutting Your Workers Comp Insurance Costs!

Today, you need to be proactive if you want to limit the amount of fraud, waste, and abuse within your business’s workers’ compensation programs, and medical record investigation may be one method to consider for your business. 

For additional methods to reduce the cost of workers’ compensation, including getting the best rate on quality workers comp insurance, contact us at (800) 947-1270 or (610) 775-3848. We're independent agents with the power to lower your worker's comp insurance costs by offering policies from multiple competing insurance providers, so you'll get the best insurance at the best price.