Headlines heralding ever-increasing job loss numbers may motivate
workers already out with legitimate work-related injuries to try to
extend their workers’ compensation benefits, especially if their
positions have been, or will be, eliminated.
California Insurance Commissioner Steve Poizner has announced a $1
million grant to help fight insurance fraud in Fresno County, noting
that “In this struggling economy, it is more important than ever to
help businesses to stay and expand in the state…fraud drives up the
costs of workers’ compensation insurance.”
Learn how to minimize and manage increasing workers’ comp costs by
ordering the CD recording of our recent comprehensive audio conference:
Workers’ Comp: How To Handle The Rising Tide of Comp Premiums in California.
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Commissioner Poizner hasn’t disclosed whether additional grants will
be made to other California counties to help fight workers’ comp fraud.
In the meantime, there’s a lot that employers can do to help battle
fraudulent claims and keep costs down. Here are some red flags that might signal that an employee out on legitimate leave may be trying to stretch his or her comp benefits:
- The employee had been reporting feeling better, but then suddenly says the injury has worsened;
- The employee’s condition worsens shortly after layoffs have been
announced, even if the layoffs don’t affect the employee’s position or
department; - The employee repeatedly delays or cancels medical appointments that could result in the person being cleared to return to work;
- The employee reports new symptoms or ailments associated with his or her injury that weren’t present before;
- The employee is unresponsive to your return-to-work efforts, or seems unwilling to accept light-duty offers;
- The employee reopens a recently closed claim.
If you believe that an injured worker is fraudulently attempting to
extend his or her benefits and delay returning to work, one of the most
effective things you can do is to document with as much detail as
possible exactly what duties will be assigned to the employee if the
person returns. Also, document every light- or modified-duty option
that you can offer the employee. This documentation can be critical in
demonstrating to physicians that an employee is physically capable of
returning to his or her job, even if that job may ultimately have to be
with another employer.
Make Sure You’re Getting the Best Possible Workers’ Comp Rates
According to the San Francisco Business Times, as of November
2008, there were 60 filings by California insurers seeking pure premium
workers’ comp rate increases to go into effect on Jan. 1 on new or
existing policies. Nearly half of these insurers, including the State
Compensation Insurance Fund, asked for increases well above the five
percent recommended by California Insurance Commissioner Steve Poizner.
Order the CD recording
of our in-depth 90-minute audio conference all about what the rate hike
means for your organization. Our experts—an experienced risk management
consultant and an experienced insurance broker—will cover what to
expect in the coming months and the preventative steps you can take to
ward off the negative effects of workers’ comp hikes.
You’ll Learn:
- The workers’ comp reforms that got us to this point and the anatomy of the rate hike
- How the hike will affect individual businesses, industry by
industry—including who could be the hardest hit and who may be in the
best shape to handle increases - Whether the hike applies to new or existing policies (or both) and if there’s any way to “lock in” lower premiums
- How to accurately compare rates among insurers to make sure you’re getting the most bang for your buck
- Expected loss rates and understanding what determinative factors insurers assess when analyzing a “loss”
- What marketing softening in some areas means for employers and how
volatility in premium pricing could spell future troubles for workers’
comp reserves - The preventive measures concerning safety and claims management you
can set into motion today to save your organization money down the line - The longer-term forecast for workers’ comp premiums in California