This Week in Comp

Compiled by David Wylie, Editorial Coordinator

Compiled by David Wylie, Editorial Coordinator

This Week in Comp provides an overview of workers’ compensation news from across the country.

Fraud

Sen. Ron Calderon has been indicted in a corruption case and accused of taking about $100,000 in bribes from a hospital executive in Southern California who ran an alleged workers’ compensation scheme…MORE

Safety

Peril of the oil patch
In Texas, 65 oil and gas workers were killed on the job in 2012  – a 10-year high and nearly 60 percent more than in 2011…MORE

Why Do Some Workers Not Report Injuries?
When employees do not report injuries immediately, they may be putting themselves and their co-workers at risk…MORE

Claim Management

Nurse Case Managers Are Well Worth the Cost
Employers and injured workers benefit when insurance carriers leverage nurse case managers’ expertise to get workers back on the job…MORE

Legislative Issues

PCI Urges TRIA Reauthorization

The Terrorism Risk Insurance Act (TRIA) provides a critical federal backstop against acts of terrorism. Unless Congress intervenes, TRIA will expire at the end of the year. Vincent Donnelly of the Property Casualty Insurers Association of America recently testified about the importance of reauthorizing the Act before the Senate Committee on Banking, Housing, and Urban Affairs…MORE

States Stepping Up?
Due to recent budgetary shortfalls and the time it takes federal OSHA to promulgate new rules, is it time for states to step up their efforts to improve occupational safety?…MORE

Return-to-Work

Workers’ Compensation: My Father’s Story
Annmarie Geddes Baribeau’s father was a blue collar guy with an ironclad work ethic. Though he was president of his local teamster’s union, he hated advocating for workers who did not pull their weight. So when Annmarie’s dad was out of work due to an on-the-job injury, he somehow felt like less of a man. Annmarie shares her father’s touching story on her blog…MORE

About the author
David Wylie is the editorial coordinator at Texas Mutual Insurance Company. He works closely with Texas Mutual’s safety professionals to teach employers and their employees how to prevent workplace accidents and their associated costs. David holds the OSHA 10-hour general safety certification and a degree in journalism from Southwest Texas State University.

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites.

The Umbrella and the Circus Tent

By Eileen Cook, Special Investigations Supervisor

By Eileen Cook, Special Investigations Supervisor

I typically avoid resorting to obscure analogies to make a point. I am, however, going to make a rare exception. I think it will paint a vivid picture for anyone interested in combatting the trickle-down effects of workers’ compensation fraud.

I can’t tell you how many times an employer has contacted my team with fraud tips along these lines: “He’s walking most days at the mall; he’s not hurt.”  “He was sitting on his front porch laughing with neighbors; he’s not hurt.”

It seems the number of claimant activities we chalk up as fraud would fit under a circus tent. In reality, the number of activities we can prove – and prove is the key word – as fraudulent would fit under something more the size of an umbrella. They are, in no particular order:

  • an injury that did not happen at all
  • an injury that occurred, but not at work
  • a continuing claim for disability when there is no disability
  • working at another job while receiving benefits for not being able to work

The good news is that I’ve been in this industry a long time, and I assure you most injured workers simply want to get well and return to the job. They’re not out to cheat the system or their employers. Their injuries cause them not only physical pain but also financial stress. Remember, workers’ comp benefits replace only a portion of injured workers’ lost wages.

So if all those claimants under the circus tent aren’t committing fraud, what are they doing? If they’re taking longer than expected to recover, they might be engaging in an activity investigators call malingering.

Think of malingering as stretching the limits of worker’s comp benefits. At the shallow end, the injured worker takes an extra day or two off work. At the deep end, the injured worker is off work so long that he develops a disability mindset.

Fortunately, there is a cure for malingering. Several cures, actually:

  • Commit to a return-to-work program. This is an employer’s best defense against malingering. The program documents how the employer, the injured worker and the doctor will cooperate to get the injured worker well and back to productive employment as soon as medically reasonable.
  • Communicate with the injured worker. Employers should stay in regular contact with injured workers. This will let the worker know the employer cares about his or her well-being. It may also raise a red flag for possible fraud. If an injured worker is difficult to contact while off work or acts annoyed when contacted, he or she may be committing fraud.
  • Talk to the adjuster. Employers should immediately contact the      adjuster handling the claim if they suspect an injured worker is malingering. If the injured worker needs extra help getting back to work, a case manager may intervene.

Winning the fight against workers’ compensation fraud requires a collaborative effort among insurance companies, regulatory agencies and employers. The better we understand what fraud is, and just as importantly, what fraud is not, the more equipped we are to identify and stop those who are truly cheating the system.

About the author
Eileen Cook has more than 40 years’ experience in law enforcement and fraud investigations. She spent 12 years as an investigator with the Brazoria and Midland County Sheriff’s Departments. After leaving law enforcement, Cook served as a training specialist at the Texas State University Institute of Criminal Justice Studies, where she trained police and probation officers for 10 years. Eileen has been helping Texas Mutual fight fraud and its cascading effects on policyholders since 1995. Cook earned a degree criminal justice from the University of Houston at Clear Lake City.

This Week in Comp

Compiled by David Wylie, Editorial Coordinator

Compiled by David Wylie, Editorial Coordinator

This Week in Comp provides an overview of workers’ compensation news from across the country.

Safety 

Focus on Preventing Older Worker Illnesses and Injuries
PinPoint News
The workforce is aging as more Americans delay retirement for financial reasons. There is mixed news in that trend. Older workers tend to be more experienced than younger workers. On the other hand, they are more likely to fall and injure themselves on the job. This brief article offers tips for protecting older workers and preventing the costly claims that often result from workplace injuries…MORE

Traffic Deaths Decline as Wrecks Rise in South Texas Drilling Area
Insurance Journal
Texas registered 236 traffic fatalities in 2013, a drop from 248 in 2012. But the Texas Department of Transportation says there was a 26 percent jump in crashes that resulted in serious injuries or fatalities in the oil-rich Eagle Ford shale…MORE

Stricter Texting While Driving Measure Advances in Iowa
Insurance Journal
Iowa lawmakers granted initial approval of a bill that would allow officers to pull over motorists suspected of texting while driving…MORE

Get Defensive Behind the Wheel
Texas Mutual Blog
In 2012, someone died on Texas roadways every day. One person was killed every two hours and thirty-five minutes. Texas Mutual’s John Calvert offers defensive driving habits that could save your life…MORE

Opioid Epidemic

Lethal drug Combinations Warrant Close Monitoring
Work Comp Wire
More than 38,000 Americans died from prescription drug overdoses in 2010. About 15,000 of those deaths involved opioids and alcohol. The risk of overdose increases when opioids, muscle relaxants and benzodiazepines are mixed…MORE 

Cost Control

How Employers Can Manage Workers’ Comp Costs
PinPoint News
Do you think of workers’ compensation premiums as an unfortunate, yet unavoidable, business expense? If so, this short article could change your perspective. Workers’ compensation can be a core business practice and a means for improving the bottom line. If you focus on creating a workplace safety culture, especially when workers’ comp premiums are down, you can reap long-term financial benefits…MORE

Legislative Issues Texas Likely to Become an ‘NCCI’ State for Workers’ Comp
Insurance Journal
The Texas Department of Insurance on Dec. 30, 2013, filed a petition to adopt the NCCI manual for workers’ compensation and allow NCCI to assume certain functions that traditionally have been administered by TDI’s Division of Workers’ Compensation. The proposal anticipates an effective date of June 1, 2014, for the transition to the NCCI model…MORE

CompScope Identifies Medical Cost Drivers, Trends, and Effect of Regulatory Changes in 16 State Workers’ Compensation Systems
Houston Chronicle
The cost drivers of medical care in state workers’ compensation systems; the effects of legislative and regulatory changes on medical costs; and trends in payments, prices and utilization of medical care for injured workers are examined in a new set of studies from the Workers’ Compensation Research Institute (WCRI)…MORE

Arizona Bill Would Ban Lawsuits Against Insurance Companies
CBS
A bill that would ban lawsuits against insurance companies for denying workers’ compensation claims in bad faith is making its way through Arizona’s House of Representatives…MORE

Resurrected Bill Expands Conn. Workers’ Comp Law
Kansas City Star
Connecticut lawmakers have resurrected a proposal to expand the state’s workers’ compensation law to cover employees who’ve suffered an emotional or mental impairment after witnessing a traumatic death or maiming while on the job…MORE

Claims Handling Dad’s Gone; George Smith Isn’t
DePaolo’s Work Comp World
After all the I’s are dotted and T’s are crossed, workers’ comp claims are closed and sent off to some virtual file cabinet. David DePaolo reminds us that it’s not always easy for victims and their families to shut the book on workplace injuries. Take the case of a worker who suffered severe brain damage during a routine hernia surgery…MORE

Return-to-Work Death Awaits the Poor Who Sit Alone
Work Comp Wire
Feeling lonely and isolated from others can lead to less restful, restorative sleep; increased blood pressure, stress and depression; and a decreased feeling of living a meaningful life. From Bob’s cluttered desk comes a reminder that in a culture where injured workers often find themselves feeling isolated and alone, that is a finding we should take note of…MORE

About the author
David Wylie is the editorial coordinator at Texas Mutual Insurance Company. He works closely with Texas Mutual’s safety professionals to teach employers and their employees how to prevent workplace accidents and their associated costs. David holds the OSHA 10-hour general safety certification and a degree in journalism from Southwest Texas State University.

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites.

Get Defensive About Your Driving

Drivers who buckle up, avoid distractions, control their speed and never get behind the wheel while tired improve their chances of getting from Point A to Point B safely.

Remember, though, that other drivers’ actions can affect your safety as much as your own actions can. Texas Mutual encourages employers to teach and enforce these defensive driving behaviors in their workplaces:

  • Keep at least three seconds between you and the car in front of you. Increase your following distance when roads are slick and visibility is poor.
  • Frequently check your rear and side mirrors for approaching cars.
  • Assume vehicles approaching from the opposite direction will not see you or slow down for you to pass cars in front of you.
  • Don’t count on cross traffic slowing down to let you pass.
  • Scan the road at least one half block ahead of you, watching for potential hazards.
  • Control your emotions if someone cuts you off.
  • Give aggressive drivers plenty of space.
  • Stay alert so you can respond quickly and appropriately to other drivers’ unexpected actions.
  • Approach intersections cautiously, never assuming you have the right of way.

Related links:

Texas Mutual offers free safety materials at worksafetexas.com. The site includes articles on simplifying fleet safety and maintaining your focus behind the wheel. We also invite you to visit our safe driving website, safehandtexas.org, for more information.
Teens aren’t the only drivers who will benefit from this informative National Safety Council article on judging gaps in traffic.

This short video gives three defensive driving tips that might save your life: remain alert, control your speed and avoid distractions.

 

On the Road with Texas Mutual Recruiting

by Stephanie Schumacher, Recruiting Consultant

Travel report:  Austin to Houston, 162 miles

Weather: Dreary and cold

Notable stops:  Weikel’s Kolaches in LaGrange – wow!

It’s February, and that means Texas Mutual is on the road recruiting from some of Texas’ best colleges.  Economists all over the nation forecast that Texas will dominate the job market in 2014, with Austin, Houston, McAllen and Dallas all vying for the number 1 spot.  Even more exciting, five Texas cities are among the fastest-growing in the country.  So we launched our 2014 recruiting plan to account for growth and find the future leaders of Texas Mutual.

Image

Texas Mutual’s Jeremy Hansen, Erika Turner-Green and Alexis Osborne meet prospective candidates at the Texas Job Fair

“Our mission at Texas Mutual is to help make Texas the safest state to work and live,” said Rich Gergasko, Texas Mutual president and CEO. “When workplace accidents do occur, we work very hard to ensure that our injured workers and their families are cared for and treated properly. As we continue to insure more Texas employers, we want to create a pipeline into the state’s higher education institutions to find the best and brightest students who are attracted to our culture.”

February 6, we set out for our first career fair in Houston with Rich’s mission in mind.  Houston-based employees Brent McClellan, Jeremy Hansen, Alexis Osborne, Erika Turner-Green and I represented Texas Mutual.  The fair, held at the Rice campus and known as the “Texas Job Fair,” featured a blend of 15 Houston-area colleges.

If you are visiting or new to the Houston area, a trip to the Rice campus is a must.  Rice was established in 1912 on a 285-acre plot.  Beautiful green spaces and heavy woods surround Byzantine-style architecture to make for a true classic collegiate atmosphere.  The fair was held at the Wellness Center, an impressive facility in the center of campus.

The basketball gym had been successfully transformed into a sea of employers.  We were excited to meet current students, alumni and even experienced professionals.  Even more exciting, this first event allowed us to test drive our new, upgraded LinkedIn Career Page.

Candidates visiting our booth used a sleek iPad kiosk to link directly to the Texas Mutual LinkedIn career page in real time.  Many were surprised to see LinkedIn identify their profiles with just a few entries.  The results?  We linked with 90 candidates eager to find out about our careers and future internship possibilities.  We were the only company to feature the LinkedIn technology and have been in touch with many of the linked applicants since ̶ a definite success.

After the fair, we said goodbye to Houston and set our sights on Waco.  Luckily for me, I passed through LaGrange on the way back for another stop at Weikel’s Kolaches.  Their cherry strudel is out of this world!

Are we visiting your campus?  Come out and meet some of our regional Texas Mutual all-stars at the following career fairs:

February 19 – Baylor University

February 26 – University of North Texas

April 3 – Texas State Technical College

Look for us this fall in Lubbock, San Antonio and far South Texas.  Until next time, be sure and stop by our LinkedIn career page to get a little insight on our culture and see how you can connect to Texas Mutual.

This Week in Comp

Compiled by David Wylie, Editorial Coordinator

Compiled by David Wylie, Editorial Coordinator

This Week in Comp provides an overview of workers’ compensation news from across the country.

Opioid Epidemic

Opioids: Gateway to Heroin
Workers’ Comp Insider
Many addicts are turning to the street drug heroin as a less-expensive alternative to prescription drugs. In fact, half of the approximately 200 heroin addicts treated at the Cleveland Clinic’s Alcohol and Drug Recovery Center started on prescription opiates…MORE

Safety

Oklahoma Teens Push Texting While Driving Ban
Claims Journal
A group of Oklahoma teens calling itself “Generation tXt” is meeting at the state Capitol to push for a new state law to prohibit texting while driving…MORE

Legislative Issues

Workers’ Comp Industry Insiders Review the Lay of the Land for 2014
Lexis Nexis
The looming expiration of the Terrorism Risk Insurance Program Reauthorization Act is one of many high-profile issues facing workers’ comp system stakeholders this year…MORE

The ACA’s Anticipated Effect on P/C and Workers’ Comp Lines
Claims Journal
Lower workers’ comp costs, delayed care, increased pharmacy costs…the potential impacts of the Affordable Care Act on the property and casualty industry is a mixed bag. Whatever the fallout, it will likely not be immediate, according to industry experts…MORE

Fraud

10 Warning Signs of Workers’ Comp Fraud
Business News Daily
Nearly every state requires businesses to provide workers’ compensation insurance (Texas is the exception). As with most mandatory legal requirements, there are always going to be individuals who try to get around this and cheat the system…MORE

Return-to-Work

Injured Worker is Back on the Job: Now What?
Texas Mutual Blog
The goal of the return-to-work process is to get injured employees well and back on the job. But the process does not end there. Bob Cogburn, vocational rehabilitation specialist at Texas Mutual, shares his tips for ensuring injured employees remain productive team members…MORE

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites.

Injured Worker is Back on the Job – Now What?

By Bob Cogburn,

By Bob Cogburn, Vocational Rehabilitation Specialist

In a previous series of post, I outlined the five steps in the return-to-work process. The last step, delivering a bona fide offer of employment to the injured worker, can be cathartic. In fact, I sometimes think once I cross it off my to-do list, the stars are aligned and all is perfect with the universe. I’ve saved my adjuster time and the policyholder a lot of money. But not so fast!

Our ultimate goal is to keep the employee at work, contributing as a productive team member.

I like what Mary S. said in response to my posts: “When my RN Case Managers are involved in these cases, we make sure the employer, the claimant and the doctor are all aware that we are monitoring everyone.”

Remember, we need to be cognizant of state workers’ comp rules. For example, the hours worked need to be specific, not “varied,” and distance traveled to the job site is a big deal, especially for the rural areas. 

Let’s face it. It takes work and diligent follow through, but here are some methods I use when the employee is back on the job:

Try everything  – I like what Brad Y did: He developed a form that specifically lists the injured worker’s modified duty restrictions, as well as the physical demand requirements of modified duty. Then, he had the worker check a “yes” or “no” box in response to the question: “Has any manager or supervisor asked you to work beyond your work restrictions?”   I initially begin to look to return the employee to the same job when possible. If not, I build on existing work experience and working relationships. This saves the worker the stress of adjusting to new tasks and surroundings. 

Make a visit – I don’t get to make many onsite visits, but they can be useful.  When the employee goes back to work, what can he REALLY do? What can’t he do? Which physical activities should he avoid? A physician statement is one thing, but seeing the employee work is quite another. And look around to identify possible light physical demand level job tasks.

Be an accomodation archivist – I am always thinking back on successful RTW experiences to share with employers. I keep a spreadsheet of as many modified jobs as I can accumulate. Past relevant modified offers from employers keep me on my toes and thinking. It may even help steer an employer away from having someone pull weeds in front of the company building just to get them back on the job. And it allows the employer to live out their commitment to putting people first.

Now we’re on track.

About the author

Bob Cogburn has nearly 25 years’ experience in vocational case management. Since 1997, he has been helping injured workers covered by a Texas Mutual® policy rehabilitate and return to productive employment. Prior to joining Texas Mutual, Bob served as a vocational rehabilitation counselor for the Department of Assistive Rehabilitation Services. He also spent time as a job placement counselor for Goodwill Industries and El Centro College. At El Centro, he managed a job club specializing in placing students with disabilities back into the workplace. Bob holds a bachelor’s in rehabilitation science from the University of Texas Health Science Center and a master’s in counseling from Amberton University.

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