Trust is essential for handling workers’ comp fraud in your business

2f83b2f3-7e75-4a8c-a68b-cf13e89d7155.jpgMost employers are very clear about why workers’ comp fraud is a serious issue, but what is often not clear is how to handle it. It’s an unfortunate part of many workplaces so it’s vital to know what to do when you suspect it’s occurring. Your reaction to the situation could determine how simple or complicated the issue becomes.

There are three things to remember when you have a hunch fraud might be occurring, and they all center on trust:

Trust your workforce

Fraud happens, but the vast majority of workers’ compensation claims are legitimate. It’s easy to jump to conclusions if you feel taken advantage of, but not everything you see as questionable is fraud. For instance, running into an injured worker pushing a grocery cart in the supermarket could raise your suspicions, but that doesn’t prove they’re committing fraud. Filing a workers’ compensation claim doesn’t require them to be home bound, but some employers would see that as a clear-cut sign that the injury wasn’t legitimate or its affects are being exaggerated.

The best approach as an employer is to be aware of what’s going on in your business but to trust your workforce. It can be tempting to assume the worst but trust between you and your employees is an important part of managing claims and encouraging return-to-work, which is ultimately best for everyone. Keep in mind that trust must be established by both parties. Adopting hiring best practices – such as completing thorough interviews, checking references and requiring pre-employment drug screenings – is just as important as a worker earning your trust day to day.

Trust your instincts

While employees deserve the benefit of the doubt, you know your business and people better than anyone else. In many instances you could be one of the first to observe a case of workers’ comp fraud. If you have reason to believe it’s happening, trust your instincts and contact Texas Mutual’s fraud investigation unit. Often employers feel that they need to obtain proof or gather a vast amount of information before they can report it, but all you really need is a hunch. Follow your instincts and report fraud as soon as you become aware of it.

Trust our team of investigators

When you do report potential workers’ comp fraud to Texas Mutual, our three teams of investigators are ready to pursue every report. They investigate each case to determine whether or not fraud is occurring, which takes the burden off you to investigate your own employees or make accusations. Workers’ comp fraud is a serious allegation and it’s important to not alienate your employee before you have confirmation. Handling the issue so you don’t have to is an important part of the role Texas Mutual plays.

Workers’ comp fraud hurts everyone involved, which is why Texas Mutual takes it just as seriously as you do. We investigate thousands of claims each year and save employers money in the long run. Visit the Fighting Fraud section of our website to find out more.

Regulatory Roundup, February 26, 2016

Regulatory Roundup is Texas Mutual’s weekly compilation of employee wellness and safety news from around the world.

Texas Mutual news

Getting started with functional fitness
Fitness shoesReady to ditch curls, bench presses and triceps extensions in favor of practical exercises that prepare your body for everyday life? You don’t need high-tech tools to reap the benefits of functional fitness…MORE

Chemical Safety Board (CSB)

Ammonium nitrate should be regulated under the Clean Air Act, says CSB
In its final report on the West Fertilizer Company explosion, the CSB recommends the Environmental Protection Agency add fertilizer-grade ammonium nitrate to the list of substances regulated under the Clean Air Act’s Risk Management Program (RMP). The RMP requires facilities with threshold amounts of dangerous gaseous and liquid substances to take precautionary actions…MORE

Federal Railroad Administration (FRA)

Feds to states: Make sure traffic lights connected to railroad crossings work
trainAcross the United States, there are nearly 5,000 railroad crossings interconnected with traffic lights. The FRA urges states to make sure those lights are synced with adjacent railroad crossing signals. The goal is to reduce the number of railroad crossing fatalities. The FRA has also partnered with Google to pinpoint railroad crossings and add alerts to map applications…MORE

National Institute for Occupational Safety and Health (NIOSH)

Do NFL players live longer than the rest of us?
For most of us, high body mass index correlates with high body fat. And high body fat is a risk factor for myriad conditions, including heart disease. Is the same true for elite athletes, who might register high BMIs simply because they have more muscle than the rest of us? A new NIOSH study seeks to answer that question and more about the guys who suit up on Sundays…MORE

Are you ready for the final phase of OSHA’s haz comm rollout?
PrintJune 1, 2016 is the final deadline in the four-year phase-in period for OSHA’s 2012 revisions to the hazard communication standard. By that date, employers must be in compliance with all aspects of the revised regulation, including employee training, or risk being fined by OSHA…MORE

NIOSH wants to protect workers from robots
Last summer, an industrial robot at a German Volkswagen assembly line gripped a worker, pressed him against a metal plate and crushed his chest. With humans and robots increasingly sharing workspace, NIOSH issued a list of tips for preventing similar clashes between the two…MORE

Portable lab brings research to oil and gas field
OilfieldNIOSH researchers are using a new portable field laboratory to determine if workers at oil and gas wells are exposed to harmful levels of potentially toxic materials. The portable lab empowers researchers to collect real-time data 24 hours a day, without the delays involved in sending samples to an offsite lab for analysis…MORE

Occupational Safety and Health Administration (OSHA)

OSHA issues draft guidance for ‘weight of evidence’ approach
The weight of evidence process is intended to help employers evaluate scientific studies on chemical hazards, which can in turn be used to determine what information needs to be included on chemical labels and Safety Data Sheets, as required under the revised hazard communication standard…MORE

Studies, Resources, Trends, News

Gunman kills at least 4 at manufacturing plant where he works
Police line-victimFour people are dead, including the shooter, and at least 14 are injured after an employee opened fire at the Kansas manufacturing plant where he worked. The incident, and the scores of others like it in recent months, underscores the importance of putting controls in place to protect employees…MORE

UL report compares financial impact of workplace injuries, health conditions across states
Texas businesses with 500 employees or more spent an average of $5 million on health care, lost productivity and missed workdays associated with workplace accidents and adverse health conditions in 2012, according to a new Underwriting Laboratories report. The Lone Star State’s workplace injury rate was slightly worse than the national average in 2012, as were our rates of smoking, obesity and related conditions. On a positive note, Texans were less likely to smoke and suffer from heart disease and stroke than their counterparts in other states…MORE

Sad or mad? Stay out of the car!

Two firefighters investigating wrecked car on its side

Drivers increase their crash risk nearly tenfold when they get behind the wheel while observably angry, sad, crying or emotionally agitated, according to the Virginia Tech Transportation Institute. Drivers more than double their crash risk when they choose to engage in distracting activities that require them to take their eyes off the road…MORE

6 ways employers can help cancer victims return to work
Nearly three-quarters of cancer patients and survivors want to work. But they must deal with fatigue and other challenges that affect their performance. Driver-related factors that include fatigue, error, impairment and distraction were present in nearly 90 percent of the crashes included in the study…MORE

Texas tornadoes trigger closer look at building construction, codes
During the 2015 holiday season, a string of tornados tore across the Dallas area and cause an estimated 1.2 billion in damage. Now, engineers are advocating for tornado-resilient structures across “tornado alley,” which stretches from North Texas through South Dakota…MORE

Getting started with functional fitness

From the bicep curl to the tricep extension, conventional weight-bearing exercises isolate muscle groups for maximum return. That’s great if you’re chasing a beach-ready body. But it doesn’t translate if your goal is to be able to swing a jack hammer, reach up to get something off a shelf, or even get out of your office chair without hurting yourself.

A trainer from the Cooper Clinic, a Texas Mutual policyholder, demonstrates a simple exercise that is good for people who suffer from arthritis.

For those everyday tasks, you need functional fitness.

Functional fitness exercises improve our posture, flexibility, range of motion, joint alignment, bone density and core strength.

So how do you get there? Here are a few tips to get you started.

Consult your doctor. Before you start any exercise program, consult your doctor, especially if you have a heart condition, asthma or other health issues.

Work with a professional. An Internet search for “functional fitness basics” yields a laundry list of results. If you want more guidance, enlist a certified trainer’s help, or see if your local gym offers functional fitness classes.

Identify your needs. Muscular strength and endurance are different concepts. Hefting 50-pound bags of concrete on a construction site requires strength. Lugging a relatively light bag of groceries up three flights of stairs leans on muscular endurance. Think about what you want to get out of functional fitness, and then choose exercises that meet your needs.

Choose exercises that meet your needs. Functional fitness exercises mimic movements we do in our everyday lives. Multidirectional lunges prepare your body for vacuuming and yardwork. Stair climbs with bicep curls condition your legs and arms for carrying groceries to your second-floor apartment. Identify exercises that will prepare your body for the rigors of the job – whether on or off the clock.

Don’t ditch traditional training. While the benefits of functional fitness are well-documented, the bench press, curl and other mainstays of strength training have their place. Experts advise you to treat functional fitness as s complement to, not a replacement for, traditional strength training.

Start with your body weight. By starting with your body weight, you’ll teach your body to control and balance its own weight before handling heavier loads.

Focus on form. Power lifters looking to gain mass work their muscles to fatigue. For example, they might do bench press reps until their body physically can’t do another. Functional fitness stresses form over quantity. When you can no longer do an exercise with proper form, it’s time for a break.

Invest in tools of the trade. You don’t need a fancy gym to invest in functional fitness. Most sporting goods stores offer stability balls, medicine balls, kettlebells, foam rollers, resistance bands, free-weights and other low-tech tools of the trade.

Follow our series on functional fitness
This post is the final installment in our series on functional fitness. If you missed previous installments, click on the links below:

Regulatory Roundup, February 19, 2016

Regulatory Roundup is Texas Mutual’s weekly digest of employee wellness and safety news.

Texas Mutual News

A case study in functional fitness
ExercisingThe typical UPS driver works 12-hour shifts, walks four miles a day and lifts about 1 million pounds per year. The job’s physical demands made it the perfect candidate for an investment in functional fitness…MORE

Texas Mutual grants fund free workplace safety training
Texas Mutual recently issued $100,000 grants to El Paso Community College and Midland College. The grants will fund free workplace safety training for the public. Texas Mutual has issued $4.5 million in safety education grants through its partnerships with Texas colleges.

U.S. Department of Transportation (DOT)

DOT proposes national safety plan for public transit systems
The plan would require public transit system operators to adopt a safety management system, as well as have their plans approved by a board of directors, or equivalent, and perform an annual review and update of the plan…MORE

Environmental Protection Agency (EPA)

EPA proposes 18-month compliance extension on hazardous emissions rule
Oil WorkersThe EPA initially required refineries to comply with its hazardous emissions rule by February. 1, 2016. The 18-month extension would give refineries time to install the equipment needed to comply with emissions limits during periods of start-up, shutdown and maintenance or inspection, as well as ensure safety requirements associated with those installations are met. Refineries that need to undertake capital projects to come into compliance with the requirements can request a 12-month extension…MORE

Food and Drug Administration (FDA)

FDA issues recommendations to reduce the risk for Zika virus blood transmission
If you’ve been to areas with active Zika virus transmission, potentially been exposed to the virus or been infected with Zika, the FDA recommends you defer donating blood. While there have been no reports to date of Zika virus entering the U.S. blood supply, the risk of blood transmission is considered likely…MORE

National Institute for Occupational Safety and Health (NIOSH)

NIOSH recommends employers treat e-cigarettes like tobacco products
The laws around smoking in the workplace are clear, well-established and indisputable. But e-cigarettes, unlike their traditional tobacco counterparts, create a cloud of uncertainty for employers. They’re not regulated, and we haven’t fully defined their health risks. In fact, consuming an e-cigarette isn’t even called smoking; it’s called vaping. In the absence of specific guidance, NIOSH recommends employers implement e-cigarette policies that mimic their policies on tobacco products…MORE

Occupational Safety and Health Administration (OSHA)

OSHA invites oil and gas industry to ‘step up’ safety
This week, OSHA launched a national campaign to promote safety in the oil and gas industry. Campaign activities will include site inspections and safety training. Resources include a website that features toolbox educational materials on hazards associated with hydraulic fracturing, tank gauging and other common tasks. Oil and gas workers have one of the highest on-the-job death risks in the country, with 142 workers killed in 2014…MORE

Compliance assistance, not fines, should be priority, senators tell OSHA
OSHAenforcement_300pxHave you ever been pulled over because you had a burned-out headlight? Did you get a warning, fix the light and learn a valuable lesson? That, in essence, is how Sen. James Lankford (R-OK) would like to see OSHA’s interactions with employers go. In a hearing before the Senate Homeland Security and Government Affairs Committee, Lankford urged OSHA to redirect resources from back-end fines to up-front compliance assistance. Texas employers have access to free compliance assistance through the state’s Occupational Safety and Health Consultation program…MORE

Cell tower worker deaths fall 75 percent
In October 2014, OSHA and the Federal Communications Commission joined forces to reduce the alarming trend in cell tower worker deaths. If statistics are any indication, the partnership appears to be working just as OSHA hoped. Cell tower worker deaths fell from 12 in 2014 to three in 2015…MORE

You can’t subcontract safety: OSHA, FCC host workshop on tower climbers
People are dying for faster cell service – literally. Between 2011 and 2015, 36 workers died in communication tower-related incidents, according to OSHA. The industry’s reliance on subcontractors, some of whom may not be qualified to climb cell towers, is at least partially to blame for the issue, according to stakeholders who participated in a recent OSHA workshop. Furthermore, stakeholders noted towers should include more platforms and dedicated tie-off points…MORE

OSHA issues new guidelines on preventing workplace violence in health care settings
Police line-victimHealth care workers account for 20 percent of workplace injuries across industries but 50 percent of workplace violent incidents. To reverse the trend, OSHA issued new guidelines that update its 1996 and 2004 voluntary guidelines for preventing workplace violence among health care and social service workers…MORE


Studies, Resources, Trends, News

FilterSense offers new intelligent controllers for dust collector operators
The controllers integrate and display the status of the process parameters, such as filter condition, DP, temperature, air flow, hopper level fan amps and solenoids. The display means operators won’t need to make visual bag house rounds…MORE

Company offers alternative to OSHA-approved gloves
OSHA requires technicians working on high-voltage hybrids and EVs to wear class 0 gloves. Some technicians say the bulky gloves hinder the tactile sensitivity they need to do their jobs. An Illinois-based company offers an alternative glove approved by the American National Standards Institute…MORE

Motor vehicle deaths increase by largest percentage in 50 years
Investigating a car wreckThe National Safety Council (NSC) estimates 38,300 people were killed on U.S. roads in 2015. That’s an 8 percent jump over 2014 and the largest year-over-year percentage increase in 50 years. A stronger economy and lower unemployment rates are likely at the core of the trend, according to the NSC. Simply put, Americans logged more miles behind the wheel in 2015 because driving was more affordable…MORE

Studies tie work stress to unhealthy lifestyles
Overworked and stressed-out employees may turn to unhealthy habits to find comfort or cope, and they may lack the time and resources for exercise and cooking meals, according to two new studies. One study noted work health programs could be more effective if they helped lower stress… MORE

Do you know your state’s distracted driving laws?
Did you know in Texas, it’s illegal to use a hand-held phone or send a text message in a school zone? Or that our neighbors, Oklahoma, passed a law banning texting behind the wheel for all ages? Learn the distracted driving laws in your state at…MORE



A case study in functional fitness

The typical UPS driver works 12-hour shifts, walks for miles a day and lifts about 1-million pounds per year. The job’s physical demands make it the perfect candidate for an investment in functional fitness.

That’s exactly what a California UPS unit did in 2003.

Within one year of launching its functional fitness program, UPS had reduced injury rates by 50 percent. By year two, rates were down 85 percent, and workers’ comp premiums dropped 60 percent.

Management noticed workplace injuries were up. Predictably, so were workers’ comp premiums. So the organization went to work on a forward-thinking solution.

The process started with a thorough review of claim trends. In many cases, the data suggested awkward and improper lifting techniques, poor body mechanics, excessive reaching, forceful exertions and environmental hazards, such as excessive heat and cold, contributed to injuries.

With guidance from outside ergonomics experts, UPS built the framework for a functional fitness program. The program included one-on-one training sessions designed to improve body mechanics, strength, flexibility and core conditioning.

Training equipment ranged from the everyday – medicine balls, resistance bands, light weights – to the sophisticated – skinfold calipers, blood pressure cuffs and computerized exercise protocols.

UPS also designed a three-minute, progressive warmup drill that flowed from the neck to the feet. The drill incorporated balance, agility and weight transference.

UPS management recognized that even the most comprehensive training program will fall short if employees don’t properly fuel their bodies. So they provided healthy lunches and stressed the importance of hydration in reducing muscle fatigue and its associated injuries.

Within one year of launching its functional fitness program, UPS had reduced injury rates by 50 percent. By year two, rates were down 85 percent, and workers’ comp premiums dropped 60 percent.

How’s that for a return on investment?

Of course, many small businesses do not have the time or money to bring in experts to help them cash in on the benefits of functional fitness. Fortunately, you don’t have to.

In our next post, we’ll share a few simple tips for making functional fitness part of your integrated safety and wellness program.

Follow our series on functional fitness
This post is the third installment in our series on functional fitness. If you missed the previous installments, click on the links below:

Regulatory Roundup, February 12, 2016

Regulatory Roundup is Texas Mutual’s weekly compilation of employee health and safety news.

Texas Mutual News

Functional fitness: Exercise you can live with
ExercisingWant to prepare your body for the rigors of your job? Leave the 1,000-pound tire rolls and 60-inch box jumps to NFL superstar JJ Watt. We industrial athletes can lean on functional fitness to get through the day injury-free…MORE

7 things you should know about the Zika virus
Here are seven things you need to know about the mosquito-borne virus the World Health Organization has declared a global health emergency…MORE

Centers for Disease Control and Prevention (CDC)

CDC issues updated guidance on Zika virus
A Dallas County resident recently became the first reported case of a U.S. citizen contracting Zika on domestic soil. The incident prompted the CDC to issue updated guidance, including new recommendations for pregnant women…MORE

Employer accommodations help employees with arthritis stay on the job
rtwArthritis is the most common disability in the U.S., and 30 percent of victims say their condition limits them at work. Employers can help by offering extended health benefits, special equipment, flexible hours, short-term leave, work-from-home policies, modified schedules and wellness tools…MORE

Safety Agency Funding

Proposal bumps budgets of three safety agencies
Under the proposed fiscal year 2017 budget, the Chemical Safety Board will get $12.4 million, up from $1.4 million the previous year. OSHA’s $595 million budget represents a $42 million bump. Finally, the Mine Safety and Health Administration budget will increase $20 million to $397.4 million…MORE

Federal Motor Carrier Safety Administration (FMCSA)

FMCSA’s anti-coercion rule now in effect
The rule gives the FMCSA the authority to take enforcement action against motor carriers, shippers, receivers and transportation intermediaries that compel commercial truck and bus drivers to violate hours of service limits and other federal safety regulations…MORE

Center for Construction Research and Training (CPWR)

CPWR to host free webinar on preventing construction industry falls
safety pays falls costs logoIn 2015, 2.5 million construction workers learned about the importance of preventing falls during the annual Stand Down for Safety campaign. The CPWR, Occupational Safety and Health Administration and National Institute for Occupational Safety and Health hope to double that number during this year’s campaign. The agencies will host a free webinar to build momentum around the event. The one-hour webinar will take place Feb. 16, 2016, at 2 p.m. EST. Falls are the leading cause of accidents in the construction industry, accounting for 30 percent of injuries and deaths…MORE

National Highway Traffic Safety Administration (NHTSA)

U.S. traffic deaths up 9 percent
IncreaseDuring the first nine months of last year, 26,000 people died in traffic accidents, a 9 percent increase compared with the same period in 2014. Human factors contribute to 94 percent of crashes, according to NHTSA research…MORE

National Institute for Occupational Safety and Health (NIOSH)

NIOSH, OSHA release safety alert on tank gauging operations
Oxygen-deficient atmospheres, inhalation exposures to concentrated petroleum hydrocarbon gases and vapors, and fires and explosions are just a few of the hazards workers are exposed to when they open thief hatches and manually gauge and sample fluids from production and flow back tanks. In fact, NIOSH identified nine fatalities over five years that were associated with working closely to open hatches of crude oil. This safety alert recommends measures employers should take to protect workers…MORE

Fatigue, high-risk motor carrier led to fatal multivehicle collision
Semi TruckThe driver of a truck-tractor involved in a fatal crash had slept less than four-and-a-half of the 37 hours preceding the crash. Furthermore, the National Transportation Safety Board had labeled his employer a high-risk carrier based on its consistently poor safety record…MORE

NIOSH ladder safety app now includes step ladders
The app provides guides and interactive tools that help users select and safely use extension ladders and step ladders…MORE

Occupational Safety and Health Administration (OSHA)

OSHA creates Web page on restroom sanitation obligations
The new page includes information on the minimum number of separate toilet facilities an employer must provide members of both sexes. Restrooms must have hot and cold water, hand soap and a means to dry hands…MORE

New whistleblower guidance could equal higher legal costs for employers
New guidance from OSHA could result in more whistleblower allegations from employees and higher legal defense costs for employers…MORE

OSHA to delay enforcement on part of electrical safety rule
OSHAenforcement_300pxOSHA will not enforce its revised minimum approach distances for voltages of 5.1 kilovolts or greater until at least Jan. 31, 2017, provided employers fulfill two obligations…MORE

OSHA extends temporary enforcement policy for confined spaces in construction
Up to and including March 8, 2016, OSHA will not issue citations under the confined spaces in construction standard to an employer engaged in residential construction work if the employer is making good faith efforts to comply with the standard. To qualify for the exemption, the employer must comply with the new standard’s training requirements or the previous standard’s training requirements…MORE

Studies, Resources, Trends, News

First responders: Beware of stranded energy in alternative vehicles
Hybrids and other alternative fuel vehicles reduce pollution and conserve fossil fuels. They also present unique safety risks for first responders in the form of stranded energy. Stranded energy happens when an alternative fuel vehicle crashes or catches on fire, leaving energy in the battery pack. Stranded energy can spark two primary hazards: high-voltage risks and thermal runaway events…MORE

Beyond exercise: Keeping healthy at your desk job
ExercisingAdults are sedentary 64 percent of their waking hours. All that chair time contributes to obesity and related conditions, such as diabetes and heart disease. Desk-bound workers can incorporate physical activity into the daily grind by standing up while on the phone, using a standing desk and speaking to a colleague in person rather than on the phone or computer…MORE

U.S. safety rules key to driverless car future: Google
Google says it designed its driverless vehicles to meet or exceed U.S. safety standards. Still, federal regulators’ interpretation of those standards will affect Google’s timeline for making fully autonomous vehicles a reality on U.S. roads…MORE

Three tools to help injured workers get well soon

iStock_000017083352_SmallTexas Mutual’s Texas Star Network has seen better results from the care provided to injured workers year after year because of the relationships we develop with physicians in our health care network. However, getting workers well and back on the job is a team effort and employers play a significant role as well.

Maintaining a safe workplace and enrolling in our health care network, the Texas Star Network, are two of the best ways to help control costs, but getting injured workers the care they need promptly has an impact as well. Focusing on an injured worker’s well-being isn’t just good for them; it’s good for your bottom line. When an injury is treated in a timely manner and by a preferred network physician, injured workers tend to have a more successful recovery and costs are more likely to be contained.

In fact, on average, Texas Star Network patients return to work eight days sooner than non-network patients and average indemnity benefits are 14 percent lower for network policies compared with non-network policies.

To assist workers with getting the care they need after an injury, Texas Mutual offers a number of tools. Using these three tools can help control costs and get employees back to work quicker:

Texas Mutual app

Texas Mutual’s network app for iPhone and Android makes it possible to find care for workers at any time, whether in the office or at a job site. The app also offers informational, easy-to-access videos about the claims process and the Texas Star Network that employers can use for training purposes or in the event of an injury. Click here to download the app in Google Play or here to download from the Apple app store.

First Fill Program

Our First Fill Program, which launched in 2015, enables injured employees to get prescribed medication quickly after an injury occurs, even if their employer hasn’t had the opportunity to file a claim. Injured workers can get a seven-day supply for each covered prescription, up to $500 per prescription, with just the First Fill form. The form can be found in the Forms section under the Employers tab at, or by clicking here.

11026471_10155285158455296_2089725072_nPreferred provider indication

Texas Mutual has done the work to identify preferred providers in the Texas Star Network and we share that information with employers. The Texas Mutual app, our online directory and the Texas Star Network phone line can all direct employers to physicians that see better return-to-work results for workers’ comp patients, choose the best course of treatment and help control costs. In the app and online, preferred providers are indicated with a green icon, and on the phone line, preferred providers will be recommended first.

A workplace injury can be a stressful time for everyone involved, but focusing on the employee and having tools that help simplify the situation are key to heading in the right direction.

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