Your Claims Questions Answered – What do I do if I suspect workers’ comp fraud?

Workers’ compensation fraud hurts business owners by causing higher premiums. That’s why we take fraud seriously at Texas Mutual and have a team dedicated to investigating these concerns. In 2016, Texas Mutual investigated more than 1,600 referrals and discovered more than $1 million in claimant fraud.

In our next video in the Your Claims Questions Answered series, we talk about what you should do if you suspect fraud. Watch the video below and take a look at our top three tips to remember when it comes to fraud.

Always contact Texas Mutual first when you suspect fraud.
If you suspect someone at your workplace is committing fraud, the first step is to contact Texas Mutual. We have a dedicated team of licensed professionals that will investigate your referral. Don’t confront the employee, but instead trust the professionals to investigate. To report suspected fraud, call (800) 488-4488 or email fraudstoppers@texasmutual.com.

Maintain a good relationship with the injured worker.
It’s important to maintain a positive relationship with the injured worker throughout the recovery process. Instead of jumping to conclusions, voice your concerns to Texas Mutual. There could be many reasons why an employee is not home on bed rest and making accusations to an injured worker could lead to more problems for your business.

Put a return-to-work program in place.
Focus on a return-to-work plan with the injured worker. If they are unable to perform the job duties they did before their injury, then determine what modified job duties they can do that will help them contribute to the team. Injured workers out six months or more have only a 50 percent chance of ever returning to work. Getting an injured worker back on the job will prevent you from being in the middle of a fraud investigation. We recently covered how to create a return-to-work program. Remember, it’s never too early to get started.

You can watch the full Your Claims Questions Answered series here. Visit texasmutual.com for FraudStoppers posters, red flags of fraud, and more information on reporting fraud.

What is workers’ compensation?

From your property to your pets, there are many reasons to buy insurance. For a business owner, workers’ compensation insurance provides protection against the serious consequences of workplace injuries. Watch the video below from our Workers’ Comp Expert Minute Series to get a better understanding of workers’ comp.

As the video explains, workers’ compensation is an insurance policy that a business owner buys to pay for medical care and lost wages for an employee hurt on the job. It provides peace of mind because without workers’ comp coverage, employers have few financial protections if an injury occurs in their business. With a workers’ compensation provider like Texas Mutual Insurance Company, we are committed to helping you keep your employees safe and we work hard to get your employees back to a productive life after an injury.

Workers’ compensation also provides important protection for employees. In the insurance world, the services and payments a claimant (in this case, the injured worker) receives are known as benefits, and in workers’ comp, there are a few different types of benefits. Benefits are based on the wages the injured worker was not able to earn as a result of the injury he or she experienced and the severity of the injury. Below is a brief overview of the types of benefits an injured worker could receive.

  • Income benefits, also known as indemnity or lost wages benefits, replace a portion of the wages that are lost because of the work-related injury. For more information on the types of income benefits, click here.
  • Medical benefits cover the costs of medical care and treatment for a worker’s compensable injury or illness.
  • Death benefits are provided to an injured worker’s surviving family in the event of a fatality.

Workers’ compensation insurance protects businesses from the serious consequences that can result from workplace injuries. Texas Mutual also goes the extra mile and not only protects your business financially but also works hard to help you keep your workforce safe. We are your partner in preventing the injuries from happening in the first place. With more than 2,000 resources in our safety resource center including 200 e-Learning courses, we give you the resources you need to keep your employees safe on the job.

If you are interested in purchasing workers’ compensation coverage, speak to your agent. You can retrieve a list of agents in your area by visiting the Independent Insurance Agents of Texas website.

Your Claims Questions Answered – What can the Texas Star Network do for my business?

Texas Mutual offers a workers’ compensation heath care option called the Texas Star Network. Comprised of medical professionals with the return-to-work goal in mind, our network is one of the many ways we save you money.

Watch our next video in the Your Claims Questions Answered series on what the Texas Star Network can do for your business and take a look at the key benefits below.

Benefits of the Texas Star Network:

  • Policyholders receive a discount of up to 12 percent off their premium
  • Patients treated by an in-network doctor return to work eight days sooner on average
  • Injured workers receive top quality medical care with lower than average costs
  • It’s easy to find in-network providers through the network app or online directory
  • You can reduce your premium by lowering claim costs

We encourage you to consult your agent to determine if the network is the right choice for your business, but keep in mind you do not have to wait until your policy renews to enroll. The network comes with responsibilities for you and your employees.

Visit texasmutual.com for information on how to enroll in the network, and to find other network tools.

Your Claims Questions Answered is a six-part video series covering the most commonly asked claims questions. We’ve featured each episode on the blog with our key takeaways. You can watch the full series here or visit our recent posts about return-to-work programs, e-mods, the claims process, and reporting an injury.

Your Claims Questions Answered – How do I create a return-to-work program?

It’s our goal at Texas Mutual to get injured workers back to a productive life as soon as medically possible. With a return-to-work program, you can save on claim costs, business expenses and injured workers can heal sooner and get back to contributing to the team.

We cover how to create a return-to-work program in our next episode of the Your Claims Questions Answered series. Watch the video below and take a look at the steps to create a return-work program in your workplace. Keeping these steps in mind will help you be prepared if the unexpected happens.

Get started now.
A return-to-work program should begin before an injury occurs. For all your employees, make sure you have a current record of their daily job duties, such as a job description, and encourage cross training. That way if an injury occurs that requires leave time, your team can make sure the job duties get fulfilled and you don’t miss a beat.

It may seem like a quick fix to bring someone new in, but the time and expense of hiring a new employee to replace an experienced worker is 50 to 150 percent of their salary.

Determine modified job duties.
The treating doctor will determine the injured worker’s ability to perform job duties. If they are unable to return to the same job, determine what parts of the job they can still do or find a different area in which the employee can make a positive contribution.

Make an offer to the injured worker for the modified position. It’s best to put it in writing, and it should include a DWC Form-073 (Texas Workers’ Compensation Work Status Report) completed by the physician.

Keep open lines of communication.
A little bit of motivation can go a long way for someone recovering from an injury. Stay in touch with the employee and check in with them. This can help them avoid feelings of isolation and the disability mindset. If the employee is back on the job with modified duties, see how they are adjusting to the new role.

Open communication is also important with Texas Mutual. If you have questions or concerns about the injured worker’s claim or recovery, call us at (800) 859-5995.

While every case is different, one of the best ways to control workers’ compensation costs is with a return-to-work program. Call the Texas Mutual safety services team at 844-WORKSAFE (967-5723) for help getting started or visit texasmutual.com for more resources. Watch the Your Claims Questions Answered series here and read our key takeaways from how claims affect your e-mod, reporting an injury, and your role in the claims process.

Your Claims Questions Answered – How do claims affect my experience modifier?

We kicked off our new video series Your Claims Questions Answered with key takeaways on your role in the claims process and how to report an injury. This week, we’re diving a little deeper into how claims can affect your experience modifier. Watch the video below and take a look at our key takeaways to learn about experience modifiers and what it means for your workers’ compensation premium.

What is an experience modifier?

An experience modifier or e-mod is a factor applied to your workers’ comp rate that is a comparison of your company’s loss experience against other employers in the same industry as you. If your company has had severe and medical-only losses, the e-mod will adjust your premium to lower the impact of those claims. Typically only mid-to-large size businesses will receive an e-mod.

How is an e-mod calculated?

The National Council on Compensation Insurance (NCCI) adjusts and rates e-mods in Texas. They look at payroll and claim history from the past three policy years to help identify potential losses. In general, employers with better-than-average loss history will see lower premium compared to the average, and employers with below-average loss history will see higher premium compared to the average.

All data is reported to NCCI, but not all losses are entered into the e-mod formula. In some cases, a small loss will have no impact or a proportionately small impact on your experience modifier.

Always report claims

A good rule of thumb is to always report your claims. Taking care of small claims on your own is not always in your best interest and most business owners are not experts in workers’ compensation law. From missing out on network savings to opening up your business for penalties, not involving Texas Mutual is not worth the risk.

The best way to manage your e-mod is with effective loss prevention and return-to-work programs. But remember, an e-mod is a pricing modifier and isn’t always a direct representation of a company’s commitment to safety. For more information on e-mods and how to qualify for one, visit texasmutual.com.

In our next installment of Your Claims Questions Answered, we’ll share our tips on creating an effective return-to-work program for your injured workers.

Your Claims Questions Answered – What do I do if an employee gets hurt?

In our new YouTube video series Your Claims Questions Answered, we address the most commonly asked claims-related questions. We covered your role in the claims process recently on the blog. Next up, we are discussing what to do when an employee gets hurt while at work. Watch the video and take a look at our key takeaways below.

Address the employee’s health

If an employee is injured on the job, the first thing you should do is assess the situation and determine if it is an emergency. Call 911 if needed and make sure the employee gets timely care to facilitate a quick recovery.

Using the Texas Star Network can help employees get the care they need and can help you manage claim costs. Injured workers can search for a treating doctor, pharmacy, or specialist through the Texas Star Network’s provider portal online or through the Texas Star Network’s mobile app.

Report the claim to Texas Mutual

To report an injury, we will need a DWC-1 Form known as the Employer’s First Report of Injury or Illness. We’ve made it easy to report claims to Texas Mutual online, by phone, fax or mail. Whichever way you choose to report, it’s best to make a report as soon as you can, so Texas Mutual can help you with the claim. The law allows employers up to eight days to report the injury.

Keep open lines of communication

Open communication supports a culture of safety by empowering employees to voice their concerns. Make sure employees know how to report safety hazards and how to access the resources they need to be safe on the job.

In the event someone is injured on the job, getting them back to a productive life is always best. Stay in touch with the employee throughout their recovery to help mitigate their feelings of isolation and maintain team comradery.  A return-to-work program can be started before an injury occurs. Visit the Return-to-Work page at texasmutual.com for more resources.

Training and preparation

There are steps you should take to be as prepared as possible for when a workplace injury occurs. Making safety a habit starts with providing the right training for your employees to do their jobs safely. Texas Mutual has free resources available for you and your employees including webinars and e-Learning online training courses.

Assign a point person to take the lead during injury incidents and create an action plan that is accessible for your employees. Practice drills can help your workplace prepare for an emergency situation and can help you identify any shortfalls in training.

Keeping these tips in mind will help you be prepared when a workplace injury occurs. Next in the Your Claims Questions Answered series, we’ll cover how claims affect your e-mod.

Before You Text Behind the Wheel, Watch this Short Video

Texas Mutual’s workers’ comp experts do their best to share their expertise with you as economically as possible. We know you’re busy, so we keep our posts short and to the point.

Sometimes, a third party reminds us that words aren’t always the best way to make a lasting impression.

This short video by the National Highway Traffic Safety Administration demonstrates, in no uncertain terms, the potentially fatal consequences of texting while driving.

The next time you’re tempted to glance at that cellphone screen, if only for split second, remember this 30-second video. It might save your life.

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