Insured Solutions
Insured Solutions

Employer Work Comp CYA or Pay the Piper

Workers Compensation was created for a truly noble cause. It has worked as intended for many years. However, as we have seen in recent decades it has morphed into a nice piggy bank for attorney’, doctors, select carriers, and yes…employees; all on your nickel.

In prior Newsletters we have commented on how attractive Work Comp is for the chronically unskilled who are sadly content to work for low wages. After all, why do they need health insurance and vacation disability insurance when by simply getting on a payroll, maybe YOURS, Work Comp with no deductibles or co-pays plus a full-income rider will do quite nicely?

It is very clear that in more recent years the income security of Work Comp has not gone unnoticed making it imperative that every employer “stand guard at the door of their payroll”. To not do so is to risk a major claim, not injury mind you, but claim and the problems it will cause for you do not just end at your back pocket.

Find below a list of RED FLAGS to consider during both your - screening or interview process, and after an injury is reported. Know that only YOU can prevent a Work Comp disaster, not your carrier whose role is to follow state laws on guaranteeing the rights of injured employees, truth or fiction surrounding the claim matters very little in the end. Your carrier is not going to do your due diligence for you - only YOU can do that.

DURING THE APPLICANT INTERVIEW RED FLAG QUESTIONS FROM THEM TO YOU

  • What are you going to do for me?
  • How hard do I have to work?
  • How soon will I get a raise?
  • What exactly are my working hours and how early can I leave every day?
  • How soon is my first vacation?
  • I've never done this job before and don't know how?
  • Can I skip the grunt work?
  • Can I get an advance?
  • What are my benefits?
  • How much money will I make?

DURING THE INTERVIEW APPLICANT RED FLAG RESPONSES FROM YOUR QUESTIONS

  • Explanation of time lapses between jobs
  • Explanation of abnormally high address changes in recent years
  • Gives negative or vague reasons for leaving prior employer
  • Provides inconsistent answers
  • Giving unrealistic or irrational answers
  • Displays a lack of preparedness – seems off balance or rambling
  • Has no career or personal goals in life – a MAJOR red flag
  • Responds negatively to just about everything – nothing is their fault and the glass is always half empty

THE CLAIMANT AFTER REPORTING AN INJURY PRIOR CLAIM HSTORY AND IN CURRENT WORK STATUS HERE ARE RED FLAGS CONCERNS TO REPORT

  • Disgruntled, soon to retire, or facing imminent firing or layoff
  • Involved in seasonal work that is about to end
  • Taking unexplained or excessive time off prior to a reported injury
  • Taking more time off than the alleged injury seems to warrant
  • Nomadic with a history of short-term employment
  • New on the job
  • Indications of financial difficulties and personal pressures
  • Recently purchased private disability policy
  • Changes physician when a release for work has been issued
  • History of reporting subjective injuries
  • Rehab report describes the employee as being muscular, well tanned, with calloused hands and grease under the fingernails.
  • First notification of injury is made after employee is terminated or laid off
  • Disputes average weekly wage due to additional incomes expectations
  • Has several other family members also receiving Work Comp benefits or social insurance type checks – including unemployment
  • Demands a quick settlement decision or commitment
  • Demands quick payments for medical providers
  • Seems unusually familiar with Work Comp procedures and law
  • Consistently uncooperative
  • Surveillance or “tip” indicates employee is working elsewhere or is engaging in activities inconsistent with the alleged injury
  • Has submitted material misrepresentation on personnel file forms i.e. Application or a Post Offer Medical Questionnaire if used
  • Comes to office for delivery of benefit checks
  • Refuses to allow visits or rehabilitation at home or specifies plenty of warning time prior to a visit for rehab
  • Participates in contact sports or physically demanding hobbies
  • Is never home or spouse/relative/room mate answer phone stating employee has "just stepped out", or they will try to contact them by other means
  • Return calls to residence have strange or unexpected background noises which indicate it may not be a residence
  • Protests about returning to work and never seems to improve
  • Cancels or fails to keep doctor appointments or refuses a diagnostic procedure to confirm an injury
  • Complains to carrier or top management at home office to press for a payment

In the end...only you can look out for YOU. Letting the significance of effective screening and reporting of claim RED FLAGS slide by from being "too busy", or crossing fingers that all will be OK - is a mistake, which will surface and do its damage to your back pocket. It happens every single day and your turn at experiencing the frustration of this almost torturous ordeal is merely a matter of time.

You may not have a perfect plan to address this subject as of today but consider...

A good plan executed today is better than a perfect plan executed at some indefinite point in the future. General George Patton was no dummy.