The National Insurance Crime Bureau (NICB) reports that the number of suspicious or questionable claims has recently notably increased. Claimant fraud occurs when false or exaggerated injury claims are filed, historically on a Monday, or after the fact, with skewed circumstances, no witnesses, and no pure evidence to dispute the incident. Employers have long been frustrated about the workers’ compensation process, as it is very liberal and heavily weighted to the benefit of the employee. The employers feel certain that the alleged injuries have no connection to their employment, yet benefits are paid and the expense impacts the performance of the employer’s insurance results. The industry is currently fighting back against the problem of fraud by focusing on two major antifraud efforts: fraud awareness and investigation/enforcement.
Great strides are being made on behalf of the employer’s interest. Here are just a few examples of employers and insurance carriers winning against fraud… Read more
After meeting on Thursday, November 12, 2015, the Florida Office of Insurance Regulation (OIR) has approved an overall decrease of 4.7% in workers’ compensation rates. Following the disapproval of its original rate filing request, the National Council on Compensation Insurance (NCCI) submitted additional information for the OIR’s consideration on Friday, November 6, 2015.
The new rates will be applied to new and renewal policies bound after January 1, 2016.
Each year, the U.S. Occupational Safety and Health Administration (OSHA) inspects workplaces around the country for safety and occupational hazards. OSHA inspectors don’t often drop by, but when they do, they drop by unannounced, ready to hand out citations and fines for non-compliance to their safety standards. So, how do you not end up blindsided and have better control of the outcome of an OSHA inspection? Preparation is key. Here’s an OSHA checklist of five important things you can do to prepare for an inspection:
- Be safe enough for an inspection 365 days a year.
You’d be surprised by how many companies think they can skimp on safety because OSHA rarely comes around for an inspection. Don’t make that mistake! The number one thing you can do to prepare for an OSHA investigation is to make safety a priority. We recommend having a comprehensive safety program in place that you commit to in the long-term. This program should include regular safety training for your employees, a plan for keeping safety equipment like goggles and hardhats in stock for employees, and a standardized protocol for responding to hazardous situations. For more information on how to implement an effective safety culture in the workplace, contact your Gulfshore Insurance Client Advisor.
- Communicate with your team.
Your employees often have a better idea than you do of workplace hazards. So, make sure you check in with them regularly to ask about the equipment they’re using and how safe they feel on the job. You want them to know that there’s an open door policy when it comes to safety concerns and that their protection at work is one of your top priorities. So, don’t be afraid to start discussions about safety and ask your employees to be on the lookout for hazards for you. Communicate with your team about the potential inspection and educate them on what is involved.
- Get your paperwork in order.
You can count on the OSHA inspector asking to see your OSHA 300 form (or other log of illnesses and injuries). Update your company’s OSHA 300 logs, records of all work-related injuries and illnesses, on a regular basis. Additionally, you should plan on having to show written documentation of employee safety training. You will also likely need to furnish written proof of the safety programs you have in place. Make sure you have all of this in writing, and make sure that you know where all pertinent documents are before the inspection. These forms should be organized and easily accessible.
- Create an inspection team.
Assign key team members to a designated “inspection team.” These individuals will be responsible for helping the rest of the company prepare and for managing the inspection once the OSHA representative is on site.
- Hold a mock inspection.
Conduct semi-regular mock inspections on your own to identify potential health and safety issues that an OSHA inspector would find. In doing so, your company can correct any major issues long before the programmed inspection. This proactive approach will also help your company manage workplace hazards in future years, removing the need for an OSHA inspection entirely.
OSHA inspections can be unnerving for a company and its employees. Whether you’re on OSHA’s list of programmed inspections, or you’re just being proactive, the methods above will help prepare your team for assessment.
On August 20, 2015, the National Council on Compensation Insurance (NCCI) delivered its annual workers’ compensation insurance rate filing to the Florida Office of Insurance Regulation.
Based upon its review of the most recent data available, NCCI has proposed an overall average rate level decrease of 1.9 percent. With a reduction in the expense constant from $200 to $160 and changes to minimum premiums, the overall average premium decrease would be 2.2 percent, effective January 1, 2016.
If approved as filed, the overall average rate level change for each industry group will be as follows:
- Manufacturing: -4.7 percent
- Contracting: +1.0 percent
- Office and Clerical: -5.1 percent
- Goods and Services: -1.6 percent
- Miscellaneous: -1.8 percent
- Total: -1.9 percent
Today, Florida’s workers’ compensation insurance rates remain stable and commensurate with other southeastern states overall. However, rates could increase, perhaps dramatically, depending on decisions issued in a couple of pending court cases being monitored by the NCCI.
The Office of Insurance Regulation is expected to schedule a public rate hearing this October. We will keep you updated.
Promptly reporting workers’ compensation claims is a best practice, and now there’s evidence that a delay in reporting injuries can raise claims costs up to 51%.
Promptly reporting workers’ compensation claims is a best practice, and now there’s evidence that a delay in reporting injuries can raise claims costs. A new study from the National Council on Compensation Insurance, Inc. (NCCI) reports that a delayed injury report can increase compensation claim costs up to 51 percent as the condition worsens. The simple strategy of reporting claims promptly can significantly reduce claims costs.
NCCI researchers found that claims costs can climb after a delay of only seven days. A report more than 29 days after an incident may result in costs nearly 49 percent higher. One reason for the increase is that attorneys are more likely to become involved in comp cases the longer a claim is delayed. Employers are encouraged to help employees understand that prompt reporting of an accidental injury decreases the likelihood of an attorney’s involvement, according to J. Bradley Young, a partner with Harris, Dowell, Fisher & Harris, who works on compensation cases.
“I still deal with employers every day who feel that if they educate their workforce about comp laws, they’re simply telling their employees how to get more money out of comp claims, which isn’t the case,” Young told researchers.
Other obstacles to early reporting in the workplace are the perceptions that the employee who reports an injury will be doubted or considered lazy and not wanting to work. By not coming forward, some injuries can worsen, making costly measures such as surgery more likely. Employers can boost employee morale by communicating that injuries are a serious matter, and that employee well-being is a priority.
Based on the NCCI survey, employers who educate their workforce about early reporting and who demonstrate concern for all workplace injuries can significantly help create positive benefits for their employees while minimizing claims costs.
Contact the Gulfshore Insurance Risk Management Team with questions concerning claims reporting processes, as well as tools available to help mitigat workplace risks.
Tim Spear is a Client Advisor and Partner at Gulfshore Insurance. Tim works with a wide range of business clients to deliver strategic risk management and commercial property and casualty insurance guidance.
Tags: Claims, Claims Reporting, Commercial Risk Management, Gulfshore Insurance, Workers' Compensation