Using Social Media to Fight Workers Compensation Fraud

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Social media, FaceBook superhero cartoon figureMost employees are honest. A few are not. When an employee presents an un-witnessed, subjective injury workers’ compensation claim, the smart employer will encourage the work comp adjuster to verify the validity of the claim.

 Some bright, but unethical employees will present a bogus injury claim, or attempt to inflate a legitimate injury, and will think about how to cover their fraud tracks. However, most employees who commit workers’ compensation fraud do not maintain their fraudulent façade consistently throughout the course of their insurance claim. Often there is information available in social media that proves the claim is bogus or inflated. The skilled insurance adjuster can frequently uncover information about previous insurance claims or prior medical treatment, but does not have the skill, the time or the capability to do private investigator type work through all the social media sites.

Investigation Firms Are Many More Times Proficient At Obtain Social Media Information

Private investigators are many time more proficient in obtaining beneficial information from social media websites than the work comp adjuster. If the social media information available is unknown to the adjuster, it provides no value. Social media information can have a major impact on the outcome of the workers’ compensation claim, but only if it is known. For example: The employee pursuing the bogus work comp claim will frequently exaggerate his/her physical limitations. The You Tube video of the employee skiing down the most difficult ski slope this side of the Alps is beneficial in controlling the cost of the workers’ compensation claim only if the employer and the adjuster are aware of the video and have obtained a copy of it.

With the electronic age, there is a lot of information available, if the person investigating the claim has the electronic capacity and the professional expertise to locate it. While some adjusters are experienced with Facebook and Twitter, it would be a rare adjuster who would be skilled in all the social media sites. Adjusters at insurance companies, third party administrators and self-insured employers normally turn to private investigators to search the numerous social media sites for information about the employee’s true physical status. A private investigator skilled in social media searches will check thefollowing list of sites and more.

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How Wearable Technology Affect Workers’ Comp

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wearable tech illustrationDuring a session at the CCWC Conference in Anaheim, CA earlier in the month, one of the presenters said something that struck a chord with me. It was the final session of this year’s annual conference, and several high level executives were discussing the future of workers’ compensation. Corvel Chairman & CEO Gordon Clemons was talking about the importance of investing in technology (a man after my own heart), when he made the prediction that “this time next year we will be talking about wearables”.

It was a great prediction, but why wait until next year? I want to talk about them now.

Clemons was absolutely right with his prediction. Wearable devices, in the form of braces, bracelets, necklaces, watches and glasses will revolutionize information management for medicine in general, and this will have great impact on care in workers’ compensation.  Sensors will be able to transmit vital health data to medical professionals; glasses such as Google Glass will be used in medical consultations and training scenarios. The possibilities are boundless, as what we are talking about is moving and monitoring personal data securely in real time. The more accurate and timely the information, the better the treatment and response can be.

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Are All Injuries Preventable?

pie chart: total coast of various types of injuriesAll injuries are preventable. If you really think about it, if everyone did everything they were supposed to do accidents probably would never happen.

Sure equipment fails, or gets worn out and fails, or tires blow out when you run over a nail, but think about it: That nail maybe wouldn’t be on the road if a worker hadn’t left a box of nails on the bed of their truck then drove away with the tailgate down. That machine would not have failed if it were replaced 2 years ago when the maintenance worker told his supervisor that this machine was old, outdated, and had “a few years left.”

Tracy Morgan Accident, Like Most Accidents, Was Preventable

Think about what happened to comedian Tracy Morgan. This is all alleged at the time I write this, but allegedly the semi-truck driver was up for 24 hours before he crashed into the back of Morgan’s limo. The truck driver is a Wal-Mart employee. No doubt he will have a great defense counsel when this goes to trial, but what if that were your truck driver out there that caused this accident? Do you know how many hours your drivers are logging behind the wheel? Are they compliant with all their reporting of work versus rest periods? How can you really prove they are being truthful and honest should this situation result from your employee? If you are not sure, I hope you have deep pockets to provide as good of a defense counsel as this driver is going to get.

Time and time again, we see injuries that are preventable. Most of these injuries get chalked up to “operator error” meaning that this worker knew better than to do what they were doing at the time they were injured. This could be from trying to lift too much, or pull too much in one load, or from operating a machine in the improper manner.

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FDA Eyes Move on Salt in Your Food

Did you think the salt debate was “settled?”

WASHINGTON (AP) — photo of high salt content nachos to try to prevent thousands of deaths each year from heart disease and stroke.

The Food and Drug Administration is preparing voluntary guidelines asking the food industry to lower sodium levels, FDA Commissioner Margaret Hamburg told The Associated Press. Hamburg said in a recent interview that the sodium is “of huge interest and concern” to the agency.

“We believe we can make a big impact working with the industry to bring sodium levels down, because the current level of consumption really is higher than it should be for health,” Hamburg said.

It’s still unclear when FDA will release the guidelines, despite its 2013 goal to have them completed this year.

Hamburg said she hoped the agency would be able to publicly discuss the issue “relatively soon.” On Tuesday, FDA spokeswoman Erica Jefferson said there is no set timeline for their release.

The food industry has already made some reductions, and has prepared for government action since a 2010 Institute of Medicine report said companies had not made enough progress on making foods less salty. The IOM advised the government to establish maximum sodium levels for different foods, though the FDA said then — and maintains now — that it favors a voluntary route.

Americans eat about 1½ teaspoons of salt daily, about a third more than the government recommends for good health and enough to increase the risk of high blood pressure, strokes and other problems. Most of that sodium is hidden inside common processed foods and restaurant meals.

In addition to flavor, companies use sodium to increase shelf life, prevent the growth of bacteria, or improve texture and appearance. That makes it more difficult to remove from some products, Hamburg noted.

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OSHA’s New Webtool To Identify Workplace Hazards

WASHINGTON – The Occupational Safety and Health Administration today released a new interactive training tool to help small businesses effectively identify hazards in the workplace. Employers and workers can virtually explore how to identify common workplace hazards in the manufacturing and construction industries. Users of the new training tool will learn not only hazard identification skills but also learn about hazard abatement and control.

“Hazard identification is a critical part of creating an injury and illness prevention program that will keep workers safe and healthy on the job,” said Dr. David Michaels, assistant secretary of labor for occupational safety and health.

“This new tool not only educates employers about how to take control of their workplaces and protect workers, it also demonstrates that following well-established safety practices is also good for the bottom line.” Assistant Secretary Michaels announced the new tool today at the American Society of Safety Engineers conference in Orlando, Fla.

OSHA Hazard Identification

Through the hazard identification tool, users can play from the perspective of either a business owner or an employee as they learn to identify realistic, common hazards and address them with practical and effective solutions. The tool explains the key components of the hazard identification process, which include information collection, observation of the workplace, investigation of incidents, employee participation and prioritizing hazards.

Continue reading OSHA’s New Webtool To Identify Workplace Hazards

The Burden of Stress in America

stress relief techniques chartA new NPR/Robert Wood Johnson Foundation/Harvard School of Public Health poll released today finds that about half of the public reported a major stressful event or experience in the past year. Nearly half (43 percent) reported that the most stressful experiences related to health.

More than half of those who experienced a great deal of stress in the past month say too many overall responsibilities and financial problems were contributors. More than a third of those with a great deal of stress say the contributors include their own health problems and health problems of family members.

“Stress touches everyone. Unfortunately, many of those feeling the most stress get trapped in cycles that can be very unhealthy. If we are going to build a culture of health in America, one big step we can take is recognizing the causes and effects not just of our own stress and the stress of those closest to us, but of others we encounter in our day-to-day lives,” says Risa Lavizzo-Mourey, MD, RWJF president and CEO.

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What Are The OH&S / Workers’ Comp Implications of “Voluntary” Events and Activities?

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frowning kid with caption "Volunteered, Got Way Happier"Workers are often asked to “volunteer” for certain activities that have some association to employment.  The association may be strong (volunteering for overtime) or weak (attending a company picnic) but there are implications for safety and health as well as workers’ compensation.

Most volunteering” cases involve a worker working on a special project, putting in overtime to clear a backlog, or participating in a special events like conferences, open houses, or community event (parade, “home and garden” show, cultural festival) .  The connection to work in these examples is pretty clear.  A worker may volunteer to participate in these activities and events but injuries that may arise out of and in the course of these events are as work-related and typically accepted as compensable in most jurisdictions.

This coverage is an important protection for workers and employers. Workers continue to have access to the workers’ compensation coverage for themselves and their families; workers’ compensation coverage protects employers from suit for work-related injuries that may arise.  If the voluntary event were not deemed work-related, the employer might still be faced with liabilities in the event of injury.

Just because a voluntary event or activity such as working to clear a backlog may be covered by workers’ compensation does not mean an employer can forget about health and safety.  Occupational health and safety standards still apply.  Before initiating a voluntary weekend shift to clear a backlog or asking someone to pull an “all-nighter” to prepare a presentation for the next morning, an employer needs to ask questions about health and safety like:

  •  Are the protections normally provided available to the worker(s)?
  •  Are there special risks or hazards associated with this work that need to be identified? 
  • If the worker is working alone, what provisions are required and in place for his or her protection?

Suppose there is a big order due out on Monday and you ask for “volunteers” to work the weekend to fulfill the commitment.  Are the usual weekday resources for the health and safety of the workers available on the weekend?  Is there access to a qualified first aid attendant, open lunch area, alarm and production stops working, etc.? Does the week-end site security system change the risk of intrusion?  Are there scheduled maintenance activities such as floor washing and waxing or system purging that could increase risks to those not normally on site when these activities take place?

And then there are the “voluntary events” like corporate picnics, softball tournaments and project celebration parties.  Are these truly voluntary or are they “work-related”?  Depending on the jurisdiction and the circumstances, injuries arising from participation in such events may well be compensable.  Each case will be determined on its own merits but adjudicators tend to look at the expectations for attendance, where the event takes place, how involved the employer is in sponsoring the event, and the degree to which the activity or event furthers the objectives of the organization.

Expectations for attendance and participation are tricky.  A worker may feel compelled to participate particularly if the firm organizing or sponsoring the activity promotes it as a “team-building” event or if there is an implied advantage or accepted requirement of participation as part of career development.  Failing to participate may be what we used to call a “career-limiting” decision.   Is a participant really “free” to choose non-attendance in the event?

Continue reading What Are The OH&S / Workers’ Comp Implications of “Voluntary” Events and Activities?

CA.Dept. of Insurance Warns Homeowners About Verifying Workers’ Comp Coverage

beware of unlicensed contractors sign(WorkersCompensation.com) -A multi-agency task force led by the California Department of Insurance, consisting of more than 100 detectives and investigators focused on curbing California’s underground economy, conducted a sweep across major metropolitan areas statewide issuing more than 60 citations for various violations and six work stop-orders. Investigators also took the opportunity to educate homeowners about their responsibility to verify contractors have a license and workers’ compensation insurance before they hire them.

Homeowners who hire contractors or vendors that do not have proper licenses or workers’ compensation insurance may risk their home and assets if someone is injured on their property or shoddy work results in damage to their home.

Many homeowner policies have a criminal activity clause that means the insurance company may not cover damage caused by shoddy work performed by an unlicensed contractor or liability coverage if a worker is injured and the contractor does not have workers’ compensation insurance.

“Homeowners must be aware of their obligation to verify that contractors they hire have proper licenses and valid workers’ compensation insurance,” said Insurance Commissioner Dave Jones. “It is not worth risking your home or other assets because you hired an unlicensed contractor or didn’t take the time to verify their license and insurance coverage. A few minutes spent ensuring your contractor or vendor is following the law is a small investment to protect yourself and your assets.”

At a private home in the Los Angele area investigators found a sub-contractor working on the job site without workers’ compensation insurance. According to detectives, the homeowner was surprised to learn he was responsible for verifying not only the general contractor’s workers’ compensation insurance, which he had done, but also for all sub-contractors.

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Court: Telecommuting Could Be Reasonable Accommodation Under the ADA

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Telecommuting womanTelecommuting is a trend that is rapidly growing in the United States, and telecommuting requests are also on the rise as a potential reasonable accommodation under the ADA. A recent Sixth Circuit Court of Appeals case,EEOC v. Ford Motor Company, 2014 U.S. App. LEXIS 7502 (6th Cir. 2014) illustrates how difficult it can be for an employer to oppose a request for telecommuting.

Jane Harris was hired in 2003 by Ford as a resale buyer, serving as an intermediary between steel suppliers and “stampers,” which are companies that use steel to produce parts for Ford. Her job was to respond to emergency supply issues to ensure no gap in steel supply to parts manufacturers. The most important part of the job was group problem solving, requiring that a buyer be available to interact with members of the resale team, suppliers and others in the Ford system when problems arose.

Harris suffered from IBS, an illness that caused her fecal incontinence. Some days she could not drive to work or stand up from her desk without potentially soiling herself. She took intermittent leave when severe symptoms occurred. In 2005 her supervisor allowed her to work from home on a flex-time telecommuting schedule on a trial basis. The company did not view the trial period as a success. She continued to work occasionally from home doing remote work, including on evenings and weekends. However, Ford did not credit Harris with the time she spent working during non-“core” hours and marked the days she stayed home because of her illness as absences. The company stressed that core business hours were important because that was the time when employees do team problem solving.

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