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Protect Against Work Comp. Fraud

Workers’ compensation laws protect employees who are injured on the job. They are designed to ensure that people who are injured or disabled on the job are provided with fixed monetary benefits, eliminating the need for litigation. These laws also provide benefits for dependents of those workers who are killed because of work-related accidents or illnesses. Some laws also protect employers and fellow workers by limiting the amount an injured employee can recover from an employer and by eliminating the liability of co-workers.  State statutes establish this framework for most employment. Federal statutes are limited to federal employees or those workers employed in some significant aspect of interstate commerce.

An excerpt from a recent article provides a detailed explanation of how to successfully navigate the process of workers compensation so that your organization is not falling prey to fraud and the misuse of this necessary but ultra subjective issue.  In the article “Protect Yourself From Workers Compensation Fraud and Risks” author Lisa Danes of GreenIndustrypros.com states ” It’s a common perception that workers’ compensation laws favor the employee.  According to Michael Pauletto, partner at attorneys Lewis Brisbois Bisgaard and Smith LLP, that perception is correct.

Workers’ compensation is a form of insurance that provides wage replacement, vocational rehabilitation, medical benefits and other benefits to employees injured on the job. Workers’ compensation fraud occurs often and can cost the employer greatly if not discovered or investigated.

For example, according to the California Insurance Department, the Fraud Division identified and reported 5,151 suspected fraud cases, assigned 847 new cases, made 268 arrests, and referred 309 cases to prosecuting authorities during fiscal year 2012-13.

Pauletto says you can’t even the playing field, but you can arm yourself with knowledge of your rights and the employee’s obligations to help minimize the damage and combat fraud.

The employer’s goal

As an employer dealing with a workers’ compensation claim, you have several goals to protect your business and your workforce. You want to get your good staff members healthy and back on the job. At the same time, you need to identify the problem people—who may attempt fraud—and minimize the damage.

Both of these steps will help to keep your workers’ compensation premiums down. The quicker an injured worker returns to work, the lower your disability claims costs will be.

You’ll also want to avoid paying Permanent Total Disability. Permanent Total Disability is when an employee loses their ability to earn a wage not only at the current employer, but permanently in any capacity.

Disability Classifications according to the New York State Workers’ Compensation Board are as follows:

Temporary Total Disability – The injured worker’s wage-earning capacity is lost totally, but only on a temporary basis.

Temporary Partial Disability – The wage-earning capacity is lost only partially, and on a temporary basis.

Permanent Total Disability – The employee’s wage-earning capacity is permanently and totally lost. There is no limit on the number of weeks payable.

Permanent Partial Disability – Part of the employee’s wage-earning capacity has been permanently lost. There are two types of permanent partial disability benefits, depending on the body part affected and the nature of the permanent disability: schedule loss of use (SLU) and non-schedule. The severity of the disability is measured when the employee has reached maximum medical improvement (MMI). MMI is presumed to occur no more than two years after the date of injury.

The final goal is to resolve the case as quickly as possible without jeopardizing it legally. This will save on court and attorney costs, and let you get back to focusing on other areas of the business.

Limitations and disability classifications

When an employee is injured on the job, they will be given a disability classification. That classification will decide what extent of work they can handle and for how long. This classification is not up to the employee, but rather a medical professional.”  For full article click here

This entry was posted on Wednesday, September 24th, 2014 at 5:38 PM and is filed under blog, Featured, News & Information, Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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