Resources

Workers’ Compensation Fraud

Warning Signs of Workers’ Compensation Fraud

Unfortunately, workers’ comp fraud cases are a reality in today’s business environment. To help employers and claims managers know what to keep an eye out for, the Louisiana Workforce Commission shares these common tip-offs of fraud. Experience shows that when two or more of the following factors are present in a workers’ compensation claim, there is a chance that the claim may be fraudulent.

Workers’ Comp Tips

Workers’ Comp Claims Administration: Tips From the Experts

Record keeping is a major part of workers’ compensation claims administration, say the experts at Gulf South Risk Services. Make sure to kick 2016 off right by ensuring you have all safety and workers’ compensation documentation well organized.

In addition to OSHA logs – which must be retained for five years by federal requirements, a company must keep the following safety records for at least a year, according to Louisiana law:

• Inspection reports;
• Accident investigation reports;
• Minutes of safety meetings; and
• Training records.

As an experienced third-party administrator of workers’ comp, safety and benefits programs, our team offers a few helpful hints that we apply to ensure quality and compliant claims management services.

• Act fast: An accident investigation of any job-related injury that requires medical attention should be initiated by the injured employee’s supervisor as soon as possible on the shift the accident occurs. Oftentimes, details can get fuzzy after a day or days have passed.
• Keep your plans handy: Louisiana employers with more than 15 employees must document plans for implementation of working and operational safety efforts. These plans should be available for review by a workers’ comp director but may be considered confidential company information. Additionally, workers’ compensation directors are required to keep a list of relevant safety professionals from outside your company as well. What other plans /procedures should be kept in your records?
  • Emergency preparedness program;
  • First aid program;
  • New hire training program; and
  • Plans for keeping everyone working at a location up to date on emergency procedures.
• Keep up with monthly inspections – and documentation: Inspections of all areas of the work place are required monthly, and a written report – or check list – should be completed. Inspection reports should be kept for at least one year.
• Keep ACCURATE and SPECIFIC date records: Getting your dates right (and being specific) can be significant in any workers’ compensation claim situation. Clearly documenting all dates (at every step in the process) is required to best protect your company and your employees.

For example, in Louisiana, in the case of an occupational disease, all claims are barred unless the employee files a claim with his/her employer within one year of the date that:

1. The disease manifests itself;
2. The employee is disabled as a result of the disease; or
3. The employee knows or has reasonable grounds to believe that the disease is occupationally related.

So including clear documentation of dates in all records is essential.

• There is no such thing as a minor incident report: All employees should be instructed to report any injury, incident or occupational disease or hazard that is work-related, even if they deem it to be minor. As the administrator of onsite workers’ compensation efforts, you should document all reports in the same thorough manner. You never know when you’ll be asked to show an incident report or provide dates for when someone had a fender bender in the parking lot or cut themselves in the office kitchen.

Contact the team at Gulf South Risk Services if you are feeling overwhelmed with workers’ compensation requirements and need an experienced team to help set things straight. Our team wishes you a safe and productive 2016!