Cavalcade of Risk – for the biweekly smorgasbord of risk-related news from the blogosphere, check out the new edition of Cavalcade of Risk hosted at Political Calculations.
The $17 million fraud – not chump change – Most employers and insurers get very heated on the topic of work comp fraud – as well they should. But while keeping an eye on the front door for shoplifting, some thieves are loading up the company safe from the back door. This week, four members of a California doctor mill were indicted in a $17 million workers’ comp fraud. This stunning scheme bilked the city of Los Angeles and 19 insurance companies. Joe Wheeler talks more about the fraud and how it exposes a weakness in the system. He rightly notes, “That this relatively small fraud provider ring offering obscure medical procedures could make off with millions of dollars before being caught should make anyone involved in workers’ comp benefits take a breath.” Note to employers: it’s not enough to think your insurer will manage everything – you need to take an active interest in managing and questioning claims, too.
In the line of duty – Louisiana flags are flying at half mast this week for two insurance investigators who were shot to death by an agent last week while investigating fraud. According to Insurance Times, investigators Kim Sledge and Rhett Jeansonne “…had gone to the Ville Platte office of suspended insurance agent John Melvin Lavergne to collect records. Lavergne shot the investigators and then killed himself.” Louisiana is now looking into whether fraud investigators should be able to carry guns.
Is the soft market finally hardening? – Joe Paduda talks about recent reports from Towers Perrin and Fitch Ratings pointing to firming work comp premiums. No, really!
Dollars for doctors – ProPublica has been featuring an ongoing series that investigates the financial ties between the medical community and the drug and device industry. You can follow the entire series from the above link. In addition to several feature stories, there were frequent updates in made in May, several of which discuss drug industry ties to medical societies. In October, ProPublica also rolled out a searchable database of physicians who have received drug money, gleaned from public disclosures of seven large pharma companies. For a sampling, here is Massachusetts.
Ferreting out the more obscure news… – Among all the informative and useful information he posts over at Comp Time, Roberto Ceniceros also manages to ferret out some of the quirkier workers comp stories. This week, he posted about Palin’s emails and the workers comp connection and last week, it was porn industry hazmat suits.
Confined space videos – WorkSafeBC produces a lot of great safety resources. Recently, a three-part video series on confined space came to our attention – worth checking them out. Part 1: Safe Yesterday, Deadly Today; Part 2: Test to Live; and Part 3: Rescue: Just Calling 911 Doesn’t Cut It.
Posts Tagged ‘Louisiana’
News roundup: Cavalcade of Risk, massive fraud scheme, investigator deaths, premium hardening & more
Wednesday, June 15th, 2011Risk carnival, election wrap-up, and tooting our own horn
Wednesday, November 3rd, 2010This week’s Cavalcade or Risk is posted by Ironman at Political Calculations. This biweeky roundup of risk posts is a sampling or “carnival” or topic-related posts. Ironman grades the entries for topicality, quality and readability – check it out.
Election results – Washington’s Initiative 1082 to privatize workers’ comp was soundly defeated last night, as about 58% of the voters opted to keep the system that has operated since 1911 in place. Obviously, this is a disappointment to private insurers and independent agents that hoped to open the state.
In Louisiana, it looks like Amendment 9 passed, but news reports we found are still vague. This change would require that claims would have to be re-argued before a panel of at least five appeals court judges before an agency’s decision could be reversed or changed.
In Arizona, Oklahoma and Colorado, voters cast ballots on constitutional amendments that would bar healthcare reform’s mandate that individuals buy insurance. Opt-out measures were passed in Oklahoma and Arizona, but was defeated in Colorado. Missouri had rejected the mandate in August, but not by a a state constitutional amendment.
At Comp Time, Roberto Ceniceros took a pre-election look at what gubernatorial wins might mean in California and New York. He notes that Jerry Brown was very quiet on the issue of workers compensation in California, but in New York, Andrew Cuomo has employee misclassification on his radar screen. As the state’s Attorney General, he recently joined attorneys general from Montana and New Jersey in an intent to sue FedEx.
And as long as we are on politics, it seems like a good time to bring up today’s news that the Treasury expects to earn a profit on AIG investments. Overall, despite the controversy, the Troubled Asset Relief Program (TARP) bailout looks as though it is earning a healthy return.
CT Commissioner resigns – somewhat upstaged by yesterday’s election brouhaha was news that Connecticut’s Insurance Commissioner resigned abruptly. National Underwriter reports that Thomas Sullivan resigns amid pressure over healthcare rate hikes. He faced criticism after approving a 47% rate hike by Anthem BC/BS of CT.
Workers Comp Insider again named to top WC blogs
We were gratified and pleased to be named to 2010 roster of the LexisNexis Top 25 Workers Compensation and Workplace Issues:
“Consistently at the top of the heap when it comes to workers’ comp blogs, the Workers’ Comp Insider is a rare combination of breadth and depth. Now in its eighth year, the Insider covers comp issues, risk management, business insurance, and workplace health and safety from Anchorage to Miami. It provides in-depth analysis concerning workplace legislation, occupational medicine, and best practices from Maine to Hawaii. It should be in the “favorites” folder of every comp attorney’s web browser.”
We thank you, our readers, for your continued interest and support. We were happy to see many friends and colleagues on the list as well – we’re honored by the company in which we find ourselves. Be sure to check out some of the other fine blogs on the list. Also, if you haven’t discovered the gem that is the LexisNexis Workers’ Compensation Law Community, we urge you to check that out, too.
Pre-Employment Fibs, Compensability, and Second Injury Funds
Tuesday, October 12th, 2010There is no doubt that Ronald Babin, an electrician in Louisiana, was injured at work. He was in the bucket of a truck, working on a transformer, when the bucket mechanism malfunctioned, crushing the bucket into the transformer for several minutes. Babin huddled in the bottom of the bucket until co-workers were able to gain control of the mechanism. He hurt his back.
This sounds like a straight-forward workers comp case, but Babin ran into a complication. This was not the first time he had hurt his back.He had four prior back injuries involving two herniated discs. At one point he was out of work for nearly two years with back problems.
When he applied for the job with Ernest Breux Electric, he filled out several pre-employment questionnaires. One asked if he had any “current or prior back injuries” (this question could well be illegal, but that’s an issue for another day). He answered “no.” On another form, he admitted to having a “back strain” – but again, did not mention serious disc problems.
Thus, Babin misrepresented his medical history. His employer relied upon that misrepresentation in hiring him. And his subsequent injury was directly related to the condition he failed to disclose. Bottom line for Babin: his claim was denied.
Rock and a Hard Place
One can sympathize with Babin. He probably felt that full disclosure would have resulted in his not getting the job. It is possible, of course, that Breux Electric would have taken the information into consideration and hired him anyway. With clear documentation on the prior injuries, Breux would likely have had access to Louisiana’s second injury fund:
– The applicant had a permanent partial disability
– The employer would have hired him with knowledge of that disability
– The new injury merged with the old injury to produce a claim for the second injury fund
By hiding the truth, Babin essentially was working without a safety net. This might not have mattered if the injury had not aggravated the pre-existing condition. But as soon as his aching back became involved, Babin lost access to the protections of the comp system.
Abolish Second Injury Funds?
Speaking of second injury funds, our colleague Peter Rousmaniere has recommended that they all be abolished. He makes a compelling case. The money in second injury funds is derived from fees paid by all insureds. However, the primary beneficiaries of these funds has not been the employers, who took the risk in hiring disabled workers, but the insurance companies, who generally pocket the payments from the funds. They are not obligated to recalculate experience modifications and return premium dollars to the insureds. Some are diligent about doing this, others are not.
Second Injury funds may not be the most effective means of encouraging employers to hire partially disabled workers. And it’s clear from this particular story that these workers should not try to lie their way into a job. In the best of all possible worlds, disabled workers would not be penalized for their candor in disclosing disabilities and employers would not be penalized for the additional risk of hiring them. But in case you have not noticed, this is hardly the best of all possible worlds.
Special thanks to Work Comp Central (subscription required) for their heads up on this and many other interesting cases.
Health Wonk Review’s Research Edition & a roundup of other news
Thursday, June 24th, 2010Brad Wright of Wright on Health has an excellent edition of Health Wonk Review, which shines a spotlight on research. Brad notes that, going forward, research will be incredibly important as health reform is implemented and evaluated. He offers a fine research roundup from leading healthcare bloggers – check it out!
Healthcare – According to a Commonwealth Fund report on healthcare, which assessed and compared data from patient and physician surveys in seven countries in 2007, 2008 and 2009, the U.S. scored sixth out of seven countries on quality issues, yet we spent more than double per person than any other surveyed country. See the full report How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update, which includes both a snapshot chart and an interactive comparison tool. Related: Results from the National Scorecard on U.S. Health System Performance, 2008
The importance of timely reporting – In Manucy v. Joe Manucy Racing, The Louisiana Court of Appeal recently ruled that an employee who was injured during horse training was ineligible for benefits because although the injury was immediately apparent, the worker did not file for benefits until about a year and a half after the injury occurred. Louisiana law stipulates a one-year from date of injury filing deadline for injuries that are immediately evident, and two years for injuries that do not develop immediately. In this case, the injury was immediately apparent, requiring ambulance transport and surgery within two months. State law varies on statues of limitations for benefit eligibility, most commonly falling between one and three years from date of injury. Many states offer some exceptions to the statutes – such as starting the clock ticking at date of disability rather than date of injury or allowing exceptions if there is conduct that might be regarded as deceptive on the part of the employer.
Going and coming – As a rule, any injuries that happen to an employee when they are traveling to or from work – ‘going and coming’ – are not compensable, but there are exceptions. Fortney v. AirTran Airways, Inc. deals with one of those exceptions: service/benefit to the employer. In this case, the employee was killed in a plane crash while flying on a reciprocal arrangement with another airline. The Kentucky Supreme Court upheld benefits to the estate of the deceased. At Lexis Nexis Workers’ Comp Community, Roland Legal PLLC summarizes the issues: “Whether an employer uses transportation or transportation expense as an inducement for an employee to accept or continue employment is material to supporting compensability, particularly when the journey is sizeable and when the employer pays all or substantially all of the expense.” See our prior post about common exceptions to the ‘going and coming’ rule.
Medicare – Get your popcorn and follow along as Joe Paduda offers a guide to the status of the Medicare “fix” and looks at various scenarios for how things may play out.
Retroactive Insurance in Georgia – events continue to play out in the wake of the insolvency of Southeastern U.S. Insurance Inc (SEUS) in Georgia (a story in and of itself, and worth a read if you haven’t been following along). After the SEUS demise, many employers were left holding the bag for the open claims of injured workers because they had not paid into the state’s insolvency fund and were therefore ineligible for coverage. New legislation will cover employers retroactively if they pay into the state insolvency fund, but the Georgia’s Insurers Insolvency Pool has filed a challenge to the new law. “The pool is placed in a position of uncertainty as to whether the legislation imposes duties and obligations on the pool retroactively in violation of the Georgia state constitution,” the filing says.
Arizona judge: no raiding the compensation fund – The state of Arizona is considering an appeal to Maricopa County Superior Court Judge Larry Grant’s ruling which found that Governor Brewer and legislators ignored the plain language of the law by trying to use $4.7 million from the State Compensation Fund to help balance the budget. According to the judge “The proceeds held by the special fund are insurance proceeds held in the benefit of employees and employers covered by the Workers’ Compensation Act.”
Safety shorts
Cavalcade of Risk and other news briefs
Wednesday, January 13th, 2010The first Cavalcade of Risk of the new decade has been posted by Louise of Colorado Health Insurance Insider – check it out. And while you’re visiting the Cavalcade, why not check out the rest of the entries on the C.H.I.I. blog? We don’t live in Colorado, but if we did, we’d definitely be doing business with Jay and Louise Norris.
The importance of the right doctor – Roberto Ceniceros of Comp Time posts about a new John Hopkins study published in the Journal of Occupational and Environmental Medicine that shows that 3.7% of doctors accounted for 72% of claim costs in a study of claims data from Louisiana Workers’ Comp Corporation from 1998 to 2002. He notes that one of the researchers commented, “…it makes sense to analyze how practice patterns drive costs before instituting sweeping reform.”
Sandy Blunt and the goings on in North Dakota – Good for Peter Rousmaniere and Joe Paduda for shedding light on the travesty of a prosecution related to Sandy Blunt, former CEO of North Dakota’s Workforce Safety and Insurance. I met Sandy Blunt at a conference in DC a number of years ago and had been following the turn-around he was effecting in North Dakota’s system. He struck me as progressive, innovative, and very sharp – it seemed a real coup for North Dakota to have his services. Then came a series of surprising charges resulting in his ouster. In following the case, it appears that most of these charges were minor, trumped up administrative issues, such as spending a few hundred dollars on lunches and gift certificates to motivate staff – practices that were not uncommon in other state departments. Other more serious charges were dismissed or shown to be erroneous. Blunt has appealed his conviction to the state’s Supreme Court and we hope he will prevail.
Insurance Fraud – Emily Holbrook of Risk Monitor posts about a spike in insurance fraud as indicated by a recent report from the Coalition of Insurance Fraud: “Overall, the economy in 2009 appears to have had a significant impact on the incidence of fraud. On average, fraud bureaus reported the number of referrals received and cases opened increased in all 15 categories of fraud included in the survey.” Unsurprisingly, the biggest number of fraud cases occurred in the category of bogus health insurance.
Popcorn flavorings vs public and worker health – Celeste Monforton of The Pump Handle provides an update on a public health issue of concern to workers and consumers alike: butter flavorings in popcorn. After a public outcry about diacetyl flavorings, which were causing worker and consumer health problems, the industry began substituting a product labeled as “no diacetyl.” Preliminary reports from NIOSH indicate that these chemical changes do not translate into less health risk to exposed workers and consumers.
EEOC report – Workplace Prof Blog posts about Equal Employment Opportunity Commission enforcement statistics, which were recently issued for fiscal year 2009. A sampling from the EEOC press release: “The FY 2009 data show that private sector job bias charges (which include those filed against state and local governments) alleging discrimination based on disability, religion and/or national origin hit record highs. The number of charges alleging age-based discrimination reached the second-highest level ever. Continuing a decade-long trend, the most frequently filed charges with the EEOC in FY 2009 were charges alleging discrimination based on race (36%), retaliation (36%), and sex-based discrimination (30%). Multiple types of discrimination may be alleged in a single charge filing.”
Work violence – Does the economy play a role in workplace violence? That’s a question posed by the Christian Science Monitor in the light of a recent shooting rampage by a disgruntled worker of manufacturer ABB Group in St. Louis that left three dead and several wounded. One factor that the article did not reference is the stress that many people feel post holidays. This story brought to mind a post-holiday workplace shooting rampage in Massachusetts a number of years ago involving another disgruntled employee.
Rescue worker health & safety resources; disaster coverage
Tuesday, August 30th, 2005Our thoughts and prayers go out to the people of southern Louisiana, Mississippi, and Alabama. In watching CNN last night, I was struck by the bravery of the police, firefighters, and volunteers who put themselves in harm’s way to rescue survivors. Health care workers are also doing an amazing job under terrible circumstances: staffing flooded hospitals, tending to refugees in the Superdome, and relocating elderly nursing home residents.
The disaster recovery is boggling in scope, and we will no doubt address it further. For now, here are some health and safety resources for rescue workers:
Worker safety after a flood
Worker Safety in a Power Outage
Emergency Response Resources for Workers
Response, Cleanup and Safety for Workers
The above links were found via Poynter. The Poynter Institute is a school for journalists, future journalists, and teachers of journalists. The website is often a good source of information for large, breaking news stories. In addition to the above links, they also have an extensive list of links to post-disaster health and safety resources for civilians and workers alike. It seems like a good time to give these resources wider circulation.
Online news coverage
In addition to the national media outlets, here are some online resources to local coverage.
NOLA – Breaking News from the Times Picayune
The Irish Trojan – a New Orleans area blogger who is posting frequent updates
Today’s Times Picayune – special online edition in pdf
Large graphic of the New Orleans levee system
Some of the following links to online TV resources can be slow loading due to demand.
WLOX – streaming video from Biloxi, MS
WJTV – online video from Jackson, MS
WPMI – online video from Mobile. AL
WLTV – online streaming video (embedded) from New Orleans
Joe Paduda has a post on Katrina’s impact on insurance costs in which he links to several articles and offers good commentary.
