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Home » Archives for February 2020

Archives for February 2020

Should Workers Comp Psychological Injuries Count As Claims?

February 28, 2020 By JL Risk Management Consultants

The Complicated World of Workers Comp Psychological Injuries

One subject that has long been the bane of claims adjusters is workers’ comp psychological injuries. 

picture of Sigmund Freud workers comp psychological injuries

Earlier this week, I included mention of a session at the upcoming WCRI Annual Conference on mental injuries resulting from an on the job injury.   Please do not think that I disbelieve or have never accepted a resulting mental injury from a Workers Comp file. 

I have accepted and paid benefits on Physical> Mental claims.  A brain-injured claimant can easily have mental concerns for many years after a Workers Comp injury.   These types of claims baffle many new adjusters.  

Two schools of thought exist in many claims departments.  One opinion is that no psychological injuries should be accepted on any claim unless a very extreme circumstance exists on the claim. 

Some state Workers Comp courts have ruled that psychological injuries should be accepted in some cases including a mental injury that results from no physical injury.

The four types of injuries in Workers Comp are:

  • Businesswoman Workers Comp Psychological Injuries lying unconsciously

    StockUnlimited

    Physical > Physical – an employee physically injures themselves which results in a physical injury that must heal over time. This type of injury is the most prevalent in Workers’ Compensation.  If a treating physician deems a person to be unable to return to work, and the claim is considered compensable, then the applicable benefits are usually paid on the claim

  • Physical >Mental – an injured employee incurs a psychological injury from the aspects of an on the job injury. This type of injury comes from the physical >physical injury in the previous bullet point.  Many claim departments remain, staunch defenders, that no mental injury results from a physical injury.  Many claim departments bristle when asked to pay for psychological benefits.   One can find many cases where a Workers Comp court decision was rendered where mental injury benefits are ordered paid to the claimant.  This remains a strong point of contention in some files.
  • Mental > Mental – the most complicated type of claims for adjusters to handle consists of an employee having a purely mental claim from the workplace. Some Workers Comp courts have ordered benefit payments on mental > mental claims.  Workers Comp claims departments usually litigate these types of files before payment.  Many of these types of claims are appealed if the claimant or insurance carrier does not prevail in litigation.   
  • Mental > Physical – a very rare file where a mental injury results in a physical injury. The one main controversial area with this type of claim is Reflex Sympathetic Dystrophy.   The definition of RSD has changed over the last few years to include Complex Regional Pain Syndrome.   A claims adjuster may never see this type of injury in their career

Please remember that I am writing this article in laypersons terms from my own experience and the experience of my co-workers over the years.   I am giving no medical advice concerning Workers Comp psychological injuries. 

 

©J&L Risk Management Inc Copyright Notice  

Filed Under: Workers Comp System Tagged With: claims baffle, Sympathetic Dystrophy

Workers Comp Psychological Aftereffects – WCRI Conference Next Week

February 26, 2020 By JL Risk Management Consultants

Workers Comp Psychological Effects – WCRI Session Next Week 

Workers’ Comp psychological effects are one of the unmentionables that the industry never really considers at the time of a claim. 

workers comp psychological effects phrenology

Public Domain

One of the unmentionables that receives little consideration in Workers Comp is the effect that the claims process has on the injured employee.   No, I am not saying that carriers should have to treat the psychological components of a claim – better known as:

Physical >>>> Mental   

One question we have to ask is what happens to the injured worker once they file a claim and after the claim has been closed?  

WCRI Prioritizes Mental Health for Workers Injured on the Job at 2020 Conference

Cambridge, MA, January 30, 2020 ― The Workers Compensation Research Institute (WCRI) announced today that a panel at its 36th Annual Issues & Research Conference, March 5–6 in Boston, MA, will discuss the mental health challenges some workers face after a workplace injury, as well as initiatives to address those challenges.

“Serious workplace injuries can lead to anxiety, depression, and other mental health issues,” said John Ruser, president and CEO of WCRI. “Indeed, new research from Boston University (BU) Professor Les Boden found that an injury serious enough to result in at least a week off work almost tripled the risk of suicide among women, and increased the risk by 50 percent among men.”

Multiethnic business workers comp psychological people

StockUnlimited

The diverse panel ─ made up of a researcher, labor leader, clinician, and employer ─ includes BU Prof. Boden; President Steven Tolman of the Massachusetts AFL-CIO; Dr. Kenneth Larsen of the New England Baptist Hospital; and Mary Christiansen of Southern California Edison.

The following are among the questions the panel will address:

  • What is the relationship between occupational injuries and mental health?
  • What treatment options are available to address mental health issues arising from occupational injuries?
  • What can labor and employers do to promote mental health and, specifically, to assist workers injured on the job?

The WCRI conference is a leading workers’ compensation forum. The two-day program highlights the Institute’s latest research findings while drawing upon the diverse perspectives of highly respected workers’ compensation experts and policymakers from across the country. Conference participants will leave with new insights, valuable networking contacts, and a better understanding of key issues in today’s competitive environment.

 

©J&L Risk Management Inc Copyright Notice

Filed Under: WCRI Annual Conference Tagged With: competitive environment, psychological components

Workers Comp Content – Avoiding the Recycle Button

February 20, 2020 By JL Risk Management Consultants

Workers Comp Content – Are We Just Recycling The Same Subjects?

Creating new and interesting Workers Comp content becomes more of a challenge with every article.   Google dislikes repetitive content.   I think it has a point.  No one wants to read the same thing over and over again. 

pic workers comp content recycling bins

Wikimedia Public Use License – EpSos de Flickr

Take the coronavirus, for instance, one news story was slightly altered and repeated again and again at almost all news outlets.   An article from 2018 shows my concern for the same-old-same-old recycled crises in Workers Comp content.    

For instance, the opioid crises occurred in the  1980s and again in the 1990s.  Workers Comp gave it due attention in 2009 and forward.  

The Workers Comp Medicare Set-Asides were the big news for quite some time.  That subject faded away.  Do not worry.  The WCMSAs will be the buzzword again soon.  Trust me. 

Fresh Workers Comp Content Frustrating At Times

Man working workers comp content at his desk

StockUnlimited

I, as have other Workers Comp blog authors, sit for many hours racking my brain to provide good content that is not a rehash of older articles that I have written in the last 10 years.  

Writing on conferences seemed to create a large amount of fresh Workers Comp content.  Then, the conferences became repetitive, so my resulting articles followed suit and also became repetitive. 

I do not write every article to satisfy Google’s SEO rules.  Most of them are written to follow those guidelines.  Many search terms where I have broken every rule ranked higher than when I stayed in the boundaries of proper SEO.    The J&L Cutcompcosts.com website does not sell any materials online.  I am told that I need to convert to https for reader privacy and safety.   What info would a user put on this website as no information is required? 

One of the more irritating rules suggests that the longer the article, the better the article will rank.  If you notice now on a Google search, you end up with massive articles that contain the answer to your one quick question – but you have to scroll through countless paragraphs to find your answer.  

California AB 5 Example

California Assembly Bill 5 ( AB 5) seemed to cover new ground in Workers’ Comp content. (Not so.)   The battle between Federal and State taxing agencies and employers that use independent contractors has been waged since the 1940s. 

Couple workers comp content arguing

StockUnlimited

Workers Comp carriers and employers debating on who is a covered contractor and who is not has been in existence as long as Workers’ Comp carriers have been in existence.

California AB 5 looked to be a new idea on how to handle independent contractors.  Then again, that new CA law still remains in flux and will not be settled for a few years, if ever. 

Top Ten Recycled Terms Over The Last 30 Years 

You can fill in this list below as it applies to your situation.   These 10 comes from my experience and background. 

  1. Employee or Employer Fraud
  2. Opiates 
  3. Major court decisions
  4. Independent Contractors 
  5. Soft Market vs. Hard Market 
  6. Carriers and PEO’s closing shop
  7. Analytics becoming the main statistical drivers – still waiting on this one 
  8. Non-opioid treatment regimens 
  9. Classification Code changes – happens every year 
  10. New forms of Workers Comp insurance that turn out to be the old forms – just repackaged 

The list could easily reach 100 if one takes enough time to think through the recycled Workers’ Comp content.  

 

©J&L Risk Management Inc Copyright Notice

Filed Under: Wokrers Comp Changes Tagged With: countless paragraphs, SEO, slightly altered

IRS Subcontractor Employee Determination Covers Three Main Points

February 18, 2020 By JL Risk Management Consultants

IRS Subcontractor Employee Determination Starts With Three Common Law Decisions 

The IRS Subcontractor Employee determination pages were updated recently.  As promised, I wanted to provide any updates.   The updates on these webpages were more structural than substantive.   

Please remember the common law rules constitute a starting point on determining whether a worker is a subcontractor or employee,  Each state law contains many rules on how on the employment relationship. 

effective irs subcontractor employee chart tax rates

Wikimedia License – Gues2625

The three main common law areas in determining employment status are:

From The IRS Subcontractor Employee Determination Rules 

Facts that provide evidence of the degree of control and independence fall into three categories:

  1. Behavioral: Does the company control or have the right to control what the worker does and how the worker does his or her job?
  2. Financial: Are the business aspects of the worker’s job controlled by the payer? (these include things like how the worker is paid, whether expenses are reimbursed, who provides tools/supplies, etc.)
  3. Type of Relationship: Are there written contracts or employee type benefits (i.e. pension plan, insurance, vacation pay, etc.)? Will the relationship continue and is the work performed a key aspect of the business?

Businesses must weigh all these factors when determining whether a worker is an employee or an independent contractor. Some factors may indicate that the worker is an employee, while other factors indicate that the worker is an independent contractor. There is no “magic” or set number of factors that “makes” the worker an employee or an independent contractor, and no one factor stands alone in making this determination. Also, factors that are relevant in one situation may not be relevant in another.

The keys are to look at the entire relationship, consider the degree or extent of the right to direct and control, and finally, to document each of the factors used in coming up with the determination.

___________

The IRS breaks down each of the three determinants into its own webpage.  

Behavioral Control 

Business people at the office place

StockUnlimited

Behavioral control refers to facts that show whether there is a right to direct or control how the worker does the work. A worker is an employee when the business has the right to direct and control the worker. The business does not have to actually direct or control the way the work is done – as long as the employer has the right to direct and control the work.

The behavioral control factors fall into the categories of:

  • Type of instructions given
  • Degree of instruction
  • Evaluation systems
  • Training

Types of Instructions Given

An employee is generally subject to the business’s instructions about when, where, and how to work. All of the following are examples of types of instructions about how to do work.

  • When and where to do the work.
  • What tools or equipment to use.
  • What workers to hire or to assist with the work.
  • Where to purchase supplies and services.
  • What work must be performed by a specified individual.
  • What order or sequence to follow when performing the work.

Degree of Instruction

The Man doing instruction Employee at the front

StockUnlimited

Degree of Instruction means that the more detailed the instructions, the more control the business exercises over the worker. More detailed instructions indicate that the worker is an employee.  Less detailed instructions reflects less control, indicating that the worker is more likely an independent contractor.

Note: The amount of instruction needed varies among different jobs. Even if no instructions are given, sufficient behavioral control may exist if the employer has the right to control how the work results are achieved. A business may lack the knowledge to instruct some highly specialized professionals; in other cases, the task may require little or no instruction. The key consideration is whether the business has retained the right to control the details of a worker’s performance or instead has given up that right.

Evaluation System

A man teach IRS Subcontractor Employee on the computer

StockUnlimited

If an evaluation system measures the details of how the work is performed, then these factors would point to an employee.

If the evaluation system measures just the end result, then this can point to either an independent contractor or an employee.

Training

If the business provides the worker with training on how to do the job, this indicates that the business wants the job done in a particular way.  This is strong evidence that the worker is an employee. Periodic or on-going training about procedures and methods is even stronger evidence of an employer-employee relationship. However, independent contractors ordinarily use their own methods.

 

Financial control

Financial control refers to facts that show whether or not the business has the right to control the economic aspects of the worker’s job.

The financial control factors fall into the categories of:

  • Significant investment
  • Unreimbursed expenses
  • Opportunity for profit or loss
  • Services available to the market
  • Method of payment

Significant investment

An independent contractor often has a significant investment in the equipment he or she uses in working for someone else.  However, in many occupations, such as construction, workers spend thousands of dollars on the tools and equipment they use and are still considered to be employees. There are no precise dollar limits that must be met in order to have a significant investment.  Furthermore, a significant investment is not necessary for independent contractor status as some types of work simply do not require large expenditures.

Unreimbursed expenses

Man explaining to IRS Subcontractor Employee on computer

StockUnlimited

Independent contractors are more likely to have unreimbursed expenses than are employees. Fixed ongoing costs that are incurred regardless of whether work is currently being performed are especially important. However, employees may also incur unreimbursed expenses in connection with the services that they perform for their business.

Opportunity for profit or loss

The opportunity to make a profit or loss is another important factor.  If a worker has a significant investment in the tools and equipment used and if the worker has unreimbursed expenses, the worker has a greater opportunity to lose money (i.e., their expenses will exceed their income from the work).  Having the possibility of incurring a loss indicates that the worker is an independent contractor.

Services available to the market

An independent contractor is generally free to seek out business opportunities. Independent contractors often advertise, maintain a visible business location, and are available to work in the relevant market.

Method of payment

Hands presenting IRS Subcontractor Employee money concept

StockUnlimited

An employee is generally guaranteed a regular wage amount for an hourly, weekly, or other period of time. This usually indicates that a worker is an employee, even when the wage or salary is supplemented by a commission. An independent contractor is usually paid by a flat fee for the job. However, it is common in some professions, such as law, to pay independent contractors hourly.

Type of relationship refers to facts that show how the worker and business perceive their relationship to each other.

 

Type of Relationship  Between the Two Parties – IRS Subcontractor Employee Determination

The factors, for the type of relationship between two parties, generally fall into the categories of:

  • Written contracts
  • Employee benefits
  • Permanency of the relationship
  • Services provided as key activity of the business

Written Contracts

Although a contract may state that the worker is an employee or an independent contractor, this is not sufficient to determine the worker’s status.  The IRS is not required to follow a contract stating that the worker is an independent contractor, responsible for paying his or her own self employment tax.  How the parties work together determines whether the worker is an employee or an independent contractor.

Employee Benefits

Hand with IRS Subcontractor Employee business finance

StockUnlimited

Employee benefits include things like insurance, pension plans, paid vacation, sick days, and disability insurance.  Businesses generally do not grant these benefits to independent contractors.  However, the lack of these types of benefits does not necessarily mean the worker is an independent contractor.

Permanency of the Relationship

If you hire a worker with the expectation that the relationship will continue indefinitely, rather than for a specific project or period, this is generally considered evidence that the intent was to create an employer-employee relationship.

Services Provided as Key Activity of the Business

If a worker provides services that are a key aspect of the business, it is more likely that the business will have the right to direct and control his or her activities.  For example, if a law firm hires an attorney, it is likely that it will present the attorney’s work as its own and would have the right to control or direct that work.  This would indicate an employer-employee relationship.

______________

Please remember this IRS subcontractor employee determination mini-guide is a rule of thumb only. 

 

©J&L Risk Management Inc Copyright Notice

Filed Under: Independent Contractor Analysis Tagged With: Evaluation systems, method, Periodic

WCRI 2020 Annual Conference Next Month – Show Me The Data + Secret

February 7, 2020 By JL Risk Management Consultants

The WCRI 2020 Annual Conference – Data and Study Paradise  –  Thursday March 5th – 6th   

The WCRI  2020 Annual Conference (Workers Comp Research Institute) heads back to Boston this year.  Last year, the Conference was held in  Phoenix.  

I will be there on the front row doing my Workers’ Comp Press duties.  The Conference will not be blogged live this year as in the past.  I will write articles from the day’s sessions.   

Worth wcri 2020 annual conference medal

StockUnlimited

The conference remains as one of the “worth it” places to be for all things Workers’ Compensation.  A few of the conferences have faded a little over the years – not this one.   The conference covers 1.5 days, sounds short but you will be overloaded with data that spark your own ideas and interests.  

Below is the conference happening sheet and a place to sign up.  The seafood alone is worth the trip.  Cold water seafood is the best. 

The secret – WCRI shows some of the data that has not been published yet – be ahead of the curve, and no they never asked me to place anything about their conference, studies, or webinars in this blog.   I do it because they have the best non-influenced data in the Workers’ Comp business – plain and simple.  

___________________________________________________

THEME: GAINING CLARITY THROUGH RESEARCH

 

Day 1 – Thursday, March 5, 2020

9:00 a.m. – 9:15 a.m. | Welcome & Introductions

Mr. Steve Perroots, Marriott International, Inc.       
Chair, WCRI Board of Directors

Dr. John W. Ruser, WCRI
President and CEO

9:15 a.m. – 10:15 a.m. | Generational Differences and Stereotypes in the Workplace

Professor wcri 2020 annual conference studying for upcoming report

StockUnlimited

In this session, Jennifer Deal ─ Wall Street Journal Experts panel contributor, author of several books, and senior research scientist at the Center for Creative Leadership ─ will discuss her research on generational differences and stereotypes in the workplace.

SHOW MORE >>

10:15 a.m. – 10:35 a.m. | Networking Break

10:35 a.m. – 11:05 a.m. | How Injuries, Claims, and Outcomes Change with Age

The age distribution of the workforce is projected to change in the next 10 years. The large cohort of baby boomers will have largely retired, shifting the age distribution toward younger workers. 

SHOW MORE >>

11:05 a.m. – 12:15 p.m. | Alternatives to Opioids for Pain Management

WCRI’s latest research finds the frequency of opioid dispensing is decreasing while non-opioid and non-pharmacologic pain treatments have increased. 

SHOW MORE >>

12:15 p.m. – 1:30 p.m. | Luncheon

1:30 p.m. – 2:25 p.m. | Economic Cycles and Their Impact on the Labor Market

Our keynote speaker is Dr. Michael Horrigan who is the president of the W.E. Upjohn Institute for Employment Research and a former Associate Commissioner of the Bureau of Labor Statistics.

SHOW MORE >>

2:25 p.m. – 2:45 p.m. | Networking Break

2:45 p.m. – 3:30 p.m. | Business Cycles and Their Impact on Workers’ Compensation

In this session, learn more from John Ruser from WCRI and Len Herk from NCCI about the impact of economic upturns and downturns on workers’ compensation claims and how macroeconomic factors influence the frequency of injuries, claims duration, and medical utilization and costs.

SHOW MORE >>

3:30 p.m. – 4:15 p.m. | Highlights from WCRI’s State Inventory Studies

This session will highlight information from WCRI’s inventory studies (e.g., prescription drugs, workers’ compensation laws, medical cost containment, etc.) to outline key regulatory provisions in today’s workers’ compensation environment. 

SHOW MORE >>

4:15 p.m. – 4:30 p.m. | Announcements & Adjourn

5:30 p.m. – 7:00 p.m. | General Networking Reception

Day 2 – Friday, March 6, 2020

9:30 a.m. – 10:30 a.m. | State of the States: Selective Findings

This session features selective findings and trends seen across WCRI’s core benchmark studies, including our 18-state CompScope™ Benchmarks reports, a multistate benchmarking program that measures the performance of a growing number of state workers’ compensation systems.  One set of findings will focus on readmission and reoperation rates as seen below.

Readmission and Reoperation Rates among Workers’ Compensation Patients

According to the Centers for Medicare and Medicaid Services, two of the main indicators of surgical quality are whether patients are readmitted or reoperated upon after a surgical procedure.

SHOW MORE >>

Everything you need to know about the conference:

 Dates and Location

  • Thursday, March 5 – Friday 6, 2020
  • Westin Copley Place
    10 Huntington Avenue, Boston, MA
  • Telephone: 617-262-9600

 Conference Hours

  • Thursday, March 5: 9am to 4:30pm
  • Friday, March 6: 9:30am to 12:30pm

 Additional Details

  • Dress is business casual
  • Luncheon will be provided on Thursday, March 5th in America South, 4th Floor Westin Copley
  • A networking reception will be held from 5:30pm to 7:00pm on Thursday evening, March 6th in the America Foyer, 4th Floor Westin Copley
  • Information on CE credits will be made available shortly
  • By attending the conference, you consent to be photographed, filmed and/or otherwise recorded and to the use of any photos/film/recordings.

 Registration Hours & Locations

  • Wednesday, March 4, 2pm to 4pm in Carriage Entrance, Westin Copley Place
  • Thursday, March 5, 7am to 4pm in America Foyer, 4th Floor, Westin Copley Place
  • Friday, March 6, 7am to 12pm in America Foyer, 4th Floor, Westin Copley Place

 Registration Fees

Early Registration (by February 13, 2020)

WCRI Member: $525

WCRI Associate Member: $195

Non-Member: $875

Spouse: $80

 

Regular Registration (after February 13, 2020)

WCRI Member: $575

WCRI Associate Member: $225

Non-Member: $975

Spouse: $80

 

©J&L Risk Management Inc Copyright Notice

Filed Under: WCRI Annual Conference Tagged With: generational differences, largely retired, Press duties

Workers’ Comp Penalties and Fines – Paying Someone Else’s Tab?

February 6, 2020 By JL Risk Management Consultants

Workers’ Comp Penalties and Fines Are Paid By Responsible Party – who is that? 

If you want to start a debate in a claims office just ask who pays for the Workers’ Comp penalties and fines in certain cases.  Why does a seemingly insignificant payment amount cause so much chagrin in a claims file?  Let us look at two areas of great consternation. 

picture of Workers" Comp Penalties and Fines police car

Public Use License – GDPII

Responsible Party for Workers’ Comp Penalties and Fines 

One scenario looks like this – an employer reports a claim 9 days after injury and the Workers’ Comp Board fines the carrier for a late compensability decision and payment of benefits.   The carrier or TPA (self-insureds) is fined $500. 

 Does the claims department pay the fine under expenses or  Indemnity/Medical benefits?   The employer was nine days late, but the carrier was left with five days and two of those are the weekend?  Does the carrier/TPA take the hit and pay it under Expenses and not under a benefit type?

For self-insureds, sometimes the TPA’s have a fourth benefit type that is labeled,  such as TPA expense.  Please remember that Self-Insureds pay the toll for everything and then have to pay the TPA a fee to handle the files.  The fourth benefit type where the TPA has to eat the penalty or fine kicks in for these situations.  Does the data entry person know there exists a fourth type of payment category?

For large deductible plans, the carrier adds in a clause that states – the insured will pay 50% of the incurred claims handling expenses.  No, really, if you are a large deductible insured, check out that clause.  I have found it in hundreds of large deductible plans.  Could you be paying 50% of the fees that your company owes no responsibility? 

For voluntary market policies, sometimes the person that is coding the payment type has to make that decision and they are under incredible time pressures to provide fast data entry.   I have seen this happen more than seldom. 

OK, Why Do Small Payments Matter?

One has to look at this question from two viewpoints – 

Small But Numerous Payments – if 10 data entry personnel cutting checks all day, all use the same rule to pay fines in Indemnity, then that could turn into a real problem.    If they are all paid under Indemnity Benefits, then small payments add up to large payments over time. 

Until someone reviews and finds those mistakes (J&L does often). the insured may never know they have been paying a little extra premium or for self-insureds an extra benefit payment.  

Power of Workers' Comp Penalties and Fines attorney form

Wikimedia Commons – James D. Sims

Fines and Penalties Can Be Huge-  say that a $125,000 settlement check arrives at the claimant attorney’s office later than 14 days after the settlement is approved.  The claimant attorney files for a 10% penalty on the payment.   

That penalty tolls at an extra $12,500 the claimant attorney and his client receive by filing a late payment notice with the Workers’ Comp Board.  Yes, J&L has seen that in files.  Claimant attorneys watch that very closely. 

If that payment was paid under Indemnity instead of an expense, then that is a $137,500 payment for a $125,000 settlement check.  

A payment such as that can tick up an Experience Modification Factor or LDF (self-insureds) with just one misplaced payment type.  How about six or eight of those?  You get the idea without requiring more examples. 

Payment Categories Become Key – Why? – Expense payments made by carriers are considered an expense of handling the claims – these payments DO NOT AFFECT THE MOD.   Most states calculate your Modification Factor from Indemnity and Medical payments only. 

Paying for the carrier’s expenses under your Mod can quickly increase your premiums and may land your company in the Assigned Risk Pool.

You Cannot Always Assume Fault with the Carrier or TPA if the TPA, for example, did not receive approval and the funds timely from the carrier in my $12,500 example, which is to blame then? The debate rolls on.   When I worked for a TPA in the 1990s, I drove a check to the claimant attorney’s office as it was due that day.   I received authority from the employer that same day.  Postmarks do not make a difference as the fines are based on the date of receipt.   

The $12,500 example was actually from a real incident from the 1990s.   I drove the $125,000 check while the ink was dry to the claimant attorney office 1.2 hours away.   Yes, the self-insured employer did not give the authority to cut the check until the same day.  Whew!  

At least there was a great fast food restaurant near the claimant attorney’s office. 

Two Ways To Avoid Paying Penalties and Fines  – one easy and one hard 

  1. Easy way – always respond to your carrier quickly if the adjuster contacts you with an ASAP call or email.  Take my example from above; I could have just let the self-insured employer pay the fine and have mailed the check.  It was on them.  Do not place your Workers’ Comp ratings in jeopardy by delaying the inevitable.  Responding to the claims staff builds a good relationship and improves your Mod or LDF.  
  2. Hard way – reviewing payment screens will enable the trained eye to see if the right payments type were assigned to what should have been the Expense payments.  Each carrier and TPA has its specialized system and payment type notations.  No standards for payment types exist when looking at the payment screens.  Years of experience reviewing payment screens remains your best bet.

Sometimes paying Workers’ Comp penalties and fine are unavoidable – again – who really pays? 

 

©J&L Risk Management Inc Copyright Notice

Filed Under: Fines Penalties Tagged With: Indemnity, large deductible insured, payment amount, Workers' Comp Board

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About Me

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James J Moore
Raleigh, NC, United States

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:
• Risk and Insurance Management Society (RIMS)
• Entrepreneur Magazine
• Bloomberg Business News
• WorkCompCentral.com
• Claims Magazine
• Risk & Insurance Magazine
• Insurance Journal
• Workers Compensation.com
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Recent Posts

  • Workers Comp COVID-19 Vaccinations – Part of Return To Work
  • Workers Comp Test Audits – Pain or Preventative Measure
  • WCIRB 8871 Webinar – What California Insureds Need To Know
  • Workers Comp Website – 10 Things To Know When Switching Providers
  • Workers Comp Zoom Presentation – Top Four Hard Lessons Learned
  • Experience Mod Increases While Loss Runs Show No Changes – WTR?
  • Workers Comp Allocated Expenses – Who Pays For Which Bills?
  • Workers Compensation Presentations Kawasaki Technique
  • 8871 Standard Exception Classification Code Question
  • J&L Founder James J Moore to Teach Insurance Academy Course Feb 4th
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