By Liz Griggs, CEO, WorkWell Prevention & Care
Workers’ compensation fraud continues to be a serious problem throughout the industry as it not only drives up insurance premiums, but it also negatively impacts the bottom line for carriers. Moreover, even with solid pieces of legislation in place, like the Workers’ Compensation Fraud Act, incidents of illegitimate claims seem to surface almost daily, like the recent construction worker’s fraud case.
With fraud activity still being so prevalent, industry trends are now showing that one in 10 small-business owners are concerned that an employee will fake an injury or illness to steal workers’ compensation benefits (according to insurancefraud.org). Given these concerns, business owners are starting to become even more sensitive towards identifying the key “red flags” of a potential fraud case. According to a 2015 Employers Holdings survey, more than half of the participants agreed that the key fraud flags include: an employee that has a history of claims (58 percent); there are no witnesses to the incident (52 percent); an employee didn’t report the injury or illness in a timely manner (52 percent); and the injury coincided with a change in employment status (51 percent).
Regrettably, there are already high costs associated with managing legitimate claims that hit the system, as workers’ compensation (and associated medical costs) is already an estimated $70 billion plus/year industry. But now the industry has to factor in the additional increasing costs of managing illegitimate claims and fraudulent activities.
While there are several types of fraud activities associated with on-the-job injury claims, employee fraud is listed among some of the costliest types of work comp fraud in the marketplace. Interesting, what many organizations may not know, is that while employee fraud may be costly, there are also some key ways to help mitigate this type of fraud, if organizations deploy the right procedures.
As a matter of fact, there are now workers’ comp solutions providers that are being even more aggressive in delivering the latest innovative technologies and solutions to help companies fight against fraud, and reduce costs and unnecessary litigations in the industry. These new innovations involve prevention and early intervention solutions that are disruptive models to the traditional workers’ compensation model that’s been around for years.
Below are five innovative best practices that companies can now consider implementing to support a fraud-free workplace environment:
- Worksite Evaluations: Involves physical therapists on the front end (not just after an injury occurs), to work with employees, supervisors and management to understand workflow and all job task requirements. As a result, therapists are able to recommend optimum positions, ergonomic strategies and physical movements required at work stations to minimize musculoskeletal impact on the employee.
- On-the-Job Fitness Solutions: Engages employees in wellness tactics like stretching, core muscle strengthening, endurance and coordination exercises that are specifically customized to improve areas of the body that are most engaged in performing work-related tasks.
- Functional Job Analysis (FJA): Uses the process of evaluating and empirically measuring the critical functional demands of the job. This analysis also involves assessing the work and the worksite. An FJA can be extremely beneficial in helping supervisors assign and/or reassign employees to positions that best fit their physical capabilities.
- Prompt Reporting: Trains and engages employees to report any health concerns as soon as they notice any discomfort. Once these early notifications are reported to supervisors, they are able to immediately address the concern and respond with appropriate evaluations, diagnosis and/or medical care – before the issue escalates.
- Early Intervention Screening: Allows prevention teams to screen employees and evaluate the worksite as a result of the employee’s concerns, supervisor requests, or first responder’s requests. The prevention team then coaches the employee regarding appropriate ways to perform job tasks, the correct movement patterns, posture changes, and strategies to reduce reported discomfort and improve safe job performance.
Reducing workers’ compensation fraud can be accomplished, given the latest solutions now available to employers. By utilizing these innovative prevention and early intervention models, costs associated with managing illegitimate claims can be reduced, and legal and medical fees can be significantly mitigated as well.
About Liz Griggs
Liz Griggs is the Founder, Chairman and Chief Executive Officer of NextImage Medical, now WorkWell Prevention & Care through the acquisition of WorkWell in 2014. Griggs oversees all aspects of the company’s leadership, strategic growth, and business development initiatives.
Griggs is a foremost thought leader in the workers’ compensation industry with over 23 years of experience. She launched the workers’ compensation managed care industry in 1993 as the co-founder of One Call Medical, OCCM. Her visionary thinking and innovative approach has influenced how the industry views managed care today. Griggs continues to innovate by refocusing managed care on cost containment through prevention and wellness.
Griggs is a Dean’s Scholar graduate from the University of Delaware and the Owner/President Management (OPM) Program at the Harvard Business School.
About WorkWell Prevention & Care
WorkWell Prevention & Care brings 25 years of excellence in soft tissue injury prevention and physical therapy treatment, as well as, next generation diagnostic imaging services, prevention and early intervention solutions to our clients. Our goal is to deliver cost effective, outcome focused solutions to our customers. WorkWell Prevention & Care provides an integrated suite of services and programs that set us apart in the industry. Our Prevention & Wellness and Diagnostic & Treatment programs offer a first in class approach that focuses on outcomes and return to work to reduce overall cost and time lost on the job.