It was noted claim costs appeared to be increasing disproportionately to the claim frequency.
Omega initiated monthly claim financial audits. Our risk manager, a highly experienced workers’ compensation professional audited all claim costs identified in the monthly loss run provided by the carrier. The audit revealed several errors, duplicate payments, overlapping expense fees, and payments made on denied claims, etc. The carrier was notified, and the appropriate credits were made, resulting in a 20% savings on costs for one month. Omega has subsequently found additional errors and savings as a result of the monthly claim financial and the audits.
Each state has annual workers’ compensation statutory assessment fees. The insurance company includes these fees as part of the premium. In addition to monthly claim audits, all premium charges are audited. Duplicate charges were identified in three states were identified through the financial audit, thus resulting in reduction of premium.
Workers’ Compensation costs are often viewed as a necessary and costly “part of doing business”. The costs have a direct impact on your ability to meet financial goals. Why then accept carrier fees and claim expenses without oversight? Omega Risk Services will hold the carrier’s accountable for your financial interests.
“Omnia’s auditing process will ultimately result in lower costs to you.”
A 49 year old merchandising employee with considerable performance issues claimed he injured his lower back while stacking boxes of diapers. He was working with two other co-workers at the time of the accident. He went down on his knees in a dramatic fashion, expressing his was in excruciating pain. He was directed to an occupational clinic by his supervisor. His co-workers assisted him to his vehicle, as he claimed he could “barely walk”. He was diagnosed with an acute lumbar strain/sprain with a possible herniated disc. He was deemed to be totally disabled.
The potential liability on this claim was $50,000 to $100,000 depending on whether or no he requires surgery, and the permanent restrictions that would likely result.
Omega provides comprehensive safety and accident investigation training for all of their clients and their managers. In addition they are provided with Accident and Workers’ Compensation Kits to assist them in post accident investigation and claim reporting. This proved to set the foundation for the accident investigation leading to the denial of this claim.
The manager had each co-workers complete a written witness statement. The statements established this was a highly suspicious claim. First, the injured worker had told the co-workers he needed to leave early that day as he had an interview with another employer. Second, they shared his contribution to the work that day was minimal as he was talking the majority of the time. Last, when they assisted him to the car, he did not put any weight on their shoulders as you would expect if he could “barely walk”.
Upon receipt of this claim and witness statements, Omega immediately reported the claim to the insurance carrier and red flagged it as HIGHLY SUSPICIOUS. Omnia’s experienced workers’ compensation risk manager conducted interviews with the alleged injured worker, his supervisor, and the witnesses. These were summarized and provided to the carrier. In addition we provided the carrier with a summary of the background of the employee performance issues. Unbeknownst to the co-workers, this worker was on probation, and was he was about to be terminated.
The claim was ultimately denied. The injured worker did not appeal. Instead he admitted that he wasn’t sure he actually injured his back at work. The claim was closed and reported to the states fraud division.
Omnia’s risk management training and aggressive claims management averted this from becoming “just another claim”, as so frequently paid by the carrier. The loss experience drives workers’ compensation premium costs. By denying this claim, Omega was able to maintain a favorable experience modification for this client. What could have been a $50,000 plus claim is not on their loss experience.