Monthly Archives: January 2011

Attempts to level the field of play: Utah, California focusing on contractors

Utah and California are clamping down on contractors who scrimp on workers’ comp coverage, while California is also looking at the problems of liens that, according to a recent state report, are “choking” the state’s injured worker system. Meanwhile the battle to redesign Montana’s system has reached a new level, and temporary rate hikes in Washington state have been made official.

According to a Jan. 31 post at InsuranceJournal.com, “Utah Senate Bill 35 is going after construction companies, requiring them to pay workers’ compensation and contribute to unemployment insurance and withholding taxes as long as their employees own less than 20 percent of the company. Employees who own 20 percent of the company would be classified as owners, for which companies do not have to pay workers’ compensation and unemployment  insurance and taxes.”

A few days earlier, ClaimsJournal.com reported, “The Professional Association of Specialty Contractors announced it is working with the California Contractors State License Board, calling upon trade contractors to identify builders, owners and general contractor personnel who fail to obtain workers’ compensation insurance for their employees. According to Senate Bill 1254, CSLB is authorized to issue cease and desist orders, as well as suspend the license of any licensed contractor that fails to abide by the state workers’ compensation insurance requirements.”

Back to Utah, here’s what The Salt Lake Tribune has to say as of Jan. 28: “Disreputable construction companies soon may no longer escape paying workers’ compensation, contributing to unemployment insurance and withholding taxes by declaring workers as owners instead of employees.

“The Utah Senate voted 27-0 on Friday to give preliminary approval to SB35 to stop that practice. A final vote is expected next week.

” ‘This is commerce with a conscience,’ said Sen. Karen Mayne, D-West Valley City, sponsor of the bill.”

Following are some related but perhaps odd links–you be the judge:

In California, peeps should be reading the text of the bill. Following is an excerpt that addresses the law of the land as is stands, today:

Existing law requires private employers to secure the payment of compensation by obtaining and maintaining workers’ compensation insurance or to self-insure as an individual employer or as one employer in a group of employers. The Contractors’ State License Law requires every licensed contractor to have on file at all times with the Contractors’ State License Board a current and valid Certificate of Workers’ Compensation Insurance or Certification of Self-Insurance, or a statement certifying that he or she has no employees and is not required to obtain or maintain workers’ compensation insurance coverage.

Here’s the essence of what the new law would change:

This bill would authorize the registrar of contractors to issue a stop order, effective immediately upon service, to any licensed or unlicensed contractor who as an employer has failed to secure workers’ compensation insurance coverage for his or her employees. The bill would make a failure to comply with the stop order a crime, thereby imposing a state-mandated local program. The bill would set forth specified procedures for the payment of employees during a work stoppage subject to a stop order, as specified, and for an employer to request a hearing to protest a stop order. Upon that request, the bill would require the registrar of contractors to hold a hearing to affirm or dismiss the stop order and issue and serve on all parties to the hearing a written notice of findings and those findings. The bill would authorize a writ of mandate to be taken from the findings to the appropriate superior court, as specified.

In case you’re not following? What that says is a regulatory body–the registrar–could bust the chops of contractors who don’t play fair. If these regs work out, it could be good for consumers and workers, alike.

We will stay tuned.

Next up, back to the lien problem in California and the situations in Montana and Washington.

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Frequently enough, a worker’s compensation case may be so complex as to demand legal representation. However, sometimes what seems like a cut-and-dried situation to an injured worker may result in a smaller award than envisioned–or even a denial. Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Filing a claim

More fraud: From shell companies to multimillion dollar settlements

[Editor’s note: This is the second of two parts on workers’ comp fraud. Part one is here.]

In the preceding post, we looked at various cases of injured workers, from relatively simple scams to a bizarre case in which a sheriff’s deputy contends he was set up to take a fall in retaliation for filing a workers’ comp claim.

The next case involves a business owner charged with a laundry list of crimes Florida, after being arrested by the state’s Chief Financial Officer (CFO), an elected position that includes oversight of the Department of Financial Services including the Division of Insurance Fraud.

A shell company

According to a Jan. 26 press release, “Florida CFO Jeff Atwater today announced the arrest of David Rodriguez-Socarras, 49, a Duval County man who allegedly created a ‘shell’ company and fictitious name in order to cash nearly $3 million in payroll checks through a money service business to avoid workers’ compensation premiums and payroll taxes.

“Socarras is facing multiple felony charges, including application fraud, workers’ compensation fraud, criminal use of personal identification information, fraudulent application for a Florida driver’s license or ID card, and possession of a fraudulent Florida driver’s license or ID card, and faces up to 20 years in prison if convicted on all charges. He was booked on Monday into the Duval County Jail with bond set at $300,000.”

57 certificate of insurance

The statement continues, “The violations were uncovered when the department’s Bureau of Workers’ Compensation Compliance served a Stop Work Order on Socarras’ business, HMV Construction Incorporated, and discovered he had provided 57 certificates of insurance to companies from Jacksonville to Naples.

“A ‘shell’ company is often created to utilize money service businesses, such as check cashing stores, to cash large construction payroll checks for contractors who are avoiding paying for workers’ compensation premiums and payroll taxes.
“Socarras’ arrest is part of an ongoing investigation by the North Florida High Intensity Drug Trafficking Area Task Force’s Money Laundering Unit that includes the DIF, Jacksonville Sheriff’s Office and U.S. Immigration and Customs Enforcement.”

A temp agency and more shells

At an Iowa employment agency, things have gone from bad to worse. Last year, someone at the agency got caught embezzling funds. Now, the owner of DES Staffing, Dinesh Sethi, “has been  indicted on federal charges of wire fraud and conspiracy to commit wire fraud” in connection with a workers’ comp scheme, according to a Jan. 24 piece in the Des Moines Register.

A Jan. 25 follow-up story says Sethi pleaded not guilty to a six-count indictment, turned in his passport and was released on his own recognizance. A conviction could result in a 25-year prison sentence, a fine of $250,000, or both.

‘At least $1 million’

According to the earlier story, “The indictment, which became public Monday, accuses Sethi of defrauding four insurance companies of at least $1 million in workers compensation premiums that should have been paid to cover employees of DES Staffing, a temporary employment agency.”
The article also says the indictment alleges the following:
  • Sethi created two decoy, “shell” companies, as if they were separate from DES, then listed most employees in the two new entities, in an attempt to avoid higher-priced workers’ comp premiums, which had jumped in 2008 “due to serious worker compensation claims, including the deaths of two employees”;
  • two employees listed some workers as holding clerical or lower-premium positions instead of their actual, higher-premium positions;
  • Sethi and the pair of employees falsified payroll records to an insurance company in 2009.
The Des Moines-based temp-staffing business is described as having 40 employees in offices in five states, with 2009 revenues of about $20 million and placements of about 1,000 temp personnel.

Chiropractor indicted

A Cincinnati Fox affiliate has a Jan. 25 story about a medical provider indicted for workers’ comp fraud and theft. If convicted, the Fairfield, OH, chiropractor will be a repeat offender–he pleaded guilty to workers’ comp fraud in 1996, after being charged for billing the Ohio Bureau of Workers’ Compensation (BWC) about $13,000 for services that were not provided.
Subsequently Bruce E. Holaday did not lose his chiropractic license but the BWC yanked the certification that allowed him to serve as a BWC provider. Still, he retained ownership of Back and Spine Center on Mack Road, where other chiropractors also work–chiropractors who are certified for BWC work.
According to the story, the BWC’s Special Investigations Department “initiated an investigation after receiving an allegation that Holaday was concealing from BWC his direct involvement in the treatment of injured workers.  Holaday was unlawfully using the names and provider identification numbers of the chiropractors with whom he practiced after being permanently decertified as a BWC health care provider, prohibiting him from seeking and receiving reimbursement from BWC.”

Four insurance companies to pay $120 million

To finish up, let’s see what it look like when carriers do the dirty deeds. Late in December, four insurers reached a settlement with the state of New York to pay about $120 million for overcharging on workers’ comp premiums.
According to a Dec. 31 piece in Businessweek, “New York Attorney General Andrew M. Cuomo said four insurers, including Zurich Financial Services AG and Ace Ltd., agreed to pay almost $120 million to settle claims they collected too much in workers’ compensation fees.
“Pennsylvania Manufacturers’ Association Insurance Co. and CNA Financial Corp. also entered into the settlement, Cuomo said today in an e-mailed statemen.”

A Dec. 31 Reuters account says, “The Workers’ Compensation Board charges annual fees to workers’ compensation insurers, who cover the fees by charging policyholders a surcharge on premiums.”Beginning in 2000, the board used a different calculation than the one used to determine the surcharges to policyholders. As a result, some insurers including ACE, Zurich, Pennsylvania Manufacturers and CNA collected too much from 36 of their member insurance companies.

“A change in the law in 2009 and 2010 allowed the state to recover the excess funds that the insurers had collected.”

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Frequently enough, a worker’s compensation case may be so complex as to demand legal representation. However, sometimes what seems like a cut-and-dried situation to an injured worker may result in a smaller award than envisioned–or even a denial. Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

It’s never a good idea to game Workers’ Comp system: injured, provider or carrier–it’s a bad idea

First of two parts on fraud in workers’ comp cases

Fraud arises in all human endeavors, in all shapes and sizes, every flavor and scent.

Accordingly, it’s no surprise that workers’ compensation fraud runs the gamut from simple to elaborate, from ordinary to exotic. For example, a Jan. 18 brief from New York state describes a “Port Jervis woman [who] was arrested by Monticello Police for submitting a workers’ compensation claim with allegedly false information about her mileage and prescription costs in order to collect $2,057 in money to which she was not entitled.

“Danielle Devore, 33, was charged with felony insurance fraud in the fourth degree, falsifying business records in the first degree and grand larceny in the fourth degree.”

Another fairly simple case: snow plow buried him

A Jan. 25 piece describes a Connecticut case in which “Richard Bates, 55, pleaded guilty in New Hartford Town Court to a misdemeanor charge of second-degree offering a false instrument for filing and was fined $1,000, prosecutors said.” He also paid about $6,500 in restitution. Apparently, he got caught working at a snow plow business after telling authorities he couldn’t work due to injuries received at a different job.

Dont’ mess with the feds

Another case, detailed in this Jan. 27 article, is a about a guy who got nabbed also doing snow removal work, plus lawn care. However, the employer with the alleged bogus workers’ comp claim was the U.S. Postal Service: “Former U.S. postal employee Norman J. Motko, Jr., 61, of Cleveland, was sentenced to five months in prison and must pay $116,980.34 in restitution after pleading guilty to worker’s compensation fraud, according to U.S. Attorney Steven M. Dettelbach.

“U.S. District Judge Lesley Wells also sentenced Motko to three years of supervised release following his prison term.”

Motko got popped for taking benefits from Dec. 2004 until Feb. 2008. The case was investigated by the Inspector General’s office of not only the USPS but also the Labor Department. Not to say state authorities are lax, but those who would game the system should recognize that a federal investigation is going to be played hardball:

The U.S. Postal Service pays over $1 billion annually in workers’ compensation costs,” said Eastern Area Special Agent in Charge Elizabeth A. Farcht, U.S. Postal Service Office of Inspector General.

“The majority of postal employees who collect federal workers’ compensation benefits have legitimate claims due to on-the-job injuries and are truly unable to perform any work. A small percentage, however, abuse the system and cost the Postal Service millions of dollars in fraudulent claims.”

“This conviction and sentencing should put those who choose to defraud the system on notice that Special Agents with the USPS Office of Inspector General will aggressively investigate these cases, and present them to the U.S. Attorney’s Office for criminal prosecution when appropriate.”

When the going gets weird

Stepping up the ladder in terms of complexity, this next case still involves an injured worker, but now we’re really in the shadow realm. We cover plenty of cases involving law enforcement officers and firefighters, but this story smacks of espionage and the dark corners of police investigating police.

From the Southeast Texas Record, this Jan. 18 article starts off thusly: “A former Brazoria County sheriff’s deputy claims that he was terminated in retaliation for filing a workers compensation claim after being injured on the job, recent court documents say.

“In a lawsuit filed Jan. 10 in the Galveston Division of the Southern District of Texas, Mark Wiggins accuses the Brazoria County Sheriff’s Department of  ‘using false accusations of misconduct to concoct a pre-text to terminate him.’

“The complainant insists that the law enforcement agency dispatched him to a public intoxication call two years ago as a way to get him fired, the suit argues.”

In other words, Wiggins is saying that once he filed his workers’ comp claim, the sheriff’s department set him up.

According to a Jan. 11 post at the Houston edition of Examiner.com, Wiggins first filed an injury report in 2008 after what he described as being attacked by a bull–certainly a possibility for almost any deputy in Texas. For that matter, it’s not outrageous to posit a situation in which even a metro police officer might engage a livestock encounter, given the blend of city/rural landscapes; high-profile, pro-circuit rodeos; big-time fairs; and small-town annual celebrations.

The Texas reality

Regardless, the daily reality is that officers of a sheriff’s department are more likely to deal with rural, or out-of-town, predicaments than are city police. Basically, police deal with problems inside the city limits, and sheriff’s departments deal with the rest of the county.

Now, back to the Southeast Texas Record, about the second claim:

The most recent injury occurred on Aug. 8, 2009, when Wiggins attempted to make an arrest after a disturbance call. He reported the injury to the sheriff’s department the next day in an effort to receive medical treatment by way of workers compensation insurance.

After filing the necessary documentation, a dispatcher called Wiggins to assist the West Columbia Police Department with an allegedly intoxicated person on the San Bernard Bridge.

“Unknown to the plaintiff at the time, this call was an invitation to a trap set by the Brazoria County Sheriff’s Department so that it could have a pre-text for firing the plaintiff,” the original petition says.

It further explains that Wiggins “performed his duty properly by concluding he should arrest the person for public intoxication as opposed to driving while intoxicated because he personally did not see the suspect driving the car.”

The arrest reportedly angered Chief Deputy Jeff Adkins, who demanded Wiggins “resign or he would never work in law enforcement again,” the suit says. In response, the complainant declined to resign under the threat.

Anyone with questions about the complexities about workers’ comp cases should read each of these linked stories, as a way to gauge to all the legal questions that can arise.

In the next installment, we’ll pursue more cases, cases that move from injured workers’ claims into alleged wrongdoing by medical providers and insurance carriers.

Stay tuned.

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Frequently enough, a worker’s compensation case may be so complex as to demand legal representation. However, sometimes what seems like a cut-and-dried situation to an injured worker may result in a smaller award than envisioned–or even a denial. Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Filing a claim

Montana, Georgia push bills to deny workers’ comp to ‘illegal workers’

Workers’ comp issues  continue to roil the political waters of Montana, where recently introduced legislation to deny workers’ comp benefits to undocumented workers appears to have sparked similar legislation in Georgia.

We covered some of the overall reform controversy in September, followed by a piece comparing the state’s nation-leading ranking as the most expensive for workers’ comp premiums in October, then discussed a November ruling by the state Supreme Court that elderly injured workers should be bumped from the system for injured workers in favor of long-term disability benefits.

By one count, the state has about 30 workers’ comp measures to contemplate.

‘A bill to deny workers compensation’

The latest, according to this Jan. 18 piece at MontanaWatchdog.com, is a “bill to deny workers’ compensation to illegal immigrants passed its second reading Tuesday on the floor of the state House of Representatives, despite warnings that the proposal could create a nightmare for employees.

“ ‘Welcome to the world of workers’ compensation,” said Rep. Gordon Vance, R-Bozeman, who introduced House Bill 71 and added this was the first of several workers’ compensation bills the Legislature would deal with this session.”

‘Sending a message’

On the same day, news outlet KFBB.com reported, “Supporters of the bill say that it will reduce costs and liability while sending a message to those employing illegal workers. But those who oppose the measure say it does not solve the overwhelming problem with Montana’s workers’ compensation and places a burden on hospitals that have to take care of the injured worker. Insurance officials say there may be only a handful of such cases a year in Montana.

“ ‘This is not a single issue problem, this is not a problem that can be solved by looking at one area, passing one bill and making everything better for the business community in the state of Montana, this has multiple facets to it and we need to address all of them and that’s what I tried to do with this bill,’ [says  Vance.]”

Op-Ed: bill ‘apt to misfire’

A more recent piece, a Jan. 25 Op-Ed at GreatFallsTribune is headlined “Bill banning work-comp for illegal immigrants apt to misfire.”

House Bill 71 is described by its sponsor as one of many workers’ compensation reform bills under consideration by the Legislature, but that’s not a good description.

Rather, it is a bill that seeks to use the workers’ compensation system to punish illegal immigrants and the businesses that hire them.The bill provides “that certain illegal aliens are not entitled to workers’ compensation wage-loss and medical benefits for a work-related injury or disease” and was on the fast track in the House, where it gained final approval 61-39 last Wednesday and was sent to the Senate.

Leaving aside the motivation for passing the bill, the problem we have with it is its likely effect.

At the state level, it would do nothing to reduce high work-comp premiums and payouts.

At the employment level, rather than denying compensation to workers injured or sickened on the job, as the sponsors intend, the bill will simply move the process of obtaining that compensation out of the work-comp system and into the courts.

Georgia bill only part of larger effort

A Jan. 24 article at the Atlanta Journal-Constitution’s news site reports, “State lawmakers filed legislation Monday seeking to ban illegal immigrants from collecting workers’ compensation benefits for on-the-job injuries in Georgia.

“Sponsored by Sen. Bill Heath, SB7 would prohibit people from collecting wage loss and medical benefits unless they were in the country legally at the time of their injury. Similar legislation is moving through the Montana Legislature.”

The article also says more wide-sweeping illegal immigration legislation–“much more”–is expected to be introduced in Georgia.

According to the article, the Georgia judiciary has recognized for years the rights of undocumented workers to receive work-related medical treatment.

“The head of the state workers’ compensation board declined to comment on SB7, but he said the Georgia Court of Appeals has held for years that such workers are entitled to these benefits. Illegal immigrants have been awarded the benefits in Georgia based on the court’s decision, though the state has not kept track of how much, said Rick Thompson, chairman of the State Board of Workers’ Compensation.”

Current law allows injured workers to leave yet still collect

In Montana, it sounds as though some observers don’t begrudge medical treatment for these injured workers as much they have a problem with loopholes in the system that, for example, allow them to leave the state and continue to receive benefit payments. According to the Jan. 18 Watchdog piece, “Under current law, when an illegal immigrant is awarded benefits they may leave the country and those benefits are then sent to their new address, taking the money out of Montana, Vance said earlier. He said that also makes it difficult to send a physician to check on the health status of the recipient.

“Kevin Braun, assistant general counsel of Montana State Fund, Montana’s insurance carrier, told the House Judiciary Committee earlier this month that his agency has seven to eight claims a year in which the claimant’s Social Security number does not match.”

Other legislators say they are concerned that the measure would harm employers or shift a burden onto hospitals.

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Frequently enough, a worker’s compensation case may be so complex as to demand legal representation. However, sometimes what seems like a cut-and-dried situation to an injured worker may result in a smaller award than envisioned–or even a denial. Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Filing a claim

Washington governor makes ‘bold’ policy move; Florida system ‘competitive,’ says agency report

Workers’ comp reform remains a hot topic in the Northwest, where Washington State Gov.  Chris Gregoire is making news with what Bloomberg.com calls “bold policy suggestions,” a few months after the I-1082 initiative failed at the ballot box:

After years of talking about government reform, Gov. Chris Gregoire is suddenly leading the way with bold policy suggestions that have roiled Washington state’s political waters ahead of the 2011 legislative session.

Her suggestions would dramatically overhaul both education and the ferry system, while also addressing the long-term problem of workers compensation costs. All three topics are among the thorniest in Olympia, and some advocates were caught off-guard by Gregoire’s ideas last week.

They probably won’t all survive the legislative session — as the saying goes, the governor proposes and the Legislature disposes. But the executive’s policy framework does play an important role in setting the tone and terms of the debate for lawmakers.

Governor hopes for $720 million in savings

According to a Jan. 6 post at BusinessInsurance.com, “The governor says several workers compensation system changes she plans to introduce could save Washington state $720 million over four years.

“Under her health care provider network proposal, workers would be able to choose their doctor while state and self-insured employers would ‘be able to encourage providers to follow best practices to help workers remain productive and healthy,’ the governor said Tuesday in a statement.

“That proposal alone would save an estimated $160 million over four years, Gov. Gregoire said.”

Union leaders, trial lawyers, other obstacles

One problem in Washington, according to a Jan. 18  guest-opinion piece in The Columbian, is that state law  provides neither for voluntary settlements nor for built-in links between benefits and work-related disease. Another hurdle may be establishing a broad support base, especially so soon after the defeat of I-1082. “Unfortunately,” says the Columbian piece,  “there seems little support for the most effective solutions, which are opposed by union leaders and trial lawyers.

“Today’s workplaces are safer than ever, and fewer claims are filed each year. So why is Washington’s workers’ comp system unsustainable?

“Too many of those claims remain open too long. In Washington, the average claimant is collecting benefits and off the job for 284 days.

“One reason is that, unlike 44 other states, Washington doesn’t allow voluntary settlement agreements. Virtually every other type of insurance has a final settlement, where the worker negotiates a lump-sum payment. But that is prohibited in our state’s workers’ comp system where claims are open-ended — which is why we have four to eight times as many lifelong pensions awarded as the next highest state, California.”

Reforms in Oregon, Florida

The author admires the level of reform effected in neighboring Oregon, noting that “real reform works”–based on measures passed there about twenty years ago–“and premiums there have not increased since 1990. In fact, premiums have decreased 13 percent since 2006 while benefits have increased.”

Unlike Washington, where the failed I-1082 ballot measure would have allowed private insurers to enter the workers’ comp market, Florida has a system that allows both private and state pools. Florida has not been as successful as Oregon in holding down premiums, but Florida’s 2010 statute-mandated report from the Office of Insurance Regulation (OIR) contends that the state’s workers’ comp market remains:

  • competitive enough such that “[n]one of the firms have sufficient market share to exercise any meaningful control” market price, yet
  • affordable enough for employers that “[b]ased on entries and voluntary withdrawals,” the market is an “attractive market for insurers.”

Recent rate hike not enough to wipe out gains of 2003 reform

Despite those findings, though, state workers’ comp rates went up “7.8 percent, effective Jan. 1, after the hike received final approval from Florida Insurance Commissioner Kevin McCarty, according to a Jan. 5 article in the South Florida Business Journal, which also reports that the rate hike “is based on the National Council on Compensation Insurance’s amended rate filing for workers’ comp insurance rates. It originally requested an 8.3 percent rate hike.”

According to an OIR press release, ” The 7.8 percent rate increase follows a decrease earlier in 2009 and still results in rate decreases accumulating to 61.9 percent since the 2003 reforms . . . ,” when the state had some of the highest rates in the nation.

The PR also says, “The report shows the Florida market features 260 entities writing workers’ compensation insurance — 255 private insurers, four self-insurance funds, and the Florida Workers’ Compensation Joint Underwriting Association (FWCJUA). The residual market, the FWCJUA, had 746 policies as of October 2010 with corresponding premiums of $5.5 million. This is a fraction of Florida’s overall workers’ compensation premium, which reported a total of $1.71 billion in written premium in the private market in 2009, ranking Florida seventh nationally.”

Florida’s rates for workers’ compensation have become some of the most competitive in the nation, which is progress when taking into account that, prior to reforms, the state had some of the highest rates in the country.

Abundance of carriers

The OIR released the commissioner’s final order along with a report on rates. It shows that 260 entities are writing workers’ compensation insurance in Florida: 255 private insurers, four self-insurance funds and the Florida Workers’ Compensation Joint Underwriting Association.

“The 2010 report clearly demonstrates a healthy marketplace in Florida, with multiple competitors, numerous options for purchasing insurance, and competitive premiums relative to other states,” McCarty said in a statement. “Maintaining competition and consumer choice is especially important for Florida businesses, given the current economic environment.”

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Frequently enough, a worker’s compensation case may be so complex as to demand legal representation. However, sometimes what seems like a cut-and-dried situation to an injured worker may result in a smaller award than envisioned–or even a denial. Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Filing a claim

AIG settlement grows, declined by some rivals; Illinois debate continues on divisive workers’ comp legislation

Following up on our post of Dec. 28, we see that the settlement in the AIG workers’ compensation case has trebled in scope. In Illinois, cases mentioned in that Dec. 28 post and in our Dec. 30 piece are gaining momentum, too.

AIG case more triples in proposed cost

Last month the AIG settlement for under-reporting workers’ comp premiums was described as reaching nearly $150 million in fines, taxes and related assessments. Competitors and various authorities contend the nearly $2 billion in mistated costs not only hurt rival insurers but also allowed AIG to dodge payments it should have made.

According to a Jan. 7 piece at Bloomberg.com, “American International Group Inc., recipient of a $182.3 billion U.S. government rescue, agreed to pay $450 million to rivals to settle claims it shortchanged industry-funded pools that insure injured workers.

“Travelers Cos. and Hartford Financial Services Group are among the seven competitors that will receive the money, New York-based AIG said in a proposed settlement filed yesterday in Chicago. Liberty Mutual’s Safeco subsidiary filed a lawsuit in 2009 accusing AIG of ‘long-term fraudulent underreporting,’ seeking more than $1 billion. Liberty Mutual, which was seeking class-action status for the case, wasn’t included in the settlement.”

Some parties decline settlement

Another Jan. 7 article, from Rueters, posted at CNBC.com, explains more about parties to the settlement–and those that have so far declined to settle: “The civil lawsuit was filed in mid-2009 by two firms, Safeco Insurance of America . . . and Ohio Casualty Insurance  . . . , on behalf of a group of insurance companies and alleged a $1 billion workers’ compensation under-reporting scheme at AIG.

“However, the proposed settlement was instead reached between AIG and seven other insurers that were among those affected by AIG’s conduct in the 1980s and 1990s and excludes Safeco Insurance and Ohio Casualty, both units of Liberty Mutual Insurance.”

Spokesman: Unfortunate that Liberty refuses ‘fair and reasonable settlement’

The article also quotes an AIG spokesperson, singling out Liberty Mutual’s recalcitrance as being against the “best interest” of members of the class-action suit: ” ‘It is unfortunate that Liberty is refusing to participate in this fair and reasonable settlement. As the seven other settling insurers have recognized in seeking to intervene in the action, Liberty’s preference to continue litigating is not in the best interests of the class members,’ AIG spokesman Mark Herr said in an email to Reuters.”

As we reported in preceding posts, it is now known that AIG had a longstanding practice of such under-reporting, in an attempt  “to evade state insurance taxes and residual market obligations.”

According to a Forbes.com piece, AIG has decided on a plan to issue warrants for its stock–which has recovered into the low $60 range since plunging in 2008–in the ongoing pursuit of being able to repay its taxpayer bailout of more than $180 billion.

Illinois begins ‘official probe’ of Menard facility

In Illinois, “[s]tate  insurance fraud investigators have opened an official probe of the Menard Correctional Center, where hundreds of guards and others have filed for or received taxpayer-funded settlements for ‘repetitive trauma’ they say was mainly caused by operating heavy cell locking mechanisms,” according to a Jan. 5 article at BND.com, the online version of the Belleville News Democrat.

In other words, there’s so many carpal-tunnel claims because the cell doors are too heavy? Makes you wonder how the warden qualified–but as it turns out, his lawyer says the warden was injured while on the job as a police officer, before being hired by the state to run the Menard facility. Also interesting is the number of state-paid, workers’ comp arbitrators who have their own claims, including the one who was involved in the case of the state trooper who crashed into the vehicle of two teenage girls who died:

Records show that some repetitive trauma awards for wrist and elbow injuries totaled more than $100,000. Menard warden David Rednour, 35, received $75,678 for a repetitive trauma injury his lawyer said actually occurred when he worked as a police officer before he was hired by the state in 2006.

Nearly one in four of the state’s 32, $115,800 per year workers’ compensation arbitrators or hearing officers, have filed for or received an award including for repetitive trauma, records show.

They include Jennifer Teague, the arbitrator in the case [in which] former Illinois state trooper Matt Mitchell is seeking an award for leg and other injuries.

Proposed legislation decried as unfair to workers

In the move to overhaul Illinois’ workers’ comp system, which as the nation’s third most costly is criticized as anti-business, State “Representative John Bradley . . . [ on Friday, January 7, 2011] filed House Amendment Number 2 to SB 1066.  This amendment is scheduled to be heard on Sunday, January 9 at 2 p.m. in the House Executive Committee,” according to this Jan. 8 post at ChicagoNow.com, a site with job hunting news and tips.

An opinion piece, the blog post urges readers to contact the legislature and ask for a vote against the measure; five points are highlighted as the major disadvantages to workers if the bill is enacted–here’s an excerpt of those points:

1)Severe restriction on choice of medical care.  This legislation limits the injured worker’s right to choose a doctor by forcing them to visit the doctor the company chooses first.

2) Utilization review — creates presumption in favor of UR which will be almost impossible to overcome.  It takes away treating doctors discretion to determine the best treatment for an injured worker.

3) Wage Differential — Significant caps (67 years of age or 5 years) and reviewable for economic change 4 times per year. . . .  These workers no longer have the ability or opportunity to earn the wage they once did.

4) Reduction of Medical Fee Schedule as well as other provisions designed to deny access to doctors chosen to treat work injuries . . . .  This reduction will result in fewer doctors wanting to treat patients on worker’s compensation.

5) This legislation is an attempt to shift the cost of the workplace injuries to the taxpayers of Illinois.

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Frequently enough, a worker’s compensation case may be so complex as to demand legal representation. However, sometimes what seems like a cut-and-dried situation to an injured worker may result in a smaller award than envisioned–or even a denial. Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Filing a claim