I'm an employer in Los Angeles California and several bogus claims are treating my bussines and the employment of nearly 100 people, I know that those claims are not real but the insurance company just pays them and later they will recover the money from a brutal increase in my policy, I talk to them but they don't care, what I can LEGALLY do to stop the abuse.
2007-03-02 09:02:47 · 7 answers · asked by elcabula2002 3 in Business & Finance ➔ Insurance
Nothing. If your agent has talked to the adjuster, and you have talked to the adjuster, and the adjuster tells you that they are going to keep paying the claim, that means the adjuster doesn't hink he has enough proof to deny the claim. Keep in mind, that workers comp is a no fault coverage - and the insurance company has to prove that the claim ISN'T covered, not the other way around.
The GOOD news is, even if the insurance company suspects fraud, and sets a private investigator on the claimant(s), THEY WON'T TELL YOU, THE EMPLOYER. But they can't DO anything to stop it, until they have proof.
2007-03-02 10:30:03 · answer #1 · answered by Anonymous 7 · 0⤊ 0⤋
In Nevada we were having the same problem - no over site or accountability so we started our own Self Insurance Group - or SIG. Large companies and hospitals have been self insured for a long time - but this is a group of similar business' banding together. Look into your laws and see if it can be done. There are administrators that set up and handle the details and third party administrator who handle the claims and it is still more cost effective than letting the state run it. The other advantage is we really do investigate the bogus claims. But right now your only option would be to hire your own PI and get proof that the employees are not disabled - working for cash somewhere - or have a history of such claims etc. Like you say - your insurer will get the money back from you, so why bother expending investigative cost that may or may not turn up something concrete.
2007-03-02 09:20:56 · answer #2 · answered by justwondering 6 · 1⤊ 0⤋
I do this in Australia. First install surveillance cameras, even if there dummies. When you get a claim hire a private investigator to come in and perform a workplace incident investigation. Have in place a signed endorsement from all staff all injuries must have a witness and to be reported immediately. Take a camera or get the supervisor to photograph the scene and the system of work performed by the employee who alleges an injury. You need to send the message to the employees that you will not roll over quietly and accept just anything. You should see a marked reduction in claims. I find the dummy cameras work a treat.
2007-03-02 12:56:16 · answer #3 · answered by Anonymous · 0⤊ 0⤋
So sorry to hear this.
I would agree that you should hire a pi.
I love it when they have those stings on TV where the fraud guy that is supposed to be home in the bed is out on the roof or water skiing.
I would think that any PI worth his weight in tuna would be able to find out if these guys are legit with one week of following them. Dangle a carrot in front of the PI by giving him a 500 or 1k bonus for getting the positive info on camera and decrease the payout of the bonus for every 2 days it takes for him to get the information...(this incentive will make him work that much harder).
You can recoup the bonus from the fraud guys....
These are federal offenses (filing fraudulent workman's comp claims) so you should have no trouble adding the investigators' salary to the money you recoup from the shieskters
GOOD LUCK
2007-03-02 09:51:50 · answer #4 · answered by Anonymous · 0⤊ 0⤋
they could't threaten your pastime because of workman's comp claims legally. With such small claims (were you out of work better than 2 days for any of them? were the dr. costs everyday, or did you may want to save going decrease back?) i do not imagine the corporate would care--they have coverage and could anticipate some injuries. in the journey that they do care, do beware for them analyzing different aspects of your artwork--in the journey that they don't like the claims, they might commence searching more durable at attendance, performance, or different aspects to work out in the journey that they could hearth you. in case you get damage on the pastime, those are the corporate's well being care service costs and not in any respect yours--maximum employers keep in mind that, are insured for it, and could no longer have an issue except they imagine you're taking unfair benefit of them.
2016-11-27 00:45:38 · answer #5 · answered by ? 4 · 0⤊ 0⤋
Get a lawyer. In turn, the lawyer will work with a private investigator.
2007-03-02 09:06:11 · answer #6 · answered by Jay 7 · 1⤊ 1⤋
get a lawyer
2007-03-02 09:10:08 · answer #7 · answered by KELLI 4 · 1⤊ 1⤋