By Donna Motley, Vice President of Claims

Recently there have been several stories on local News stations claiming the “injustice” of our current Workers’ Compensation system. Allegations have been made by a well known, local plaintiff attorney, that part of the medical profession conspires with the insurance companies to “deny” Workers’ Compensation claims. And that the doctors are making thousands and thousands of dollars by doing so. It just so happens, this plaintiff attorney, who attends local Union meetings soliciting business, once filed a RICO (Racketeer Influenced and Corrupt Organizations Act) suit against us, as well as against our insured (employer/owner), claims adjuster and medical evaluation doctor. We tried the case in the Workers’ Compensation courts AND WON. We also WON on Appeal. We WON in civil court which was appealed to the Supreme Court who denied the appeal as well. Since the case against us, this attorney continues to file similar cases against other carriers and besmirch insurance companies/carriers and all connected with defending these claims.

(more…)

The State and Federal Labor Law Posters should be arriving in your mail at the end of the month so be watching for them!

By Donna Motley, Vice President of Claims

I’ve written in the past about Fraud in Workers’ Compensation. Types of Insurance Fraud include: Welfare, Unemployment, Mortgage, Automobile, Healthcare, Medicaid, etc.

This year we had our tri-annual State Audit and one of the questions they asked was how we handle fraud. We would first have to define “fraud”. Webster’s dictionary defines fraud as: “intentional perversion of truth in order to induce another to part with something of value or to surrender a legal right”. Per the Insurance Institute of Michigan website, an example of (insurance) fraud (pertaining to Workers’ Compensation) is: exaggerating the extent of a minor injury to collect (W/C) benefits; billing insurance companies for medical services that were not rendered. I think we can take it further. What about alleging a work injury when the injury really occurred outside of work? Or what about the person who alleges their medication was “stolen” and they need another re-fill when the reality is that either they are addicted to the drug or they are selling the pills on the street? What about the person who claims they need “in home assistance” because they are too incapacitated to even make themselves a sandwich? Or how about the person that won’t let the Nurse Case Manager in the examining room so they can tell the doctor how heavy or repetitive their job is, or their pain level is a 14 on a scale of 1 to 10?

(more…)

It is that time of the year when you will be receiving sales calls informing you that there have been important changes on the State and Federal Labor Law posters.We are aware of those changes and are in the process of compiling these updates ~ please expect your new 2016 updated labor law posters to arrive at the end of December.

By Glenda Moyle, Premium Accounting Manager

Well, we have started working on the January 2016 renewals. I have been working on these for over 30 years and it’s hard to believe that another year has sped by.

If you have an effective date in January, you should have already received your payroll renewal form asking for new estimated payrolls for the 2016 policy year. The goal is to accurately estimate payrolls which reduces the chance of a surprise audit of additional premium.

A common question I hear is what do we do if the payroll estimate form is not returned to MTMIC? Well, we use the higher of your 2014 audited payrolls or your current policy (2015 estimated) payrolls for your quote. It is never too late to send the form back to us. We can always revise your payment schedule.

If you need another copy of the payroll form please contact me at Glenda.moyle@mtmic.com/blog

By Ruth Kiefer, Loss Control Manager, MSc, ARM

Many of you have been with us for a very long time, and may remember when we first formed our safety alliance with the Consultation, Education, and Training (CET) Division of MiOSHA in 2007. This alliance was created in order to help our policyholders improve their shop safety and provide up-to-date education and safety training from former compliance officers. Who else would know better right?

Since that time, we have conducted over 122 joint visits with CET. Many of you have formed a valuable relationship with them and invite them back on a yearly or bi-yearly basis. Since we have found this to be a positive experience for the majority of our policyholders, we are renewing our alliance once again.

(more…)

By Donna Motley, Vice President of Claims

Workers’ Compensation insurance coverage is mandated in the State of Michigan. Even so, Workers’ Compensation is a “benefit” to the employee (and the employer). Employees are “entitled” to medical care and compensation should they have an injury while in the course of employment. But that does not allow the injured worker to have an “entitlement attitude”. Workers’ Compensation is not a “social program”. Benefits are governed by laws that were enacted over 100 years ago. Those laws have been periodically modified to change with the times. When you talk about laws, you are talking about attorneys – hence the modifications! Our success in the Workers’ Compensation courts is strongly influenced by the current political arena in our State at that time.

Employers know the part they play in the process: safety programs, safety training, drug screening, employment physicals, prompt reporting of injuries, accident investigations (and preventions).

(more…)

By: Ruth Kiefer, MSc, ARM, Loss Control Manager

Well, it’s that time of year again when MiOSHA released their top violations for general industry at the Michigan Safety Conference. This is also where we, as loss control consultants, focus our attention when we conduct our site safety surveys at your facilities. This year they broke down the top violations into both Heath Violations and Safety Violations, we will start with the Health Violations, which you may be less familiar with. If you are unsure if you have a health violation, you may ask your loss control consultant for more guidance on any of these violations noted below.

Listed below are the 2014 most recent general industry health violations cited by MiOSHA:

1. Part 602 – Asbestos Standards for Construction – 622 Citations Issued

• Not having an exposure assessment before starting renovation projects at your facility. Any building built before 1971 must have an asbestoses survey completed.
• Not having proper engineering controls and work practices when renovating.

(more…)

By Chris Demeter, Senior Loss Control Consultan

Due to the changes to the Recordkeeping Standard, the OSHA “Job Safety and Health It’s The Law” poster was updated to reflect those changes. According to OSHA, previous versions of the poster is currently acceptable. The changes to the Recordkeeping Standard was addressed in the December 2014 MTMIC newsletter. Previous newsletters can be obtained through the MTMIC website: http://www. mtmic.com/blog/

(more…)

By Travis Halsted, Loss Control Consultant

Accident investigation and analysis is a means used to prevent accidents. As such, the investigation or analysis must produce information leading to corrective actions to prevent or reduce the number of accidents in the workplace. In 2014 the state of Michigan had 37 workplace fatalities. The investigations from these events are essential as they provide the possible root cause of the accident as well as assist in developing long term remedies. Injuries result in loss of productivity and efficiency, increased workloads on supervisors and co-workers, possible damaged equipment costs, economic hardship to the injured workers’ family, and a cost of the time spent on the accident investigation, return to work programs, and workers’ compensation claims management. By conducting accident investigations a company could possibly implement a remedy that could prevent future occurrences.

(more…)

By Donna Motley, Director of Claims

Medical expenses always seem to be on the rise. The Workers’ Compensation weekly benefit (the amount paid to the injured worker) usually increases annually even though it is based on the State Average Weekly Wage. Workers’ Compensation coverage is mandatory in the State of Michigan – part of the cost of doing business!

Once a Workers’ Compensation claim is turned in to our office, we take the reins and take control, attempting to minimize all the costs involved, the length of disability, and to assure a successful return of the injured worker to productivity. Everyone benefits. But, as an employer, there are things that you can do to help mitigate the expenses or costs on the claim.

Obviously, one of the most important things an employer can do, is report the claim As Soon As Possible! That way, we are controlling treatment (and costs) from the onset. As an employer, NEVER tell an injured worker to seek treatment with their primary care physician or a physician of their choosing. Any treatment outside the Occupational Clinic results in a delay in obtaining medical records that are required before authorization to treat can be rendered. If an employee is off work during this period – the cost of the claim has just increased significantly. If the injury is questionable and/or you are unsure of the direction that should be taken, PLEASE call our office for advice.

(more…)

By Chris Demeter, Senior Loss Control Consultant

OSHA has expanded the list of severe injuries & illnesses that employers must report and updated the list of industries who are partially exempt from routinely keeping OSHA records.

“OSHA will now receive crucial reports of fatalities and severe work-related injuries and illnesses that will significantly enhance the agency’s ability to target our resources to save lives and prevent further injury and illness. This new data will enable the agency to identify the workplaces where workers are at the greatest risk and target our compliance assistance and enforcement resources accordingly.”
— Assistant Secretary of Labor for Occupational Safety and Health, Dr. David Michaels

For workplaces under Federal OSHA jurisdiction

• Final rule becomes effective January 1, 2015 For workplaces in State Plan States (MIOSHA)
• States encouraged to implement new coverage provisions on January 1, 2015, or as soon after as possible.

The rule expands the list of severe work-related injuries and illnesses that all covered employers must report.

(more…)

The MTMIC Marketing Staff are in the process of mailing out the updated State and Federal Labor Law Posters for 2015. Your company will be receiving them in the next couple of weeks. Contact Patty Allen at patricia.allen@mtmic.com/blog if you will be in need of more than one set of posters.

Please let us know if we can assist you in any manner and thank you for being a customer of MTMIC, we value your business.

By Donna Motley, Director of Claims

Communication in our industry is crucial. We have at our disposal multiple ways to communicate, telephone, computer (e-mail), faxing, even the old fashion form of “written” communication. In the Workers’ Compensation arena, we still need “written” proof of a claim. As you are aware, the Employers Basic Report of Injury (Form 100) must be submitted before we can physically set up a claim file. Obviously, the form needs to be completed properly in order to fill in the fields required by the computer. Claim information is tracked by the State of Michigan – hence the required fields.

(more…)

By Donna Motley
Director of Claims

The cost of insurance, any kind of insurance, is not cheap. As premiums escalate, there appears to be a new “buzzword” – FRAUD. While the notion of fraud is not new, more and more people are starting to get angry and show interest in putting a stop to it. Some states (not Michigan) have started movements to prosecute those committing insurance fraud. I read recently that Michigan’s automobile premiums had the largest increase in the U.S. in 2013 because of claims paid outside of property damage. That would mean the bulk of payments were for “alleged” injuries and medical care.

(more…)