How to Report Work Comp Fraud

The Illinois Department of Insurance has a newly redesigned Workers' Compensation Fraud Web Site.

They provide complete complaint checklists in order to report someone you suspect carrying out Work Comp Fraud.

Below are the pieces of information you need to complete the complaint and email to DOI.WorkCompFraud@illinois.gov

Provide the following information in matters that may involve fraud perpetrated by a claimant:

  • Identity of the claimant

  • Date of injury, if known

  • Type of Injury

  • Activity level with a vivid description of activity

  • Employer, if known

  • Insurance company, if known

  • Secondary employer, if known, or if claimant is self-employed

  • Additional witnesses

  • Complainant must submit in writing, identify themselves, and be willing to testify

If the target is an employer, healthcare provider, attorney, or insurance agent/company, the complainant should provide:

  • Name/address of company or business

  • Relationship to business owner or company if any (employee, partner, etc)

  • Name/address of insurance agent or company

  • Name/address of healthcare provider and dates of treatment

  • Name/address of attorney

  • Synopsis of what they believed constituted the fraud

  • Additional witnesses

  • Complainant must submit in writing, identify themselves, and be willing to testify

You may always contact the Illinois Department of Insurance directly at:

Illinois Department of Insurance
Workers’ Compensation Fraud Unit
122 S. Michigan Ave., 19th Floor
Chicago, Illinois 60603
877-WCF-UNIT (877-923-8648)
DOI.WorkCompFraud@illinois.gov

For more information visit - http://insurance.illinois.gov/wcfu/


Dan Zeiler

dan@zeiler.com

708.597.5900 x134

 

 

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Intoxication and a Denied Work Comp Claim

The Illinois Workers Compensation Reform Bill of 2011 allowed for the denial of benefits when intoxication was the primary cause of an employee injury.  Our office recently had the first case where a claim has been denied.   

An employee of a local landscape contractor stuck his hand under a mower guard.  Needless to say the result wasn’t good for the employees hand.   A supervisor, following claim procedures, went to the sight to investigate and document the incident.  The employee was then driven to their assigned occupational health clinic for treatment.  This landscape contractor includes post-accident drug screening in their loss control program.  The employee was tested and a number of illegal substances were found to be in this employees blood system.  A claim was submitted to the workers compensation carrier and with the encouragement of the employer - the claim was denied.  

We ran the numbers through our workers compensation experience modification calculation tool.  The minimum claim cost including treatment and indemnification benefits is estimated to be $15,000.  The effect on the mod was 14% and a three year additional premium cost to the employer of $12,627.

We can help your business establish a drug free program. Options include:

  • Post-Offer (pre-employment) Testing
  • Probable Suspicion / Reasonable Cause Testing
  • Post-Accident Testing
  • Random Testing

Please reach out to us if we can be of any assistance.

Dan Zeiler

dan@zeiler.com

708.597.5900 x134

 

 

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Experience Modification Looks Complicated, But It Isn't

 

Experience modification (experience mod) is a key factor when monitoring workers compensation premiums. Experience mod is a rating factor that determines your workers compensation premium based on loss experience. A 1.0 rating means expected losses equal actual losses that occur. A rating below 1.0 indicates that actual losses occurred are less than expected losses, resulting in a lower premium. A rating above 1.0 means actual losses are higher than expected losses, resulting in a higher premium. In short, your experience mod compares your workers compensation claims to companies of similar size and industry.  

Experience mod ratings are calculated based on certain components. One component is the payroll for the business. Workers compensation claims are highly dependent on payroll numbers being accurate, therefore payroll figures are often audited. A second component is the loss history of the business. The loss history can be determined from analyzing claim data that has been filed. When calculating the premium for the policy, items such as the frequency of claims are essential to provide an accurate premium. It gives an insight as to how the business operates and if there are trends regarding workers compensation claims. The last component is reserves used for claims. Claim data provides information to help compute payments, and reserves are required for claim totals. Reserves are assigned to open claims and represent future payouts. Claim adjusters often handle large amounts of claims, so it is imperative to have open claims reviewed for accuracy to avoid the formulation of the experience mod can become incorrect.  

In the real world injuries will happen, but the response can help keep your experience modification rate from increasing. Having a plan to manage injuries and workers compensation claims is imperative for getting control. An effective safety program that eliminates hazards is the starting point. Also, your experience mod is influenced more by small, frequent losses rather than large infrequent ones. Implementing a Return to Work Program is important for any business. Having a program in place will help lower days off which in turn will keep your experience mod down. For example, if an employee sprains their ankle, what can you do to decrease their days off? Can they input data while sitting at a computer or maybe help out somewhere else? Read our article  Illinois Workers Compensation Insurance - Keep Your Premiums Low  to learn more.

If you have questions or would like more information, call any of our 3 locations in the Chicago-land area today. Our customer service representatives are eager to share their knowledge and speak with you about any insurance related topic. Zeiler Insurance is an independent insurance agency and has been providing quality customer service for 101 years in our Alsip, Chicago, and Gurnee locations. Our goal is to help you understand insurance as well as provide you with the most competitive insurance rates in the industry. Whether you are a customer or just want more information, let us help you with our years of expertise in the insurance business.

Dan
dan@zeiler.com
708.597.5900 x134
http://www.zeiler.com

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How Workers Comp Experience Rating Can Save You Money

How does safety pay dividends to the business owner? Time and resources spent on developing a culture of safety repays the business in the long run. Safety cultures rely on reducing the number of workers compensation claims, in return, the odds of a disastrous claim are reduced.

Business owners with workers compensation experience modification above 1.25 need to review their safety policies with professionals. It is possible one year or even one claim causes this situation; but it should not be ignored. Discover and repair the root cause.

A 1.01 to 1.25 modification indicates worse than average experience. State rates can be less than adequate for a short period of time. The actuarial or mathematical calculations just incorrectly reflect the average expected claims. Slightly elevated modifications may be caused by these issues; however, review your losses by department in these cases and see if a problem area exists.

For slightly elevated modifications, review the safety program and types of losses. Seek out a professional risk manager for help if needed. Look for patterns in the losses, and consider changes in safety equipment or procedures to reduce problem issues.

Proactively nurturing a safety culture will pay long-term dividends. Experience modifications will decrease with positive results. How?

Each state calculates workers compensation experience modifications independently. Many states do utilize the services of the National Council on Compensation Insurance (NCCI) to gather data and promulgate base rates and experience modifications; but each state regulates its own workers compensation system such as Illinois workers compensation. 

Workers compensation experience rating predicts future behavior by analyzing past performance. It is a consequence of loss control performance, neither a reward for no losses nor a punishment for too many claims.

The generic formula for experience modifications follows some rules:

Just as payrolls are the basis for the standard premium, they form the basis for expected claims. Payroll is multiplied by an average claim factor to produce total expected claims.A discount factor is then applied to predict the potential severity of the claims.The product of this equation is expected losses.Actual medical only (MO) claims combine and report as a number of claims/total amount. Some states designate the MO claims as primary (maximum average) and excess, and then apply a discount rate to one or both of these amounts.Most states set a limit on the value of any one claim, and then discount large claims on a sliding scale.This historical claim experience is divided by expected losses. That quotient is the experience modification.

The insurance industry spends millions of dollars to find ways to predict the future. Loss analysts discovered one important fact: the best predictor of future claims is the frequency with which companies suffer losses in the past.

Frequency reflects the number of claims per employee, usually expressed as claims per payroll unit ($100), claims per year, or claims per time unit. Frequency, however, more importantly, reflects the safety culture of the business.

If the frequency of claims is predictable, how about the severity of an individual loss? No, severity, the magnitude of the loss, is not predictable. With greater frequency, however, comes greater odds that a severe claim will occur. For more information on controlling costs, read Employers: Control Your Workers' Comp Costs.

Experience modifications indicate the status of the safety culture within a business. Good management listens to risk management and loss control experts who ultimately reduce workers' compensation costs and possibly the workers compensation premium. 

If you have questions or would like more information, call any of our 3 locations in the Chicago-land area today. Our customer service representatives are eager to share their knowledge and speak with you about any insurance related topic. Zeiler Insurance is an independent insurance agent and has been providing quality customer service for 101 years in our Alsip, Chicago, and Gurnee locations. Our goal is to help you understand insurance as well as provide you with the most competitive insurance rates in the industry. Whether you are a customer or just want more information, let us help you with our years of expertise in the insurance business.

Dan
dan@zeiler.com
708.597.5900 x134
www.zeiler.com

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When is a Workers’ Compensation Claim Compensable?

When is a Workers’ Compensation Claim Compensable?

Carefully evaluating workers’ compensation claims is crucial in helping your company save money and prevent fraud. Workers’ compensation is simply a form of insurance that offers employees medical coverage in the event they are injured during a work-related function. Depending on the state of residence, it may also give compensation for disabilities sustained or cover rehabilitation costs so the employee can return to the workplace quickly and smoothly.

Workers’ compensation is crucial to protecting employees, but it is often a source of contention among employers because it comes with considerable gray areas. When is a claim compensable? How do we identify a fraudulent claim? How do we report a claim, and should we report all workplace injuries no matter how serious? This is provided by Zeiler Insurance Services, Inc.to help you determine when—and if—an injury is covered by workers’ compensation.

Requirements

The claim must meet all five of these requirements in order to be compensable. Let’s examine each individually:

Happened to One of Your Employees

The first requirement is in place to ensure it is your employee filing the claim, not an independent contractor or vendor who works for themselves or a third party. Even if the incident occurs on your property, unless it is someone who works directly for you, the claim is not compensable.

Resulted in an Injury or Illness

Injury is not the only thing that can potentially be covered by workers’ compensation. Illnesses could also qualify as a compensable claim, but only if they are related directly to the job. The illness also must be caused directly by the working conditions to be covered in a workers’ compensation policy. For example, a miner’s contraction of black lung would be compensable in all states. However, an employee in an office with a co-worker who smokes would not be eligible for workers’ compensation for treatment of illness due to secondhand smoke.

Arose Out of Employment

This requirement means there must be a direct connection between the injury and the desire or attempt to further the employer’s business. If the employer benefits in some way, whether monetarily or otherwise, from the employee’s activity, then the claim meets this qualification.

Occurred in the Course and Scope of Employment

The employee must be at work when the injury occurs. This includes any place or location mandated or expected by the employer. So when an injury occurs at the employee’s physical everyday work site, that employee must prove he or she was injured while actively engaging in the furtherance of the employer’s business. There is a special provision called the “coming and going rule,” which maintains that benefits are denied for injuries received when traveling to or from work. Additionally, injuries arising out of transit from one work site to another, for instance when traveling to visit clients, are compensable. This provision also requires that the actions leading to the injury of the employee in question be prompted by the aspiration to further the employer’s business interests.

Resulted in Impairment and/or Lost Wages

The injury or illness in question must cause the employee to be impaired in some way and lose wages from not being able to complete his or her tasks completely. It is also a compensable incident if the injury or illness results in impairment but without lost wages, or vice versa.

Identifying a Fraudulent Claim

Studies commonly show that roughly 90 percent of all workers’ compensation claims filed are legitimate. However, it is still important as an employer to watch for these red flags that may indicate a fraudulent claim:

  • Filing multiple claims
  • Longer absences than anticipated by the employee, combined with an unwillingness to return to work
  • Unwillingness to be assigned to other, lighter jobs within the company or to complete partial duties
  • Constantly missing medical appointments
  • Employee will not provide date, time or location of the incident that caused injury
  • Employee has no recollection of services provided for related medical bills
  • Lack of witnesses to an accident or incident
  • Employee cannot produce specific information about the nature of the injury
  • Employee has a history of short-term employment

If any of these red flags occur, it by no means makes the claim automatically fraudulent – these are simply guidelines to keep employers proactively evaluating the legitimacy of a workers’ compensation claim.

For more information on Illinois Workers Compensation Insurance and Illinois Employee Benefits visit: Workers Compensation Insurance Chicago Illinois

If you have questions or concerns on this issue, do not hesitate to call Zeiler Insurance and speak to one of our customer service representatives. As an independent agency, Zeiler Insurance prides itself with quality customer service for the people of the Chicago-land area and the rest of the Midwest. Customer or not, we can review your insurance and see if you are being protected appropriately for the right price.

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When An Employee Refuses Work Comp Treatment

Based on the geographic location of your business, many state workers’ compensation statutes limit and mandate certain employer actions when a worker is injured. Depending on the state, there are specific timelines to follow and forms to complete. But what about when a worker is injured and refuses to accept treatment or file a claim? What are your responsibilities? While the exact legal answer depends on your situation and state laws, consider the following to limit your liability.

When You Notice

If you notice that an employee has been injured, even if the employee has not mentioned it, gently bring it up and discuss the circumstances of the injury with the employee to determine whether the injury is job-related. Many state workers’ compensation statutes obligate employers to report injuries as soon as they have knowledge of them. Delay in reporting the injury could result in much more costly claims. Completing the paperwork to report injuries is not an admission of your liability—on the contrary, it could protect you.  

In the Case of Refusal

When you do discuss the injury with the employee, explain that reporting job-related injuries entitles injured workers to certain benefits while recovering from the injury. If the employee does not wish to file a claim for the injury, file the employer’s portion of the report with a statement of refusal to pursue a claim signed by the employee. It is crucial that you document this conversation to protect your organization from being penalized in the future.

Employees that do initially report injuries but then refuse treatment under the physician or facility that your organization furnishes should sign a similar form confirming this refusal.

Benefits for Employees that Refuse Treatment

State workers’ comp statutes vary, but in most cases, workers’ compensation benefits are suspended for employees that refuse to comply with any reasonable request for examination or refuse to accept medical service or physical rehabilitation which the employer elects to furnish. Benefits may not be payable for this period of refusal of treatment—check with your workers’ comp carrier.

What to Do Now

It is important that you prepare for an eventual employee refusal to submit a claim or refusal to accept treatment for a workplace injury. All employers should have a legal representative draft a form for refusal of treatment that complies with state requirements so it is immediately available when needed. Discuss with supervisors the importance of documenting and reporting all injuries, whether or not the worker chooses to report them.

Workers’ compensation insurance is obligatory in most states. Contact the insurance professionals at Zeiler Insurance Services for more information.

Similar Articles: Workers Compensation Insurance Chicago Illinois

If you have questions or concerns on this issue, do not hesitate to call Zeiler Insurance and speak to one of our customer service representatives. As an independent agency, Zeiler Insurance prides itself with quality customer service for the people of the Chicago-land area and the rest of the Midwest. Customer or not, we can review your insurance and see if you are being protected appropriately for the right price.

Dan
dan@zeiler.com
708.597.5900 x134

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Illinois Workers Comp and College Interns

Are interns covered on work comp? 

It’s that time of year - Chicago area businesses will be adding college interns to their summer workforce. Whether they are paid interns or not - the question is “are interns covered on workers compensation in Illinois?”.

99% of the time the answer is YES – interns are covered… even if unpaid. The question falls back to the definition of an employee and for this you can refer to the IRS website for the definition. The IRS sites Common Law Rules.  If the intern is deemed an employee then under the Illinois Workers Compensation Act they would be covered on your Workers Compensation policy. From the IRS website:

Common Law Rules

Facts that provide evidence of the degree of control and independence fall into three categories:

  1. Behavioral: Does the company control or have the right to control what the worker does and how the worker does his or her job?
  2. Financial: Are the business aspects of the worker’s job controlled by the payer? (these include things like how worker is paid, whether expenses are reimbursed, who provides tools/supplies, etc.)
  3. Type of Relationship: Are there written contracts or employee type benefits (i.e. pension plan, insurance, vacation pay, etc.)? Will the relationship continue and is the work performed a key aspect of the business?

Businesses must weigh all these factors when determining whether a worker is an employee or independent contractor. Some factors may indicate that the worker is an employee, while other factors indicate that the worker is an independent contractor. There is no “magic” or set number of factors that “makes” the worker an employee or an independent contractor, and no one factor stands alone in making this determination. Also, factors which are relevant in one situation may not be relevant in another.

The keys are to look at the entire relationship, consider the degree or extent of the right to direct and control, and finally, to document each of the factors used in coming up with the determination.

Please call with questions. 

Dan 

dan@zeiler.com 

708.597.5900 x134

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Ingalls Occupational Health Program - Southwest Suburbs

I had the opportunity to tour Ingalls Occupational Health Care Center in Crestwood, Illinois last month. I can honestly say I was impressed with their entire Occupational Health Program. 

With 4 clinic locations in the Southwest Suburbs (South Holland, Crestwood, Flossmoor, and Tinley Park) this Pro-Employer Center for work related injuries is a vital tool for all business owners.  

Ingalls services include; Urgent Care, Radiology, MRI, Cardiology, Physical Therapy, Drug & Alcohol Testing, and Outpatient Surgery - just to name a few.

The program also includes Worksite Wellness & Prevention Assistance and an Employer Resource Center. 

I cannot stress enough the importance of having a strong relationship with a quality Occupational Health Clinic to control your Workers Compensation costs. In the event of an employee's accident, why not suggest a treatment facility that will get them back to work?

My contact at Ingalls is Michele Netherton, Business Development Manager. She can be reached at 708.915.4806 or mnethert@ingalls.org 

As you know, I am always available to discuss these programs and help implement an effective Risk Management Program. 

Dan Zeiler

708.597.5900 x134

dan@zeiler.com 

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Illinois Workers Compensation Insurance Audit

I just received the results on a disputed audit for a local Chicago business client. The error on this audit is typical of how the audit process favors the insurance companies. The process starts with all of the payroll assigned to the governing classification and then qualifying payroll exceptions get carved out depending on duties, type of pay, etc.  

In this case it was the starting pay that was in error.  A number was pulled off of a spreadsheet that had nothing to do with the annual payroll figure noted on that same spreadsheet. This was a $32,000 mistake.

 

Please call with questions.

Dan Zeiler

708.597.5900 x134

dan@zeiler.com

www.zeiler.com

 

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Illinois Workers Compensation Insurance ERA Credit

I want to remind you about the importance of taking advantage of the Experience Rating Adjustment (ERA) factor offered in Illinois. 
 
I'm working with a potential client on ways to help control their Workers Compensation insurance expense.  The incidents on the Specific Loss Report shown below are actual claims on the Experience Mod of a Chicago, Illinois business.
 
The report below shows the effect of three claims on the Experience Mod and the additional premium projected (for the three years that it affects the Mod):
1.) A large loss ($113,256). Kind of what you might expect from the mechanics of an insurance policy. The company gets hit with a loss and your premium is affected with paying a surcharge. In this case the three year cost is $28,266 with a 17% effect on the workers compensation experience mod.
2.) A small claim ($2,883) that included “indemnity”.  Indemnity is basically disability payments for time off for the injured worker.  This employee sprained his ankle.  Take a peek at the three year claim cost…Yep!!  $5,519. The Insurance Company actually profits on this one.
3.) A second small claim ($2,083).  This claim was medical only with no “indemnity” paid.  As you can see, the three year cost on this claim is $1,206.
 
The reason for the big difference between 2 and 3?  Experience Rating Adjustment (ERA) factor. Only 70% of the claim cost is used in the experience modification calculation for Medical Only Claims. The purpose of which is to encourage businesses to report small claims.
 
 
Going back to our employee that sprained his ankle - what type of work could you have him do around the office, even though his ankle is sprained, so that his days "off" don't rack up your Experience Mod? 
 
Do you think you might have some safety manuals he could read or better yet maybe even wash a truck or two?
 
From the report, this claim affected the mod by 3.35%.  What if the mod for this business was floating in the 1.00 area?  
 
 
On a side note - If this example involved a contractor, this 3.35% could have disqualified the contractor from the Contractor Classification Premium Adjustment Program (CCPAP). These credits can be 40% of the Workers Compensation premium.
 
Please call with questions.
 
Dan Zeiler
 
708.597.5900 x134
 
dan@zeiler.com
 
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April is Safe Digging Month

April is Safe Digging Month 

An underground utility line is damaged every six minutes because someone decided to dig before calling 811.

The following steps provided by Travelers can help contractors in Illinois control exposures, avoid losses, or contain losses that do occur:

  • Take daily photos of the work site
  • Check utility marks to help ensure all known utilities have been located
  • In the event a strike does occur, once site safety is established, gather detailed documentation of where the marks were in relation to the excavation; documentation can include photos, diagrams and witness statements

Not collecting these facts immediately could seriously damage any contractor's defense. The average utility damage claim is approximately $25,000, and, as such, implementing an effective incident investigation plan containing the elements above can help you defend yourself as a contractor.

___________________________________________________________________________________________________________

All states have laws that require utilities be pre-located by an appropriate locator service, which can be reached by calling 811 -  the national "Call Before You Dig" phone number.

 

Please call with questions.

Dan Zeiler

708.597.5900 x134

dan@zeiler.com

www.zeiler.com

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“Primary Causation” Added to Illinois’ Workers’ Compensation Law

 

“Seeking to help Illinois attract investment, create jobs, and end fraud and abuse,” state Sen. Dale Righter (R-Mattoon) filed legislation that would add “primary causation” to Illinois’ workers’ compensation law.

“For years, a higher percentage of Illinois citizens have been out of work, compared to our neighboring states,” Righter said. “We are plagued by people moving for better jobs to neighboring states and new businesses choosing other states. According to my constituents and business owners in Illinois, a significant reason our state isn’t competitive is because we lack ‘primary causation’ in our workers’ compensation law.”

Righter’s Senate Bill 846 would require an employer’s workers’ compensation insurance to pay a claim only if the employee’s injury was caused primarily by a workplace accident. Under current law, any connection to a workplace accident. Under current law, any connection to a workplace accident, regardless of how remote, obliges the workers’ compensation policy to cover 100 percent of the costs associated with the injury, according to a press release from Righter’s office.

“In far too many instances, our law has allowed simply the slightest connection with the workplace to justify a workers’ compensation policy to pay the entirety of the costs related to an injury. It is unfair and an abuse,” Righter said.

“Requiring primary causation would strike a fair balance.”

Righter estimates that adding “primary causation” to Illinois’ workers’ compensation law would save employers $1 billion per year in reduced insurance premiums. By way of evidence, prepayments point to Indiana and Missouri, where premiums are less than half of what employers pay in Illinois. Twenty-nine states have a more stringent causation standard than Illinois.

“I am optimistic with a governor who understands how to make Illinois competitive, we can make this legislation law,” Righter said. “It’s ridiculous our job creators are on the hook for paying millions in bogus claims. It has to end now.”

Senate Bill 846 also states that if an employee is discharged from his or her employer for cause, then temporary partial disability and temporary total disability payments will not be paid.

 

Please call with questions.

Dan 

dan@zeiler.com 

708.597.5900 x134

www.zeiler.com

Source: http://www.dalerighter.com/Media/News/TabId/273/p/27565/v/2000/workers-compensation-reform-legislation-makes-illinois-more-competitive.aspx 

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"Workers' Compensation costs are too high." - Illinois Gov. Bruce Rauner

Illinois Gov. Bruce Rauner on Thursday began laying out priorities for his first year in office, saying property taxes and workers’ compensation costs are too high, Medicaid spending is unsustainable and state workers’ salaries and benefits are too generous.

In a speech he said was a preview of the State of the State address he’ll give next month, the Winnetka Republican said Illinois is in “massive deterioration mode.”

He said he will propose a number of reforms to turn the state around, and indicated they would involve making Illinois more attractive to businesses while slashing spending on everything from health insurance for the poor to public-worker pensions and the state’s payroll. 

“This is the critical lesson that we’re seeing: We’re on an unsustainable path,” Rauner told students at the University of Chicago Booth School of Business. “We need fundamental structural change and raising taxes alone … isn’t going to fix the problem, and in a lot of ways it’s going to make it worse.”

While he didn’t outline specific proposals, many of Rauner’s ideas are likely to draw heavy opposition from majority Democrats and even some fellow Republicans in the General Assembly, as well as public-employee labor unions.

He said higher-than-average costs of workers’ compensation and unemployment insurance are driving businesses out of the state, property taxes are “brutally high” and “shenanigans” in the public-employee pension system have made Illinois’ multibillion-dollar pension debt “a time bomb for taxpayers.”

Rauner said public employees’ average salaries are among the highest of any state in the U.S. and the state’s share of health care premiums is too high. Anders Lindall, spokesman for the American Federation of State, County Municipal Employees Council 31, said Rauner was using numbers that are inaccurate and in some cases outdated. He said public union employees are not the cause of the state’s challenges.

AFSCME, the state’s largest public-employee union, is set to begin negotiations with Rauner’s administration on a new contract. “The type of misleading statement and false facts we see today are not an encouraging first step you want to see from someone who is truly trying to work together for the common good,” Lindall said. 

Rikeesha Phelon, spokeswoman for Senate President John Cullerton, said the Chicago Democrat wants to see how Rauner’s statements translate into legislative policy and a proposed budget. Rauner is scheduled to deliver his budget address on Feb. 18, two weeks after his State of the State.

But Cullerton clearly wasn’t pleased after Rauner ripped legislators in his inaugural speech for leading Illinois into a budget disaster, saying afterward that many of the new governor’s comments were inaccurate and that he “is going to have to learn about state government.”

Rauner on Thursday also named new members of what he’s calling his “Turnaround Team” — people he said have experience in budgeting and management. They include former Hawaii Gov. Linda Lingle, a Republican who will serve as senior adviser. - See more at: http://thez.zeiler.com/workers-compensation-costs-are-too-high-illinois-gov-bruce-rauner#sthash.gpILWH1h.dpuf

 

Dan Zeiler

dan@zeiler.com

708.597.5900 x134

www.zeiler.com

Source: http://chicago.cbslocal.com/2015/01/23/rauner-previews-1st-year-priorities-cut-taxes-medicaid/

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Illinois DOI Announces 2 Convictions Resulting from its Workers’ Comp Fraud Investigations

Illinois Department of Insurance (DOI) Director Andrew Boron today announced investigations by the Department’s Workers’ Compensation Fraud Unit have resulted in two convictions.  A former Crystal Lake police officer charged with workers’ compensation fraud in McHenry County and a former business owner charged with forgery in Cook County have both been convicted and sentenced.

“As I have said before, we take accusations of fraud very seriously.  These convictions are a direct result of our investigations and should send a clear message that workers’ compensation fraud will not be tolerated in Illinois,” said DOI Director Boron. 

The Crystal Lake felon, a former police officer for Crystal Lake, was sentenced to one year of probation, ordered to pay $9,588.13 in restitution, and required to pay $730 in fines, fees, and court costs.  He pleaded guilty in October to workers’ compensation fraud. He made statements to create the impression the nature and extent of an injury he claimed to have suffered to his wrist while at work was more extensive than it really was.  Video surveillance showed him lifting weights in the police station in the month following the injury while he was assigned to light duty.  Additional video surveillance showed him not only lifting weights, but working as a personal trainer. He filed a case with the Illinois Workers’ Compensation Commission for his wrist injury in October of 2012, but that case was voluntarily dismissed less than a month later, after DOI’s investigator sought to interview him.

The second fellon from Cook County was sentenced to two years of probation.  As part of his probation, he was ordered to complete drug treatment.  He pleaded guilty to forgery in November. He lacked workers’ compensation insurance after his policy was cancelled for non-payment of premium in 2008 then issued false Certificates of Insurance to a general contractor he performed work for as proof of workers’ compensation insurance.  The general contractor, who relied on the Certificates of Insurance provided, was assessed thousands of dollars in additional premium by his own insurance company to cover the uninsured risk. 

Fraud based upon the issuance of false Certificates of Insurance puts employees and companies such as general contractors at risk, yet it is one of the easiest forms of fraud to detect and prevent.  If there is any question as to the authenticity of the documentation being provided regarding workers’ compensation coverage, the certificate holder should contact the insurance company listed on the certificate directly to verify that a policy is in fact in place. 

Dan Zeiler

dan@zeiler.com

708.597.5900 x134

- Provided by WorkersCompensation.com

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2015 Illinois Workers Compensation Rates

I have had many inquiries into the 2015 Illinois Workers Compensation Rates. If anyone has interest send me an email with the Workers Compensation Class Code in question and I will forward the detail.  If you don't know your class code, let me know the type of business you are in and I'd be happy to help.

Dan Zeiler

dan@zeiler.com  

708.597.5900 x134 

- 2015 Illinois Workers Compensation Rates 

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2014 Illinois Workers Compensation Rates

I have had many inquiries into the 2014 Illinois Workers Compensation Rates.  If anyone has interest send me an email with the Workers Compensation Class Code in question and I will forward the detail.  If you don't know your class code let me know the type of business you are in and I'd be happy to help.

 

 

 

 

 

 

 

 

 

 

 

 

 

Dan

708.293.5500

dan@zeiler.com

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Man from Normal Sentenced to 8 ½ Years in Prison for Workers’ Compensation Fraud

Illinois Department of Insurance (DOI) Director Andrew Boron today announced a recent workers’ compensation fraud investigation has resulted in an eight and a half year sentence for a central Illinois man. Elbert Rayford, Jr., of Normal, was sentenced on January 24 to more than eight years in prison for attempting to obtain roughly $45,000 in workers’ compensation benefits through fraud. Rayford, a former employee of T.G. Gum Trucking in Farmer City, misrepresented his medical condition and exaggerated his symptoms to doctors and physical therapists in order to remain off work, collect temporary total disability (TTD) benefits, and receive medical care that was no longer necessary.

“Workers’ Compensation Fraud is a crime. We will investigate to determine wrongdoing and then work with law enforcement to make sure perpetrators are prosecuted to the fullest extent of the law,” said DOI Director Andrew Boron.

The investigation was conducted by the Department of Insurance Workers’ Compensation Fraud Unit. Video surveillance showed Mr. Rayford engaged in activities that demonstrated his statements to medical providers were untrue. The case was referred to the McLean County State’s Attorney’s Office for prosecution.

“We appreciate the investigation done by the Illinois Department of Insurance which helped bring about the successful prosecution of this case. The McLean County State’s Attorney’s Office does not take the attempted misappropriation of public funds lightly and we were pleased to assist in bringing Mr. Rayford to justice. We hope this sentence serves as a deterrent to anyone else who considers committing this type of fraud,” said Assistant State’s Attorney Jessica Woods.

Eight and a half years is the longest sentence handed down for violating the anti-fraud provisions of the Illinois Workers’ Compensation Act. The anti-fraud provisions were first enacted in 2005 and were later amended in 2011. The 2011 amendments included stronger sentencing provisions which applied to this case based on the date Mr. Rayford committed fraud. Rayford, who pled guilty, will also be required to pay $585.38 in restitution and serve two years of mandatory supervised release as a part of his sentence upon his release from prison.

For more information about Workers’ Compensation Fraud, including matters that may involve fraud perpetrated by a claimant, visit the DOI website at http://insurance.illinois.gov/WCFU/default.asp. To report an employer, healthcare provider, attorney, insurance agent or company, contact the Workers’ Compensation Fraud Unit at 877-WCF-UNIT (877-923-8648).

Source: illinois.gov

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