Workers' comp: fraudsters caught in the act
In a recent edition of 20/20, Bari Kroll and ABC News consultant Bob Kiehn conducted surveillance of suspected offenders of false workers' comp claims. They caught several people right on camera. You can see the segment in the video clip below or view this article for a transcript: Worker's Compensation Fraudsters Caught Faking Injuries
If you suspect worker fraud, your workers' compensation insurer can help ferret it out - or if you are self-insured, your state insurance authority might have anti-fraud resources that can help. Human nature being what it is, there will always be some amount of fraud, but if an organization has too much fraud, it's often indicative of underutilized employer controls: communicating and establishing expectations with employees, managing injuries immediately, and bringing employees back on Return To Work programs. Your EAP can also help. See our prior post by Jim Walter: Turbo-Charging your Workers Comp Program with your EAP
If you ask employers to describe an employee assistance program, they'll usually talk about resources and services to solve employee personal problems. They'll describe it as an employee benefit. And if they've had occasion to use the services of an EAP, they'll probably tell you that it is a very valuable benefit.
What you won't hear is any reference to workers' comp. Few employers talk about how an EAP can be an effective tool to reduce workers' comp and disability costs or how an EAP can support employees during the recovery process to ensure they get back to their normal life as quickly as possible.
But those of us at ESI Employee Assistance Group believe that we have cracked the code and figured out how to insert the EAP into an organization to help the employee expedite recovery while also helping the organization reduce overall comp costs.
Let's start with the fundamental reason why organizations opt to have an employee assistance program. It all revolves around that fact that 1 out of every 5 employees face some sort of significant personal problem in any given year. Those problems impact their lives and their productivity at work. A good EAP can go a long way toward addressing these problems and helping these employees get back to full productivity.
When it comes to workers' comp, the fundamental problem is two-fold. First, too many people are injured on the job. And when injured, employees are frequently away from work far longer than the injuries require.
And that's where the EAP and workers' comp connect.
The EAP—Work Comp Connection
Anyone who is familiar with workers' comp knows that there are three key elements to an effective cost containment program:
• An aggressive injury prevention effort
• Immediate medical treatment by quality providers who understand workers' comp
• An active return to work and transitional duty program
What we've learned at ESI, is that it is possible to utilize the EAP to essentially turbo-charge this sort of program.
Start with how injuries occur. While some injuries are the result of work site hazards, many injuries—arguably the lion's share—are the result of unsafe behavior. Relevant data clearly indicates that personal issues are the single most significant cause of unsafe behavior. The U.S. Department of Labor's data suggests that upwards of 40 percent of all workplace injuries have alcohol or substance abuse as the key contributing factor. And if you add other personal problems to the mix—depression, stress, medical issues, etc. — it is clear that employee problems are at the root of many workplace injuries. An effective EAP can head off many of these problems before they result in harm to the employee, to coworkers and to your organization.
And if you examine why injured workers have extended disability, all too often unresolved personal problems rather than medical problems are sabotaging the person's recovery. Personal issues are frequently barriers that keep people from returning to work and resuming their normal life in a timely fashion. Issues such as depression, family problems, debt and, once again, alcohol and substance abuse are the main contributors to extended disability. By helping employees tap into the services of the EAP, these barriers can be knocked down and recovery and return to work can be expedited
Why don't more employers use this cost reduction tool?
Properly used, an effective employee assistance program can address both the pre- and post-injury issues. So why aren't organizations using their EAPs more effectively?
First, responsibility for the workers' compensation program and the EAP almost always reside in different parts of the organization. The human resource department is responsible for the EAP, while risk management or the CFO is responsible for comp. Rarely is there one person or one department handling both. Add to that the fact that most EAPs are not attuned to the opportunity to impact workers' comp and disability. And, finally, the EAP is generally viewed as a nice benefit, but not a strategic business partner; and not as a strategy for turbo-charging prevention and return to work programs
To ensure an effective program, a couple of things have to happen. HR and Risk Management need to work together to promote the EAP, not only as a benefit for employees, but also as a tool for pre- and post-injury management. Next, employees must be made fully aware of the benefit. Supervisors must be trained to identify problemed employees and how to steer employees to the EAP. And, finally, the organization needs to select an EAP provider that is up to the task: one that fully understands work site productivity demands and complex issues such as disability prevention, as well as the counseling needs of employees.
Over the years, we have seen many employers integrate the EAP into their risk management efforts with extraordinary results. One large self insurance group has experienced an overall drop of more than 40% in claims. We believe that we have just begun to scratch the surface of how to make the EAP an effective cost containment tool and are working to make it even more effective.
Clearly, an EAP can be an effective tool in your overall workers' comp program. You and your EAP just have to know how to do it right.
Want to ensure a winning team in your organization? In addition to help for your employees, ESI EAP offers a full suite of tools for supervisors and managers, including our ESI Management Academy. Trainings cover compliance issues, management skills and more. If you want to learn more about how ESI can provide more employee EAP benefits and more employer services, call us at 800-535-4841.