What is Fraud
Fraud occurs when a person knowingly or intentionally conceals, misrepresents, and makes a false statement to either deny or obtain workers' compensation benefits or insurance coverage, or otherwise profit from the deceit. The key to conviction is proving in court that the misrepresentation or concealment occurred knowingly or intentionally. Premium fraud and benefit fraud are the most common types of workers compensation fraud. Premium fraud is usually committed by an employer who misrepresents the amount of payroll or classification of employees, or who attempts to avoid a higher insurance risk modifier by transferring employees to a new business entity rated as a lower risk category. Benefit fraud is usually committed by: a worker who works full time at an unreported job and draws benefits when he or she is supposed to be unable to work, or when a worker fakes an injury; a health care provider or attorney who assists the worker in fraudulent schemes, participates in double billing or bills for services not provided.
An insurance carrier commits fraud if documents are intentionally falsified in order to deprive benefits. Fraud Indicators Fraud indicators do not mean fraud has occurred, but they may require a closer review of the claim or application. Employer fraud indicators include but are not limited to: classification codes not consistent with duties normally associated with the employer's type of business, for example, a construction company that reports mainly clerical classifications payroll information on the insurance application inconsistent with payroll reported to the Workforce Commission, much larger premium paid for the previous year's policy small payroll reported by a large company or employee leasing company frequent addition and cancellation of coverage, especially if several business entities appear to be owned or controlled by the same person or group. Employee fraud indicators include but are not limited to; injuries that have no witness other than the worker, injuries occurring late Friday or early Monday, injuries not reported until a week or more after they occur, injuries occurring before a strike or holiday, or in anticipation of lay off or termination, injuries occurring where the worker would not usually work, injuries not usually occurring in the particular job description, for example, a secretary injured when lifting a heavy object, worker observed in activities inconsistent with the reported injury, worker history of workers compensation claims, conflicting diagnosis from subsequent treating doctors, any evidence of working elsewhere while drawing benefits. Attorney/health care provider fraud indicators include; receiving bills or explanation of benefits for services from health care providers, insurers or attorneys that seem unnecessary or fictitious boilerplate medical reports, or reports that are merely copies of previously submitted reports, treatment dates on holidays for non-emergency situations, bills from a health care provider or attorney that present an unreasonable amount of hours per day, complaints from the worker that the attorney is (never) available although the attorney files fee affidavits for services, attorney relationship with a health care provider that appears to be a partnership in handling workers' compensation claims..
Leon Penaworker-comp-law.com is dedicated to assisting others by providing information, links and Google Searchworker-comp-law.com provides a verity of articles, we also except articles.If you have any articles that you would like to post. send your article along with your contact information. TO: Leon I am looking for articles on Workers Comp Law, personal injury Law, Health and fitness issues and others. Please link to: worker-comp-law.com from your own website.How To Answer Your Call In Mid-Life
Hank Bochenski's story proves it is never too late to walk away from a life you feel trapped in and do something that you really love. Hank spent 30 years in demanding senior positions at large high-tech companies. By the time he went home each day, he felt like all the blood had been drained out of him. Hank's real passion was his collection of more than 1,000 movies. He had recently spent hours converting the collection from VHS to DVD, a process he enjoyed.
One day his wife walked by as he worked on this project and said, "It's too bad you can't make money doing this." Before his wife's offhand remark, he hadn't considered that he could do this full time. He did some research and found a company called Home Video Studio Inc., in Indianapolis. HVS offers 21 services, including DVD transfers, DVD duplications, home movie transfers, photo-video keepsakes, sports scholarship videos and videotape repair. Hank and his wife did some due diligence and decided that this was a perfect...
How To Answer Your Call In Mid-Life
Life insurance > How To Answer Your Call In Mid-Life
A Simple (Audible) Way to Achieve Time Management
Do you always feel a step behind in life? Do you wish you could find more time? Do you have trouble accomplishing all the goals and errands you have each day? Ineffective time management can be a frustrating plague that envelops your life. You feel like you have lost control over your circumstances. This frustration can hurt your relationships, career, and overall health. Achieve time management skills by listening to audio books on the subject. Taking the time to listen to advice from time management professionals can help alleviate the harmful stress of constantly feeling crunched for time.
One of the most efficient ways to improve your time management skills is to base your life activities on a successful time management model.
You will be hard pressed to find a time management expert that was born with perfect time management skills. They had to learn the coping skills that helped them to get on track. They are professionals and face the same emotional, mental,...
A Simple (Audible) Way to Achieve Time Management
Life insurance > A Simple (Audible) Way to Achieve Time Management
Understanding How Your Credit History May Affect Your Car Insurance Coverage
Many personal auto insurance companies consider your credit information when determining how much premium to charge for your insurance. So if you are calling around for new insurance, keep in mind that many insurers are looking at your credit history. I hope that we will be able to let you know why and how they do this. The reason that some insurance companies use credit information is because they feel there is a direct correlation between consumer's credit history behaviors and expected claims that may occur. Therefore, they feel that people with better credit behavior are less likely to severe insurance losses.
Many insurance companies still use your age, driving history, type of vehicle, where you live in determining how much you should pay for your insurance. Therefore, if you have not established a credit history yet, the companies that use credit history may not be best for you. They may not allow you to be eligible for certain discounts, which could result in higher premiums....
Understanding How Your Credit History May Affect Your Car Insurance Coverage
Life insurance > Understanding How Your Credit History May Affect Your Car Insurance Coverage
Texas Group Health Insurance
Most people are generally covered under the group health plans provided by their own employer or by the spouse's employer. Whichever way, coverage provided under the group insurance programs not only serves to control the medical expenses of employees, but also provides them with the security and peace of mind, which goes a long way in ensuring their loyalty towards the company.
Group plans can be broadly classified under small employer plans and large employer group plans. Texas government has made some provisions for the small employer group plans in that they do have to have to cover state mandated benefits that are to be covered by the large employer companies.
It is also important to point out that it is not mandatory for the employers to provide group health coverage.
Also, the companies are not required to pay the premiums on behalf of their employees.
Small Employers Group Plans: To benefit from the small employers plans, the company...
Life insurance > Texas Group Health Insurance
What is Fraud
Fraud occurs when a person knowingly or intentionally conceals, misrepresents, and makes a false statement to either deny or obtain workers' compensation benefits or insurance coverage, or otherwise profit from the deceit. The key to conviction is proving in court that the misrepresentation or concealment occurred knowingly or intentionally. Premium fraud and benefit fraud are the most common types of workers compensation fraud. Premium fraud is usually committed by an employer who misrepresents the amount of payroll or classification of employees, or who attempts to avoid a higher insurance risk modifier by transferring employees to a new business entity rated as a lower risk category. Benefit fraud is usually committed by: a worker who works full time at an unreported job and draws benefits when he or she is supposed to be unable to work, or when a worker fakes an injury; a health care provider or attorney who assists the worker in fraudulent schemes, participates in double billing...
What is Fraud
Life insurance > What is Fraud
How to Reduce Car Insurance Premiums
Here are some useful tips on how to reduce car insurance premiums. Firstly, you need to find a sense of balance between coverage and cost. Apart from negotiating a good deal, there are some other things that you can do to further bring down your car insurance premium for example; Many insurers average yearly mileage at 12,000 miles. If you do not drive this amount, you can inform your insurer, thus resulting in a reduction in your premium. Park the car - Parking your car in a secure location such as a locked garage or a secure designated off road parking spot can potentially reduce your premiums.
Bulk buying - Most of the big insurance companies offer all forms of insurance such as home, life etc. You may receive a discount for buying multiple forms of insurance with the same company. Female drivers are statistically less prone to accidents. Women can avail their quotes from a firm that specialises in covering female drivers. Anti-theft alarm - Equip your car with electronic central...
How to Reduce Car Insurance Premiums
Life insurance > How to Reduce Car Insurance Premiums
Secrets of Creating Success with Ease
Do you ever strum your fingers on the desk top as you look down at your work and think, ?Right, how can I do all this lot without really working?'Brought up in an era with a clich? that went: ?You must work hard for a living' my attitude to work conflicted with what I'd learned from my elders and peers. I felt ?wrong' because I wanted to be lazy. I felt ?guilty' for wanting to do as little as possible and ?unworthy' in my role as office manager for an insurance brokerage. But I tell you I've cracked it! I've discovered how to maximize my results without working like a dog.When I tell you how easy this is, you might not believe me. When I tell you how easy this is you'll probably think that the idea is so alien to your ?work hard for a living' ethics that you won't want to believe me, so before I share my secret to success with you, let me first tell you something worth bearing in mind?Every day doctors prescribe more and more anti-depressants,Every month more and more couples separate...
Secrets of Creating Success with Ease
Life insurance > Secrets of Creating Success with Ease
Life insurance
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