1 communication equals success county of los angeles return to work coordinators conference october...
TRANSCRIPT
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COMMUNICATION EQUALS SUCCESS
County of Los Angeles Return to Work Coordinators Conference
October 21, 2010
Presented by
Ted Koerner, President, American Employer Defense
800-795-4451
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• Help reduce cost of faked or exaggerated injury claims
• How can you help?
What is our objective?
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• What starts as an admitted injury can later be exaggerated to the point of being fraudulent.
There are Legitimate
Claims
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Many motivations to remain off work
Watch, listen and report…
• If the alleged injury relates to a pre-existing injury or is something that happened away from work.
•If the Claimant was experiencing significant financial difficulties or domestic problems prior to filing of the claim.
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LIFE AWAY FROM WORK OFTEN MOTIVATES BAD CLAIMS
• Claimant has recently been having numerous agitated phone conversations with a family member or an attorney.
• Is suffering through an aggravated prolonged expensive divorce.
• Claimant’s driver’s license was recently suspended or revoked, i.e.: lack of financial responsibility after a recent auto accident, D.U.I., or suspended for unpaid child support orders.
• Claimant recently demanded time off or seems to have a pattern of seasonal time off for injuries... Can’t afford child care during the summer recess.
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REPORT TO CLAIMS ADJUSTER IF…
• Claimant has scheduling conflicts due to child custody agreements or orders.
• Claimant or family member is known to operate a small business.
• A family member or loved one was recently transferred out of the area.
• Claimant refuses to accept modified work assignment.
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Online: [email protected] or lacountyfraud.org
• Claimant lingering on modified work and is rumored to be far more active away
from work.
• Claimant participates in high-risk, strenuous activities.
• Co-workers express opinions that the injury did not happen as reported.
• claimant overheard threatening to file a claim or is working somewhere else.
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County Tip Lines: 213-974-0914 or 800-544-6861
• Claimant is rumored to be remodeling a residence, restoring a vehicle, has a vacation property.
• Claimant is rumored to be moving soon or traveling for recreation. Expedite this information, it won’t last long and we may never see this activity again anytime soon!
• Claimant is known to have a new baby or be caring for a sick or disabled child or parent.
• Frequently complains about scheduling or transportation difficulties.
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• Communicating what you hear/what you know is crucial
• Expedite communication
• “Delay = Exposure”
• A missed opportunity means we pay more than needed
You are Key
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No Claim is immune to exaggeration
Case in point:
Yesmin Navarro, age 65, grandmother
Date of Injury: 1991
At her Doctor’s
In May, 2009…
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Is this woman 100% permanently disabled?
And then 3 days later…
And what we saw 2 years earlier
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EXAGGERATION LEADS TO…SUPERIOR COURT OF THE STATE OF CALIFORNIA
FOR THE COUNTY OF LOS ANGELES
THE PEOPLE OF THE STATE OF CALIFORNIA, Plaintiff, v.
01 YESMIN NAVARRO (01/25/1943) Defendant.
CASE NO. BA367136
FELONY COMPLAINTFOR ARREST WARRANT
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FELONY ONE OF SIX
COUNT 1
On or about August 26, 2008, in the County of Los Angeles, the crime
of WORKERS’ COMPENSATION INSURANCE FRAUD, in
violation of INSURANCE CODE SECTION 1871.4(a)(1), a Felony,
was committed by YESMIN NAVARRO, who did unlawfully and
knowingly make and cause to be made a false and fraudulent material
statement and material representation for the purpose of obtaining and
denying compensation, as defined in section 3207 of the Labor Code.
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FELONY 2 OF 6
COUNT 2
On or about August 26, 2009, in the County of Los Angeles, the crime of
ATTEMPTED PERJURY UNDER OATH, in violation of PENAL CODE
SECTION 664/118(a), a Felony, was committed by YESMIN NAVARRO,
who being a person who, having taken an oath that he/she would testify,
declare, depose, and certify truly before a competent tribunal, officer, and
person, to wit, OLIVIA GOMEZ, in a case in which such an oath may by
law be administered, to wit, DEPOSITION, did contrary to such oath
attempted to state as true a material matter which he/she knew to be false,
to wit: EFFECTS OF INJURY ON DAILY LIFE.
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AND THE BAIL AMOUNT IS…
I order that the defendant be held to answer therefore and be admitted to bail in the sum of:
YESMIN NAVARRO $90,000.00 Dollars
and be committed to the custody of the Sheriff of Los Angeles County until such bail is given. Date of arraignment in Superior Court will be:
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GONE IN SIXTY SECONDS
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THIS DOCUMENT SAVED COLA $300,000.00
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THIS DOCUMENT SAVED COLA $380,000.00
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In Closing…
• Don’t Delay - Report Today
• Window of Opportunity May Close Today
• Smallest Detail May Reduce Cost of Claim
• Keep Notes
• From Beginning to End Information Always Important
• Be Inspired to Help
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Question - Comments - Thoughts
AMERICAN EMPLOYER DEFENSE
800-795-4451