Fraud Biggest Workers Compensation Problem

Article excerpt

Journal Record Staff Reporter

One of the most frightening aspects of the future of workers compensation insurance in Oklahoma is the way it's viewed by young people today, according to a woman whose company monitors industrial health insurance problems.

Too many young people feel they can fake an injury and live comfortably off workers compensation payments for years, said Paula Jones of Professional Audit and Rehabilitation Enterprises Ltd.

"A friend of mine told me about stopping at a convenience store where several teen-age boys were hanging out talking about their future careers and how education fits into their plans," Jones said. "One of them said he didn't need to study because he was going to get a good job in production line work and hurt his back, then sit back the rest of his life collecting workers comp checks.

"Obviously that boy had a role model, some adult who did this and got away with it, so he thinks he can too. That's the real problem with workers comp in Oklahoma, the fraud that's there that everyone can take advantage of.

"Another problem with workers comp is that most people sit back, even if they don't like it, and say the government has to do something about it. I feel that each company needs to do something because there are ways to cut costs and reduce fraud.

"We had better be able to find some solutions."

Jones and her co-worker Donnie Parsons are working on a project for the company, called Interventions Disability Management System, which helps contain medical costs for client companies.

"This is the first employer-based disability management program to integrate proven workers compensation benefits and cost containment techniques with the Americans With Disabilities Act," said Parsons, the company's national sales director. "This not only helps control workers comp costs, it also reduces all costs due to employee illness through an integrated system of attitudinal changes, company policies and case management."

The system has been proved in California with several corporate, municipal and medical firm clients, Parsons said. In fact, a hospital in Fresno, Calif., which used the process reduced its medical cost from $2.6 million to $1.1 million in one year.

"This is not a program," he said. "This is a process. A program indicates there is a starting and a stopping point. A process means that it is never ending, a continual search for ways to improve, a sort of total quality management system applied to helping employees who are injured or ill."

A seminar and workshop to explain the process is scheduled for Nov. 30 at the Waterford Hotel. Participants are coming from several states to hear Richard Pimentel discuss the so-called crisis in workers compensation insurance and the Americans With Disabilities Act.

The process was developed jointly by Milt Wright Associates Inc. of Northridge, Calif., and Feldman-Arakaki Associates of Hacienda Heights, Calif.

Professional Audit and Rehabilitation Enterprises, better known as PARE, was licensed as a multistate distributor of the system, Jones said.

"With this system, it's not just changing attitudes, although that's a big part of it," she said. "What it does is look at what the company is now doing for cost containment in workers comp and medical disability claims and helps develop new policies and procedures to get the employee back to work faster. It also utilizes case management to inform employees of what their rights and responsibilities are. …

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