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1 COMMUNICATION EQUALS SUCCESS County of Los Angeles Return to Work Coordinators Conference October 21, 2010 Presented by Ted Koerner, President, American.

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Presentation on theme: "1 COMMUNICATION EQUALS SUCCESS County of Los Angeles Return to Work Coordinators Conference October 21, 2010 Presented by Ted Koerner, President, American."— Presentation transcript:

1 1 COMMUNICATION EQUALS SUCCESS County of Los Angeles Return to Work Coordinators Conference October 21, 2010 Presented by Ted Koerner, President, American Employer Defense

2 2 Help reduce cost of faked or exaggerated injury claims How can you help? What is our objective?

3 3 What starts as an admitted injury can later be exaggerated to the point of being fraudulent. There are Legitimate Claims

4 4 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.

5 5 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.

6 6 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.

7 7 Online: 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.

8 8 County Tip Lines: or 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.

9 9 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

10 10 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…

11 11 Is this woman 100% permanently disabled? And then 3 days later… And what we saw 2 years earlier

12 12 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. BA FELONY COMPLAINT FOR ARREST WARRANT

13 13 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 (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.

14 14 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.

15 15 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, 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:

16 16 GONE IN SIXTY SECONDS

17 17 THIS DOCUMENT SAVED COLA $300,000.00

18 18 THIS DOCUMENT SAVED COLA $380,000.00

19 19 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

20 20 Question - Comments - Thoughts AMERICAN EMPLOYER DEFENSE


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