BrickStreet Insurance Attacks Workers’ Comp Fraud
By Wayne Sheets, Contributing Business WriterArticle Photos
BrickStreet Insurance's Special Investigative Unit has saved the workers' compensation insurer more than $2.3 million, an official told about 30 local employers and insurance professionals Oct. 30 during the Elkins-Randolph County Chamber of Commerce "Eggs &?Issues" event.
"These savings are based on results of investigations completed that resulted in some form of action being taken on workers' compensation fraudulent claims,"?said Dave Plantz, director of BrickStreet's Special Investigative Unit. "During the calendar year 2006, we saved the company an estimated $268,317. In 2007, the savings were estimated at over $1.8 million, and so far this year, we've saved our policyholders over $219,111."
According to the American Association of State Compensation Insurance Funds, workers' compensation fraud is estimated to be the second largest white-collar crime in the nation, second only to income tax evasion.
Plantz and Business Director for Small Accounts Hope Fallen are touring the state tutoring employers and insurance executives on ways to recognize, report and help prevent fraud in the worker's compensation insurance industry.
"Our mission is to detect and deter potential fraud and abuse committed against BrickStreet Insurance, and to thoroughly investigate and accurately report our findings," Plantz said.
Plantz said he's noticed a reduction in fraud cases since the special investigative unit started work.
"I believe we are seeing a reduction in the filing of fraudulent claims by policyholders, medical providers and employees alike. They are beginning to realize that we are working hard in this area and I believe it is beginning to have some affect on the number of claims filed," he said.
According to Plantz, SIU officers are typically retired state police officers who have extensive backgrounds in criminal investigation. Many were previously assigned to the Bureau of Criminal Investigations and spent most of their careers investigating major crimes or narcotics cases.
"The officers are also longtime residents in the area in which they serve," Plantz said. "It's not like we are sending an officer from the Charleston area to investigate a situation in the coal fields of the southwestern part of the state. The officers are familiar with the people and businesses of the area in which they serve. This gives them a tremendous advantage for working their area as opposed to a stranger who is unfamiliar with the area."
Plantz said that his unit investigates between 700 and 900 cases each year. "Most cases are closed in about 50 days, and some are closed in less than a week. Some, obviously, take much longer."
According to BrickStreet officials, the SIU's process begins with researching a claim and the claimant. The claimant's physical address is determined and this information is forwarded to the field investigator. A strategy for investigation is developed which normally includes surveillance and interviews. Recommendations based on findings of the investigation are then forwarded to BrickStreet Insurance and/or the Office of the Insurance Commissioner.
Some examples of fraud include claimants wrongfully seeking benefits or misrepresenting the extent of their injuries, medical providers who prolong treatment or have questionable practices and employers who under report the numbers of employees or improperly classify employees.
To date, the SIU has determined fraud or abuse perpetrators including employers, medical providers and claimants, Plantz said. He also pointed out warning signs of fraud including the timing of the injury, which might be suspicious:
- Was the injury a "Monday morning" injury that may have occurred over the past weekend?
- Is there a coincidence between the employee's injury and a need for personal time off?
- Did the injury happen before or after a strike, job termination, layoff or at the conclusion of seasonal work?
- Other warning signals include no witnesses to an accident, sketchy details, a longer than necessary delay in reporting the injury to the employer, and if the employee has a history of complaints, short-term employment or a history of suspicious injuries and/or litigated claims.
For more information about BrickStreet's SIU, call Plantz at 941-1000, ext. 5508, or Lisa Prater at ext. 5213.
Suspected fraud may be reported by calling the toll-free hotline at 1-866-926-3469 or by sending an e-mail to reportfraud@brickstreet.com.
