Presents 2015 NFIB Fraud & Safety Services

“Fighting Fraud” Partnerships

2014 Partnership “Fraud” Results

• 2014 “SID” Fraud Found– Found $6.6 million in fraud at Texas Mutual– Lead to $5.2 million in future savings for

policyholders

• Strong Partnership– Can stop or reduce some fraud– Will likely Identify more fraud – Identify greater future savings

We begin the partnership

• Communicate your concerns

• Listen to your carrier’s concerns

• Take a STAND against fraud

• Notify Adjuster and SID/SIU Investigator

• Enhance the investigation with information

DOUBLE DIP INVESTIGATION

Suspicion: Self Employment

Fraud is…..

• An offense committed

• With intent to obtain benefits

• By knowingly or intentionally

• Lying about or concealing facts

Possible Fraud IndicatorsWhat you can look for…….

• Tip from a credible source

• New or disgruntled worker

• No witness to alleged injury

• Inconsistent or illogical description of incident

• Hard to contact injured worker

• Injured worker acts upset when contacted

• Suspicious injury on Monday or Friday

Examples of Claimant Fraud

• Staged accident

• Injury not in course/scope

• Working while receiving TIBs/SIBs

• Inconsistent activities

• Feigning disability

Purpose of the Investigations

• Fraud Investigation• Determines evidence of fraudulent injury event• Uncovers activity that shows no disability• Determines ability to work• Determines fraudulent actions

What can you do to help?

• Conduct initial incident investigation• Gather evidence

• Photos of the injured worker• Face• Injury

• Copy of injured worker’s statement• Copy of statements from witnesses

• Immediately provide evidence to your carrier

Takeaways For a Better Partnership

• Let the communication flow………• Conduct a good investigation for your records and

share all information with your carrier• Stay in contact with your injured worker• Notify your carrier the day your injured worker

returns to work• Know what fraud is and the investigation’s purpose• Take a stance against fraud

                

Safety: No Small Matter for Small Businesses

Agenda• The Return on Investment of safety

• Workplace safety tips

• Free Texas Mutual safety resources

• Why join an NFIB safety group?

Cause of Injury Number of Claims

Medical Incurred

Indemnity Incurred Total Incurred

Burn 1 $0 $0 $0

Slip, Trip, or Fall 1 $473 $0 $473

Strain 2 $1,165 $0 $1,165

Total 4 $1,638 $0 $1,638

ROI of Safety

16

ROI of Safety• Medical• Indemnity

Direct Costs

ROI of Safety• Accident report• Repair property• Lost productivity• Overtime• Hiring and training• Morale• Regulatory audits

& finesIndirect Costs

ROI of Safety

Direct Cost $1,638

Indirect Cost $3,276

Profit Margin 5%

Additional Sales Needed to Cover Indirect Costs $65,520

Protecting Your Most Valuable Asset

The ROI of Safety

• Reduced absenteeism

• Increased morale

• Decreased workers’ compensation

costs

Tips for a Safer Workplace

• Review or establish hiring procedures

oEstablish training schedule

• Create written safety plan

• Regularly inspect your workplace for hazards

• Investigate accidents

• Launch a substance abuse program*

• Use your free resources

* Consult an attorney before you launch a substance abuse program to ensure you comply with all laws and regulations.

Tips for a Safer Workplace

Safety Resource CenterTexasMutual.com

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Custom Safety Group Home Pages

Self Assessment ToolsOnline videosDVDsToolbox TalksSafety ProgramsPostersAnalysis ToolsInjury TrendsService PlansWebinars

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• 844-WORKSAFE (967-5723) - 8 a.m. – 5 p.m. CST• Safety@texasmutual.com - any time• Virtual safety consultations• Help accessing online safety resources• Assistance with specific safety issues• Safety training requests

Safety Services Support Center

WorkSafeTexas.com

Safety @ Work Blog

NFIB Safety Groups

• NFIB Wholesale/Retail

• NFIB Manufacturing

• NFIB Construction

Why Join an NFIB Safety Group?

• Industry-specific safety resources

• Workers’ compensation premium discount

• Two potential Texas Mutual dividends*– Individual policyholder dividend

– Safety group dividendo$1.6B paid since 1999*

*Dividends are based on performance, are not guaranteed and must comply with Texas Department of Insurance regulations.

Visit NFIB.com Member Benefits

Recap

                

• Consider the true cost of injuries

• Implement & enforce a safety program

• Use your free safety resources

• Ask your agent about NFIB safety groups