By Angela Underwood
Florida and Illinois (WorkersCompesnation.com) – The Senate Appropriations Subcommittee on General Government has approved the formation for additional anti-fraud units under Sen. Jeff Brandes’ (R-St. Petersburg) proposal.
Senate Bill 1012, sponsored by Brandes, has the full support of The Coalition Against Insurance Fraud, a 24-year-old anti-fraud alliance made up of consumers, insurance companies and legislators. Howard Goldblatt, director of government affairs, has been with the coalition from the beginning in 1993 and helped draft legislation that Sen. Brandes’ s proposal is modeled from.
“The genesis was that the insurers were not able to get policy makers and state legislators to fully understand the effect and impact of insurance fraud on their business and customers,” Goldblatt said of the coalition’s formation more than two decades ago.
From the meeting of the minds, very vested parties sat around a table and ironed out the concept of the coalition being a voice for the stakeholders, consumers and government organizations, according to the director.
“They came together to say we agree to disagree on all these other non-fraud related issues but insurance fraud is why we are at the same table,” Goldblatt said, adding that is when the alliance began working on model legislation that has since been enacted in at least 20 states.
Penning a letter of support to Sen. Brandes, the coalition noted its full support of the bill. “Your bill, as amended will help take Florida to the next step. Insurers have had robust anti-fraud efforts but your bill brings that to a new higher ground by making sure all insurers are on a level playing field. It will benefit insurers and the insurance consumers of the state,” reads the letter.
Esquire Matthew Smith has been practicing workers’ compensation in the courtroom since the 80s, before the coalition was even formed. Since his recent appointment as the associate director to government affairs, Smith said he knows both sides of the fence.
“I have had the opportunity to see the coalition from the outside, now I get to see it differently. Having watched the coalition since it started in 1993 and working with insurers across the United States, one single word that distinguishes the coalition is credibility,” Smith said.
While Florida’s legislation handles southeast workers’ compensation fraud, Illinois SB 12 penalizes any person or entity with a Class A felony for stealing workers’ compensation benefits in the amount of $500 or less and with a Class 1 felony for more than $100,000 of theft.
A Class 3 felony is reserved for any individual or entity who uses falsified workers’ compensation insurance certificates or for anyone who gives bogus information in an insurance fraud investigation. In addition, the legislation further clarifies accidental injury while setting limited compensation after time.
Chief Legal Officer at Insureon Nicole Nelson said workers’ compensation law was put in place to protect the worker from facing undue hardship after suffering a work-related injury; however, some employers and workers abuse this law, potentially looking for ways to earn or save an extra buck.
“Employees look for the extra money and time off that filing a workers’ compensation claim brings, and employers want to help their bottom line by forgoing workers’ compensation insurance altogether,” she said, adding the need to update and change the old laws, even in just 15 years, is important as employees and employers are coming up with new techniques to benefit improperly.
“Just as fraud in other areas of the law has seen a rapid change of law due to changes in technology, workers’ compensation is having to play catch-up,” said Nelson, a member of the Illinois Workers’ Compensation Association.
Goldblatt said Brandes’s proposal is more than fair. “The larger the fraud, the stiffer the penalty,” said Goldblatt, adding there should never be a low-level penalty for high monetary fraud, especially involving a fatality.
“Any fraud that puts anyone’s life in jeopardy or death automatically gets bumped up,” he said, adding a staged automobile crash or arson fire clearly places life threatening risks. “It is one thing to file a false claim on injury, it is another thing when you purposely crash a car or set a fire.”
Nelson said one of the worse cases of workers’ compensation fraud the Insureon official has seen involved a worker who claimed to have injured their knee while stepping off a bus during the course of their job.
“However, when video surveillance from the bus itself was pulled, it showed the worker stepping off the bus with no issue and then placing themselves on the ground and calling for help. This worker had injured their leg the previous day in a non-work-related incident but wanted the benefit of the paid time off and medical coverage workers’ compensation benefits bring,” she said.
Another dangerous con according to the coalition officials is when an employer misstates a rule to lower premiums, i.e., writing a contract that workers cannot go past the second floor to lessen the likelihood of workplace falls. “That is what makes workers compensation unique in the world of fraud. The worker has no idea they may not be covered if they are injured,” Goldblatt said.
Goldblatt said the coalition will continue to fight on from the DC headquarters. “We can easily be anywhere. But being in Washington gives us that unique view in working with Health and Human Services and Office of Medicare,” he added. Nelson said fraud in workers’ compensation will continue into the future despite the changing laws.
“Stricter laws and penalties will help decrease the frequency with which we see them see them; however, they will never fully go away,” she said. “Laws will continue to evolve as well to keep up with the changing landscape of the workforce. As the country changes from industrial, manual labor jobs to more desk jobs, workers’ compensation laws will adapt.”
