AGC Members and L&I Meet to Discuss Workers' Comp Fraud

A packed conference room was one indicator of the strong interest the construction industry has in the issue of workers compensation fraud.

On January 8 AGC held its second Brown Bag with officials from the Department of Labor and Industries. Dozens of AGC members discussed fraud issues with Carl Hammersburg Assistant Director Fraud & Prevention Program and Janet Morris Insurance and Consultation Program Manager. The L&I representatives described how fraud investigations are triggered what the department does to investigate allegations of fraud and what employers can do to improve this process.

One of the more important points emphasized during the meeting was the need for employers to keep sound documentation - and to provide that documentation to L&I. If you have information and do not share it with the claims manager it is likely that they will not act on it said L&Is Morris.

Employers often dont create a good paper trail said AGC Safety Director Mandi Kime. But if they dont they have nothing to work with in a fraud case.

One outcome of the brown bag session was that it seemed to help participants address a vicious cycle - employers are hesitant to communicate with L&I about potential fraud cases because they tend to think their concerns wont go anywhere but L&I cannot easily pursue fraud investigations without good communication and documentation from the employers.

I left the meeting with a little more hope for the system said Don Coovert Safety Director for John Korsmo Construction. Im more likely to contact the department in the future if my firm has concerns about a claim as I feel more comfortable that they will take the issue seriously. The L&I fraud department seems willing to work with us and I appreciate the emphasis on the fact that the more we present to them the better chance wed have of getting a productive outcome

Hammersburg said the department has made several improvements with regard to fraud cases in recent years. Among them are the use of data cross-matches with Employment Security the Department of Corrections and the DSHS New Hire list; a designated Assistant Attorney General to prosecute criminal cases; and the frequent participation of an L&I occupational nurse in conversations between physicians and investigators to improve the medical discussion.

According to Coovert the face-to-face interaction itself through the Brown Bag event was helpful. As an individual its easy to feel disconnected from the larger system so its nice to be among a group of people with the same concerns and have the departments ear he said. This is something wed likely not have access to without the AGC.

Below are links to helpful information:

Background and tips on workers comp investigations from Janet Morris L&I Insurance and Consultation Program Manager.

Fraud Prevention and Compliance powerpoint by Carl Hammersburg L&I Assistant Director Fraud & Prevention Program. This includes info on the signs of worker fraud and the use of a private investigator.

Workers Comp Fraud: How and When to Get an Investigation by AGC Retro Director Lauren Gubbe from a previous issue of AGC Works.

AGCs Legislative Office is planning future Brown Bag sessions with government agency officials. In the works is a presentation on the public works projects approved by the State and the States capital budget for 2009. No date has been set for this Brown Bag but it will likely occur in early May. Additional information will be posted in upcoming issues of AGC Works.