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Benefit
Abuse - A costly and Growing Problem
Do some of your employees
see the company's Sickness and Accident Benefit Program or
Worker's Compensation as a potential extra paid holidays or
additional income?
Don't take it lightly - It's a costly and growing problem.
There are two types of claims, legitimate and fraudulent.
There are two types of fraudulent claims, totally false or
exaggerated. Needless to say the exaggerated are that, taking
advantage of a "good thing".
A
common area of abuse is the soft tissue injury. Painful back,
neck, shoulder area muscle injuries are very difficult for
a doctor to evaluate and they must depend on a patient's description
of the discomfort and limitation in the examining room. General
treatment is pain reducing medication, some physiotherapy
and rest. We have all "pulled a muscle" from time
to time and know how long it takes for the pain to go away.
Did you ever have one that lasted two weeks, let alone two
months, or even six months?
Aside
from the "extended holiday" motive there is the
"second job" syndrome. This occurs when an individual
needs money and has the opportunity to work under the table.
There is also the Mr. Mom story or just plain lazy.
Take
action if you have suspicions about a claim:
| 1. |
Make
it policy that employees will be called at home periodically
if they are off on benefit leave, "to inquire about
their condition". If they are often not home refer
to note 4. |
| 2. |
Arrange
for an independent medical, I.M., Insurance companies
do it and so can you. Have specific limitations indicated
by the doctor i.e., not capable of sitting or standing
for more than fifteen minutes at a time, not capable of
lifting more then ten pounds, etc. |
| 3. |
With
the medical report in mind, offer modified work that respects
the employee's limitations. Insist that the employee accepts
the modified work even if it's for half days in the beginning. |
| 4. |
If
all the above fails have the employee's activities monitored
for three consecutive days by way of investigators with
video cameras. |
| 5. |
Remember
that if one employee gets away with it his fellow workers
may follow. |
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