Monday, May 10, 2010

EAPs to the Rescue with Workers' Compensation Fraud?

One of my favorite subjects is business insurance. I like to watch news, press releases, and blogs reporting on the many aspects of this field. As I have often opined, business insurance is a stake holder of effective, core technology employee assistance programs. The only problem is, they don't know it. That's the fault of EAPs as a group.

Insurance protects businesses and producers sell insurance. Your bridge to meet these employers and establish yourself is one of following three professionals who know a business owner best: the lawyer, the accountant, or the insurance agent. Insurance agents are your best bet because of synergies associated with the their needs, business needs, and the purpose of EAPs are nicely melded. They must all be concerned about human behavior in the workplace that leads to risk and financial loss.

Who pays for the legal bills of employees sued for sexual harassment? Who pays for the workers' compensation costs associated with sexual harassment (yes, harassed workers have often collected money for sexual harassment) and who will lose money if lawsuits come for sexual harassment? The answer is business insurers. Of course, employers pay too, if insured, through high deductibles.

There are many types of business insurance and there are many behavioral risk exposures that business insurance is designed to address. EAPs interface with many of them.

So the logic is there to team up with this group. Get started. Start in Colorado, or at least follow this legislation to see where it goes an how much influence it carries. Here's the news.

One of the insurance writers I follow is Gary Boop. He writes for "". Gary reported today on a piece of legislation working its way through the Statehouse in the Colorado. The politicians there are focused on prohibiting workers compensation insurers from spying on or doing clandestine surveillance of employees injured on workers' compensation. This technique of finding employees who are stealing money from employers by faking injuries and collecting fat paychecks has been used for decades to reduce workers' compensation costs. Do you know the ramification of such legislation? They are potentially great and it means news skills and capabilities are going to be important to reducing costs. That's where you come in.

Consider this New Colorado bill H.B. 1012

What does this have to do with EAPs? I hope you see the connection, but let me spell it out clearly for you. Limitation of an employer's ability to investigate fraud means there must be some other way to find it, but even better, a renewed interest in preventing it will obviously be on the horizon.

Instead of ignoring injured employees and then seeking to discover criminal malingering to collect benefits, heading these problems off at the pass will get more scrutiny.

I predict that someday a business service will emerge that will be funded by workers' compensation insurers, and that it will play the following role. It will operate confidentially and
  • Meet with employees to assess the emotional impact of their injuries,
  • Do a family assessment to determine likely areas of distress and conflict at risk for protracting an injury,
  • Conduct an occupational alcoholism assessment,
  • Help an employee remain motivated and anticipating a return to work,
  • Resolve conflicts between an injured employee and the boss or coworkers back at the worksite,
  • Offer support for the injured employee during the period of time they are off work,
  • Offer guidance, tips, and support upon return to duty so employees experience reduced anxiety and conflict associated with return to light duty or full duty assignments.
I believe these activities would make a hell of a business opportunity to help reduce costs for workers' compensation managed care and employers. Specialists who would do such work would need the skills of employee assistance professionals. So, why can't EAPs get more involved now before such a service robs the field of an opportunity?

EAPs typically don't do these things now, but they could add these services to their continuum of activities and get enormous credit for doing so.

If you have entertained the idea of looking more at the EAP/Workers' Compensation interface, and you happen to service employees in Colorado, run don't walk, to develop your capabilities of servicing these employees with the goal of monitoring their care so they are less likely to fall prey to the temptation of malingering.

Of course, sometimes injuries are very real, except bogus injuries or injuries that were very real at the time become easy to lie about once their pain and debilitating symptoms disappear.

Any thoughts about this? See the drift?