4. Our Focus
Sources of Workers Comp Fraud Originates from one of
three sources, Employers, Doctors or Employees.
Our firm is focused of reducing fraudulent claims from
EMPLOYEES thru choice and education.
8. Economic Drivers
THE ECONOMY
Insurers are still concerned that the weakened economy is encouraging
the steady growth workers comp fraud. In 2008, the state of
Connecticut saw a its workers comp claims double - attributing it to the
weak economy.
National Insurance Crime Bureau: With tougher economic times, we
feel that there is an increased exposure for employees to claim work
related injury for a variety of manufactured reasons. Some examples are
when the injury occurs on personal time, the employee either no longer
has medical health insurance or they cannot afford their plans deductible.
9.
10. Social Ethics
ATTITUDES
10% of US employees feel it is OK for someone injured
at home to claim the injury is work related.
11.
12. Legislative Policy
UNEXPECTED EFFECT
In 1998, roughly 2.5% of workers compensation claims originated from
employees in their first 6 months of tenure. Shortly after, Welfare Reform was
introduced which undoubtedly forced workers into the market who were
unprepared for the discipline required to work. By 2007, about 43% of
workers compensation claims originated from employees in their first 6
months of tenure.
13.
14. The Outcome Remains
Yet, because these claims are fraud from the first dollar, off-the-job
disabilities claimed as an on-the-job accident or sickness
remain the #1 source of Workers Comp Fraud.
80% of Workers Comp claims are filed on Monday.
15.
16. 24 Hours of Choice
The real source of Employee Workers Comp Fraud is probably some
strange combination factor of these three contributors (Economy, Social
Ethics and Legislation) and others.
Philosophically, employers and Service Providers should continue to
educate to help change social attitudes and ethics on this issue. Also
strategize so our middle class doesn’t become economically over-
burdened with healthcare. And yes, continue to work for the the best
legislative moves.
Practically, Implement a 24 Hour Plan
17.
18. 24 Hours of Choice
The 24 plan is built upon a simple premise:
Most employees, when given the choice of claiming the accident as off the
job vs claiming it as on the job and risking fraud. They would rather claim
it as off the job especially when they have a 24 hour plan that will still
allow them to get paid while they get well.
A 24 plan takes away the temptation for most employees to file a
fraudulent claim when they can claim it correctly as off the job accident
AND STILL GET PAID.
22. Case Study: XYZ Construction Firm
Administrator believes 25% of claims are off the job claims filed
as workers compensation claims.
SOLUTION:
Same group enrolled a 24 hour voluntary STD plan structured
with 1st day accident, 8 day sickness, 66% of pay tax free.
70% of employees enroll at their own cost.
RESULTS:
50% reduction of suspect claims and 13% reduction in overall
claims. The estimated total cost of each claim = $65,000.
38 claims a year, went down to 33. This saved $325,000 in
claims cost for this 250 life group.
26. Case Study: The Premium Impact
100 life group with $2,000,000 payroll
4% WC rate factor, $80,000 workers comp premium
90% group rating discount net cost $8,000
A 75% workers comp dividend reduces net cost to employer
- $2,000/yr.
ONE Workers Comp claim and the employer could be
disqualified from group rating - Costs could go up to
$80,000 per year!
30. Company Overview
Founded in 1986 by Thomas Wagoner (CEO)
• Corporate office located in Dublin, OH
• Sales offices in Cincinnati, Hudson, and Wooster
• 20 Corporate employees
• 50+ Regional enrollment representatives
• Endorsed or sustaining member of many statewide
associations including OGA, OTA, AOPHA, OANH, OHCA,
and more
31.
32. Company Overview
Accelerated Benefits focuses its efforts in five primary areas:
• Employer paid programs
• Employee paid programs
• Administrative services
• Wellness consulting
• Retirement plan services & business continuation
33.
34. Company Overview
A growing business…
• In 2006, 12th largest agency in Central Ohio (Business First)
• In 2007, 5th largest agency in Central Ohio (Business First)
• In 2008, 3rd largest agency in Central Ohio (Business First)
• In 2009, 3rd largest agency in Central Ohio (largest locally owned broker-
CEO Magazine)
• Currently representing more than 500 employers in the state of Ohio
• Sister company, Integrated Employee Benefit Solutions, established in 1997
• Sister company, Integrated Wellness Solutions, established in 2009
35.
36. Company Overview
Company Growth has been fueled by our “Five-C
Employee Benefit Program:”
• Cost
• Compliance
• Communication
• Coordination
• Consulting Services
37.
38. Advantages of AccBen
Why Accelerated Benefits?
• Operational support in all aspects of benefits (cost, compliance, communication, coordination)
• One point of contact
• Personalized local service with national capabilities
• Technology solutions
• Privately-owned
• Corporate wellness integration
42. Employee Bios
Thomas Wagoner, President and CEO
Founder and company CEO Tom Wagoner is highly-regarded as an expert in the industry.
In addition to being a sought after media resource, he serves on the faculty of the Lorman
institute and presents to groups of varying size across the region. Wagoner has also
served as an annuitist, providing expert testimony at legal trials. Wagoner was named a
Columbus CEO Superstar in 2009. He has authored several articles addressing President
Obama’s healthcare reform proposal, as well as controlling healthcare costs. He will handle
all strategic planning initiatives, hold negotiations at renewal time, facilitate on-going
reviews during the year, and assist with benchmarking and predictive modeling.
Education & Accreditations
• Graduated from Miami University (Oxford, OH) with a B.S. in Finance and Economics and
pursued postgraduate studies at the University of Dayton in investment and investment
banking
• Member of the FPA, ICFP, and is an Investment Advisor Rep (IAR). Currently holds the
following licenses / accreditations: CFP, NASD Series 6, NASD Series 7, NASD Series 22,
and Health, Life, and Annuities license
Industry Experience
• 20+ years including many seminars and appearances on radio and television broadcasts
Contact
(614) 791-1143, ext. 305
TWagoner@Accben.com
