HAWK Advisers took a deep dive into the murky waters surrounding Workers’ Compensation & Employee Benefits in our latest seminar to help employers spot, identify, and defend their company from lurking sharks.

Suit up, we’re diving into our discussion below!

CHEWS WISELY: Employee Hiring Process

It is important to adopt a structured and comprehensive hiring process – doing so will position your company for success by attracting the right talent. A well-defined hiring process is cost-effective and will streamline how you find and qualify candidates. Even with a strong hiring process, you may still find some sharks in the water. According to the U.S. Department of Labor, the average cost for each bad hire can equal 30% of that individual’s annual earnings. A bad hire can also create a negative impact on team performance, result in lost customers, a weakened employer brand, become toxic to employee morale and potential litigation fees.

Here are some tips:

  • Conditional Offer of Employment
  • Eligibility of Employment – Form I-9 and E-verify
  • Check Driving Records
      • Tip: Checking driving records are extremely important, especially if you (the employer) plan to provide the employee with a company-issued vehicle. Negligent Entrustment arises when one individual is held liable due to the negligence of another after providing the second party with a “dangerous device” with which the second party causes injury to a third party. The legal premise behind this claim is that the person who has provided the device knew or should have known that the device could be used to harm others based on the second party’s age, inexperience, or reckless behavior.
  • Interview & Background Checks
      • Tip: You can catch a shark by using behavioral interviewing and background checks! Behavioral interviewing is when you look for depth in their responses to discover how the interviewee acted in specific employment-related situations.
  • Medical Questionnaires
  • Medical Fitness
    • Only necessary when there is a job-related need for fitness examination.
  • Drug Testing
      • Tip: Did you know that you can receive a 5% drug-free discount? Learn more here.

WORKERS’ CHOMP FRAUD: Don’t Be Shark Bait!

Warning Signs:

  • New employee- the injured employee has been on the job 30 days or less
  • No witnesses – no one sees the accident, and the employee’s own description does not logically support the cause of the injury
  • Conflicting descriptions – the employee’s description of the accident conflicts with the medical history or first report of injury
  • Hard to reach – beware the claimant who is hard to reach at home when allegedly disabled
  • Treatment is refused – the claimant refuses a diagnostic procedure to confirm the nature or extent of an injury
  • Hobbies – injury might have been a result of non-work related activity
  • Suspicious providers – an employee’s medical providers or legal consultants have a history of handling suspicious claims, or the same doctors and lawyers are used by groups of claimants
  • Late reporting – the injured employee waited to report the incident with no valid explanation for the delay

Fighting Fraud:

  • Implement a return-to-work program
  • Educate employees about fraud & the importance of early reporting
  • Keep in touch
  • Partner with reputable medical providers
  • Investigate accidents immediately
  • Maintain a safe work environment

BITING INTO BENEFITS: Risk vs. Reward & Pitfalls in Healthcare

The facts are JAW-normous, the cost of healthcare continues to rise each year. According to a study published this year by the Journal of the American Medical Association, in 2017 healthcare spending in the U.S. was 3.5 trillion or roughly $11,000 per person. By 2027, that’s projected to grow to 6 trillion which will be around $17,000 per person. As the cost of healthcare continues to rise, it’s probable to expect health insurance costs to rise as well, causing the search for creative solutions to keeping costs down. However, it’s important to understand the risk vs. reward with these solutions.

In this seminar, we examined the risk vs. reward and pitfalls in healthcare, ending with a look ahead to the 2020 election and what the future might hold.

  • MediShare Plans
    • These are cost sharing programs among members with similar goals, morals, and values and they help to share in the cost of each other’s medical bills.
    • Although typically cheaper than traditional insurance, it’s important to be aware of the potential gaps in coverage.
      • Ex: They usually have pre-existing condition clauses and annual/lifetime limits attached to the plans. There is also the potential that there could be more needs (claims) than shares (funding) available.
  • Short-Term, Limited Duration Insurance
    • Short-term, limited-duration insurance has received some recent attention due to the Trump administrations expansion on regulations to allow for these plans to last for 364 days and be renewable for 3 years.
    • However, these plans typically come with limits and exclusions and can often provide a false sense of consumer protection.
      • Tip: It is critical that consumers fully understand the ins and outs of coverage prior to enrolling in this type of plan.
    • Reference-Based Pricing
      • In our discussion surrounding reference-based pricing we examined how a traditional PPO plan works vs. a reference-based pricing plan. Ultimately, it’s important to contemplate a “fair market” price for various hospital services. Consider how much you’ll be willing to pay in premiums under a traditional PPO plan to avoid the risk of balance billing issues that could occur under a RBP plan.
      • In order for reference-based pricing to be successful, three assumptions must be true:
            1. Consumers understand hospital charges and know how to access care.
            2. Local providers will accept RBP models creating limited disruption from non-participating providers.
            3. You are working with experienced vendors and your provider contracts will protect you (the employer) from potential litigation.
    • Balance Billing
      • Balance billing occurs when a doctor or hospital bills the patient for any amount beyond that governed by his/her insurance contract. Many instances are appearing where patients unknowingly or without a choice are receiving care from an out-of-network physician or other provider. In fact, 4 in 10 families will receive a balance bill from the ER.
      • Although legislation addressing these issues has somewhat stalled, recent media attention has brought light and in some cases remedied the severity of these issues.
  • Single-Payer Healthcare
    • We can all agree that there is much uncertainty surrounding healthcare in relation to the varying viewpoints on single-payer entering the election in 2020. Many suggestions fit somewhere between the existing health system and a nationalized healthcare program.
    • In this seminar, we explored the various proposals and possibilities of where the future of healthcare could take us.
      • Tip: Stay informed as new information continues to surface – it is important to do your own research and form your own opinions.
      • Tip: ACA Compliance should remain a top concern for the time being.


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