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COMMUNICATION EQUALS SUCCESS

County of Los Angeles Return to Work Coordinators Conference

October 21, 2010

Presented by

Ted Koerner, President, American Employer Defense

800-795-4451

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• Help reduce cost of faked or exaggerated injury claims

• How can you help?

What is our objective?

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• What starts as an admitted injury can later be exaggerated to the point of being fraudulent.

There are Legitimate

Claims

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Many motivations to remain off work

Watch, listen and report…

• If the alleged injury relates to a pre-existing injury or is something that happened away from work.

•If the Claimant was experiencing significant financial difficulties or domestic problems prior to filing of the claim.

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LIFE AWAY FROM WORK OFTEN MOTIVATES BAD CLAIMS

• Claimant has recently been having numerous agitated phone conversations with a family member or an attorney.

• Is suffering through an aggravated prolonged expensive divorce.

• Claimant’s driver’s license was recently suspended or revoked, i.e.: lack of financial responsibility after a recent auto accident, D.U.I., or suspended for unpaid child support orders.

• Claimant recently demanded time off or seems to have a pattern of seasonal time off for injuries... Can’t afford child care during the summer recess.

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REPORT TO CLAIMS ADJUSTER IF…

• Claimant has scheduling conflicts due to child custody agreements or orders.

• Claimant or family member is known to operate a small business.

• A family member or loved one was recently transferred out of the area.

• Claimant refuses to accept modified work assignment.

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Online: bmckenzie@ceo.lacounty.gov or lacountyfraud.org

• Claimant lingering on modified work and is rumored to be far more active away

from work.

• Claimant participates in high-risk, strenuous activities.

• Co-workers express opinions that the injury did not happen as reported.

• claimant overheard threatening to file a claim or is working somewhere else.

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County Tip Lines: 213-974-0914 or 800-544-6861

• Claimant is rumored to be remodeling a residence, restoring a vehicle, has a vacation property.

• Claimant is rumored to be moving soon or traveling for recreation. Expedite this information, it won’t last long and we may never see this activity again anytime soon!

• Claimant is known to have a new baby or be caring for a sick or disabled child or parent.

• Frequently complains about scheduling or transportation difficulties.

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• Communicating what you hear/what you know is crucial

• Expedite communication

• “Delay = Exposure”

• A missed opportunity means we pay more than needed

You are Key

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No Claim is immune to exaggeration

Case in point:

Yesmin Navarro, age 65, grandmother

Date of Injury: 1991

At her Doctor’s

In May, 2009…

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Is this woman 100% permanently disabled?

And then 3 days later…

And what we saw 2 years earlier

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EXAGGERATION LEADS TO…SUPERIOR COURT OF THE STATE OF CALIFORNIA

FOR THE COUNTY OF LOS ANGELES

THE PEOPLE OF THE STATE OF CALIFORNIA, Plaintiff, v.

01 YESMIN NAVARRO (01/25/1943) Defendant.

CASE NO. BA367136

FELONY COMPLAINTFOR ARREST WARRANT

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FELONY ONE OF SIX

COUNT 1

On or about August 26, 2008, in the County of Los Angeles, the crime

of WORKERS’ COMPENSATION INSURANCE FRAUD, in

violation of INSURANCE CODE SECTION 1871.4(a)(1), a Felony,

was committed by YESMIN NAVARRO, who did unlawfully and

knowingly make and cause to be made a false and fraudulent material

statement and material representation for the purpose of obtaining and

denying compensation, as defined in section 3207 of the Labor Code.

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FELONY 2 OF 6

COUNT 2

On or about August 26, 2009, in the County of Los Angeles, the crime of

ATTEMPTED PERJURY UNDER OATH, in violation of PENAL CODE

SECTION 664/118(a), a Felony, was committed by YESMIN NAVARRO,

who being a person who, having taken an oath that he/she would testify,

declare, depose, and certify truly before a competent tribunal, officer, and

person, to wit, OLIVIA GOMEZ, in a case in which such an oath may by

law be administered, to wit, DEPOSITION, did contrary to such oath

attempted to state as true a material matter which he/she knew to be false,

to wit: EFFECTS OF INJURY ON DAILY LIFE.

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AND THE BAIL AMOUNT IS…

I order that the defendant be held to answer therefore and be admitted to bail in the sum of:

YESMIN NAVARRO $90,000.00 Dollars

and be committed to the custody of the Sheriff of Los Angeles County until such bail is given. Date of arraignment in Superior Court will be:

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GONE IN SIXTY SECONDS

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THIS DOCUMENT SAVED COLA $300,000.00

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THIS DOCUMENT SAVED COLA $380,000.00

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In Closing…

• Don’t Delay - Report Today

• Window of Opportunity May Close Today

• Smallest Detail May Reduce Cost of Claim

• Keep Notes

• From Beginning to End Information Always Important

• Be Inspired to Help

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Question - Comments - Thoughts

AMERICAN EMPLOYER DEFENSE

800-795-4451