Annotated Bibliography

Running head: UNIT IV A.B. 1

UNIT IV ANNOTATED BIBLIOGRAPHY 5

Unit IV Annotated Bibliography

Samuel Clark

Columbia Southern University

Workers Compensation Disputes

California Workers’ Comp Medical Review Runs Through 13K Disputes Every Month. (2017). Insurance Journal, 95(14), W1.

The amount of disputes in workers compensation claims keeps growing as injury rates have not gone down much over the past years. So many different variables and regulations have been put in place to try and prevent insurance fraud and it has turned into this complex system with many unsatisfied parties involved.

California has a good example of this with over 13,000 disputes each month and with no sign up improvement. Insurance regulations cause doctors to follow certain protocols on how treatments are handed out and patients tend to get irritated over this process making them feel as though they are not being taken care of properly. This alone creates a big influx of disputes as workers get attorneys involved and then the issues keep snowballing downhill.

The insurance side of thigs in the case with California; the monthly total of cases deemed ineligible has been cut by nearly one-third in 2016. Disputes in workers compensation claims can work in favor of the insurance companies as well as in favor of the worker.

Ceniceros, R. (2008). Travelers loses workers comp coverage dispute. Business Insurance, 43

This dispute was between Tosco refinery when they had lost some employees and had injured employees in a refinery fire. Many times throughout claims the insurance companies will deny payments if they feel there is a breach of contract between them and the employer.

Insurance companies will also deny claims if they feel the employer is in willful violation of suspected causes to the injured employee’s. These will go to court when either side files judgments or ends up appealing previous rulings.

Florida House Panel Moves Workers’ Comp Reform Allowing Attorneys Fees in Disputes. (2017, March 15). A.M. Best Newswire. Retrieved from https://link-gale-com.libraryresources.columbiasouthern.edu/apps/doc/A485591942/ITOF?u=oran95108&sid=ITOF&xid=96eedae4

Insurance companies can also be unhappy with attorney rates as we see with the cases in Florida. Attorney fees can cause extra expenses for insurance companies in workers compensation claims and can cause rates to increase. Attorney rate increases can play a factor as it was ruled unconstitutional to place a cap on attorney fees for the state of Florida.

This will play a part with rates and policy costs for companies as this increasing of cost will eventually get passed on to the customer. Businesses pays fees, insurance companies pays fees, and attorneys pay fees. This may seem so convoluted at times and hard to understand but line of cost keeps rising as disputes continue to climb.

Illinois Supreme Court Affirms Circuit Court Jurisdiction Over Workers Comp Referral Fee Disputes. (2015, February 4). Legal Monitor Worldwide. Retrieved from https://link-gale-com.libraryresources.columbiasouthern.edu/apps/doc/A400179064/ITOF?u=oran95108&sid=ITOF&xid=aecbd598

Disputes among the compensation boards and attorney boards can also cause higher costs in workers compensations. Some of these disagreements can be raised up to the Supreme Court which will rule on the facts and laws set in place.

Representation in workers compensation cases is another cost aspect which puts strain on all parties involved. Companies pay for attorneys, insurance companies pay for attorneys and worst of all the worker involved loses a percentage of their settlement to the attorneys.

So if companies and insurance companies are paying for attorneys it seems even more unethical for attorneys to take and average of 20% away from the injured worker in their settlement. Everyone has to pay their fees in some manor or another and as disputes continue over these fees the cost insured will keep rising.

Liberty Mutual Files Appeal in AIG Dispute Over $450 Million Workers' Comp Settlement. (2012, June 29). A.M. Best Newswire. Retrieved from https://link-gale-com.libraryresources.columbiasouthern.edu/apps/doc/A294811837/ITOF?u=oran95108&sid=ITOF&xid=80944a8b

Constant disputes between companies, employees, and insurance companies continue to grow as federal and state legislation keep changing and developing around workers compensation insurances.

In this dispute the American International Group (AIG) had to pay out a total of $146.5 million distributed across all 50 states for unreported premiums on workers compensation insurance. Pennsylvania was the leading state into this probe along with Delaware and Florida. Pennsylvania had $8.6 million in fines and $3.6 million in workers compensation security fund along with $4.6 million in premium taxes and assessments. This dispute was a settlement between AIG and Liberty Mutual over a $450 million dollar settlement.

It is not hard to see why the rising cost of insurance and health care keeps going up as we look into the amount of disputes and lawsuits over workers compensation. Everyone needs to make money and these disputes will continue as companies try to stay ahead of the rising costs.

Reitz, D. (2008). Workers’ comp subrogation disputes get be tricky with large-deductible plan. National Underwriter Property & Casualty-Risk & Benefits Management, 16.

Bigger companies will at times take on large deductibles for lower insurance rates. Like we as consumers will take on a $1,000 dollar deductible instead of a $500 deductible in order to pay lower cost insurance. Companies will do the same thing for example: I work for a sizable global company and the company has a $500,000 deductible. This means the insurance company will pay nothing out of pocket until this deductible has been reached.

Imagine you have a severe injury and the employee will end up on long term disability. As the employer; you have already paid out $500,000 and the insurance company has been covering the remainder. The employee then has to go on long term disability with the severity and nature of the injuries sustained. The workers compensation case changes over to a long term disability case causing the insurance company to claim a new case and the deductible would need to be met.

This sums up what D. Reitz is referring to in this article about Workers’ comp subrogation disputes. Different state laws may have some bearing on how these disputes go such as the difference between Pennsylvania and Texas mentioned in the article.