HOSPITAL CASUALTY IN RECEIVERSHIP:
Oklahoma Insurance Commissioner Carroll Fisher placed Hospital Casualty Co. into receivership after its Board of Directors requested the action. Hospital Casualty provides medical liability insurance to hospitals and nursing homes in Oklahoma The receivership decision was made after a detailed review of the company's financial condition and its prospects for policy renewals. Receivership will allow the Oklahoma Insurance Department to further review the company's financial status and determine the best course of action to protect the interests of the policyholders and others who have an interest in Hospital Casualty. Policies will remain in effect as the company works through the transition with the insurance department. Policyholders should contact their agents to discuss replacing their policies at their earliest opportunity. Anyone with questions concerning Hospital Casualty should call the company at (405) 290-5774. Policies are expected to be in place through Oct. 1. The Associated Press and the Oklahoman reported the company's reserve deficit had grown to $57.9 million at the end of June. The insurer's closure is anticipated to leave 63 hospitals and 231 nursing homes without coverage.
LOUISIANA FRAUDSTER NABBED:
Louisiana's Workers' Compensation Administration reported that a joint effort by the Louisiana Department of Labor's Office of Workers' Compensation Administration and the State Attorney General's Office resulted in the prosecution of a Jennings man who attempted to cheat the state's workers' compensation insurance program. Hank Bourque, 49, pleaded guilty to felony theft in a Jefferson Davis Parish courtroom for filing a false workers' compensation claim. Bourque was ordered to make restitution in the amount of $48,900 to the Wausau Insurance Company for lost wages and medical expenses paid to him. In February 2000, Bourque reported that he hurt his back while loading a set of concrete stairs onto the back of a pickup truck for his employer, the Jefferson Davis Parish School Board. A joint investigation conducted by the Office of Workers' Compensation and the Attorney General's Office found that while Bourque was present when the stairs were being loaded, he was not physically involved in loading them. It was determined that Bourque filed a false claim to cover medical expenses he incurred from a prior non-work-related physical injury. In addition to repaying $48,900 to Wausau Insurance Company, Bourque received a two-year suspended jail sentence and five years of supervised probation for which he must pay a $50 monthly supervision fee.
COMP FRAUD, TEXAS STYLE:
Texas Mutual Insurance Company announced that Quenton Durrett of Durrett Demolition in Manvel, Texas received a one-year sentence, suspended for four years, for workers' compensation fraud-related charges. The 167th District Court of Travis County reduced the charges to a misdemeanor, and ordered Durrett to pay a $500 fine and $26,000 in restitution to Texas Mutual. According to Texas Mutual investigators, Durrett repeatedly claimed that his company had no employees and no payroll records. An investigation uncovered evidence showing that Durrett maintained a company bank account from which employees were paid, and he used two payroll companies to pay the Durrett Demolition payroll. The fraud allowed Durrett to avoid paying the correct premium for his company, and it left Texas Mutual liable for injuries sustained by his employees.
BATON ROUGE AGENCY SHUT DOWN:
The Louisiana Department of Insurance shut the doors of Banner Insurance Agency Inc. at two Baton Rouge locations, according to Insurance Commissioner Robert Wooley. The Louisiana State Police Insurance Fraud Unit executed a search warrant and closure of the doors of the Banner Insurance Agency at 5559 Plank Road and 5515 South Sherwood Forest Boulevard in Baton Rouge. At the same time, LDI fraud investigators issued a Cease and Desist order and a summary suspension of the Banner Insurance Agency Inc. agency license. The investigation is continuing. The department's C&D order alleges the agency was in violation of three state laws contained in the Louisiana Insurance Code, with charges ranging from financial irresponsibility in the conduct of business, to misrepresentation of the insurance contract, to presentation of a false written statement related to an insurance policy. LDI records show that the Banner Insurance Agency has businesses at the above locations and has held a property and casualty insurance license since 1979. To report suspected insurance fraud, contact the LDI Fraud Unit, statewide, toll-free, at (800) 259-5300 or at (225) 342-4956. Calls will be held confidential upon request.
HOUSTON MAN INDICTED:
Texas Mutual Insurance Company reported that Travis County's 147th District Court grand jury indicted Henry Prince of Houston for workers' compensation fraud-related charges. The insurer said Prince allegedly used a "double-dipping" scam to illegally receive approximately $3,400 in temporary income benefits (TIBs). State law allows some injured workers to receive TIBs when their on-the-job injuries prevent them from returning to work. The law also requires each worker to notify the workers' compensation insurance carrier when he or she begins working again. Double-dipping scams involve allegedly injured workers who claim that they are unable to work—so they can continue to receive TIBs—when in fact they are working, usually for a new employer. In effect, they get paid twice: once for working at a new job and again for being too hurt to work. With every TIBs check it issues, Texas Mutual includes a statement reminding the worker to contact the adjuster if he or she returns to full-time or part-time work. Additionally, Texas Mutual adjusters often contact workers directly to determine their work status.
C&D ORDER ISSUED IN LOUISIANA:
The Louisiana Department of Insurance shut down a Jena, La. insurance producer and issued a Cease and Desist order, along with a summary suspension of her insurance license, for allegedly misappropriating premium dollars paid by unsuspecting insurance customers, according to Louisiana Insurance Commissioner Robert Wooley. Department of Insurance Fraud Unit investigators were accompanied by State Police Fraud Unit Investigators when they served Lisa Renee Reeves, 37, at her place of business, the Excellent Insurance Agency, 3061 West Oak Street, Suite A, Jena. The C&D order states that Reeves misappropriated insurance premiums and issued bogus insurance identification cards in a number of instances, with some cases involving several thousand dollars. It further states that she is prohibited from engaging in any activity relating to the business of insurance, effective immediately. In addition, she is subject to fines and other penalties for the activities outlined in the order. LDI records show that Lisa Renee Reeves was issued a property and casualty insurance license in January of 1988 and that the license remained in force until the current action. Consumers who bought policies or conducted other insurance business, such as paying premiums, with Lisa Renee Reeves at Excellent Insurance Agency, 3061 West Oak Street, Suite A, PO Box 915, Jena, should call the insurance company to verify that they have the coverage they paid for. If they have trouble reaching the insurance company, they can call the Louisiana Department of Insurance at (225) 342-4956, or toll-free statewide, (800) 259-5300, for assistance.
IGNORING WORKPLACE VIOLENCE:
A recent follow-up survey by the American Society of Safety Engineers (ASSE) found that many companies and organizations in all industries have yet to address the problem of workplace violence. ASSE said its Risk Management/Insurance Practice Specialty group surveyed ASSE members in 1999 on what was being done to address workplace violence in their workplaces. The survey found that although the number of violent incidents in the respondents' workplaces stayed the same, 70 percent of employers said their organization had not undergone a formal risk assessment of the potential for violent acts. A follow-up survey of ASSE members, "ASSE 2004 Workplace Violence Survey & White Paper," found that not much had changed. In response to a question concerning actions taken since the 9/11 terrorist attacks and the anthrax scare, 56 percent of employers said they have established or revised their security policy; 44 percent changed emergency procedures; 34 percent increased employee contact, training and discussions on the topic, while 18 percent made no changes in their organization. According to 2002 U.S. Bureau of Labor Statistics homicides are the third highest cause of on-the-job deaths. Prior to 9/11, where terrorists killed close to 3,000 workers, workplace violence/homicides were still one of the top causes of on-the-job fatalities. The 2004 ASSE survey also found there was no change from the 1999 survey in response to whether companies had provided training on how to identify the warning signs of violent behavior—58 percent said "yes" and 42 percent said "no." The 2004 survey also showed that little or no workplace violence training has been provided and there was an increase in the number of respondents from the earlier survey—74 percent—who said their company had not done a formal risk assessment. In 2004, only 1 percent of respondents said their company had a written policy addressing violence in the workplace. However, 90 percent of those responding said their company has a policy addressing weapons in the workplace. Workplace violence includes homicides, physical attacks, rapes, aggravated and other assaults, all forms of harassment and any other act that creates a hostile work environment, noted ASSE member and co-author of the survey JoAnn M. Sullivan. A total of 4,560 surveys were mailed in April 2004 to randomly selected ASSE members and 755 surveys were returned, about a 17 percent return rate. A full copy of the "ASSE 2004 Workplace Violence Survey & White Paper," which also includes a list of resources, can be found on the ASSE Web site by going to http://www.asse.org and to ASSE News. Or request a copy by contacting ASSE directly at customerservice@asse.org. The Des Plaines, Ill.-based ASSE is a professional safety organization with 30,000 members.
