RBH Enterprises Guilty of Workers’ Comp Fraud
March 25, 2005 - Texas Mutual Insurance Company reported today that RBH Enterprises, Inc. of Keller pleaded guilty to a first-degree felony offense for workers’ compensation insurance fraud-related charges. Judge Julie Kocurek of the 390th Travis County District Court ordered the company to pay a $100 fine to the state and $25,000 in restitution to Texas Mutual Insurance Company.
Texas Mutual® investigator Sandra Milburn uncovered evidence that RBH Enterprises was fraudulently represented as an independent subcontractor by an insured. The insured applied for workers’ compensation coverage through Texas Mutual Insurance Company, but it did not report the payroll of RBH. Because insurance companies use payroll as a basis for their premium calculations for workers’ comp coverage, the scam allowed the insured company to obtain a lower premium than it actually owed.
Milburn turned the evidence over to Travis County Assistant District Attorney Donna Crosby. The RBH investigation was part of the Texas Mutual® “Zero Tolerance for Fraud” policy. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.
March 11, 2005— Texas Mutual Insurance Company reported today that Minerva Davila of New Braunfels pleaded guilty to workers’ compensation fraud-related charges. The Travis County 147th District Court sentenced Davila to two years’ deferred adjudication and ordered her to pay $4,599 in restitution to Texas Mutual Insurance Company, perform 160 hours of community service, and attend treatment and counseling as recommended by probation.
Davila allegedly suffered on-the-job injuries while working at Comal County Child Emergency. Texas Mutual Insurance Company began paying her temporary income benefits (TIBs) after her doctor placed her in an off-work status.
A Texas Mutual® investigation uncovered evidence alleging that Davila had worked as a housekeeper at a New Braunfels conference center less than one month after her alleged injury. Meanwhile, Davila continued to tell Texas Mutual Insurance Company that she could not work, and she continued to collect TIBs.
State law allows injured workers to receive TIBs only while they are unable to work. The law also requires injured workers to notify their workers’ compensation insurance company when they begin working again.
Investigators call this sort of scam “double-dipping” because the claimant is getting paid by her new employer for working and, in effect, getting paid by her previous employer’s insurance company for being too hurt to work. Double-dipping scams, if allowed to continue, can lead to a higher workers’ comp insurance premium for the first employer when the company renews its coverage.
With every TIBs check, Texas Mutual Insurance Company includes a statement reminding the claimant to contact the adjuster if he or she returns to full-time or part-time work. Additionally, Texas Mutual® adjusters often contact claimants directly to determine their work status.
The Davila investigation was part of the Texas Mutual® “Zero Tolerance for Fraud” policy. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.
Texas Mutual Cleans Up Fraud Scam
March 8, 2005— Texas Mutual Insurance Company reported today that Kevin Savage of San Antonio pleaded guilty to workers’ compensation fraud-related charges.
The Travis County 147th District Court sentenced Savage to a one-year suspended jail term, 18 months of probation, and 160 hours of community service. The court also ordered Savage to return $6,991 in illegally obtained benefits to Texas Mutual Insurance Company, pay a $500 fine, and attend counseling and treatment as recommended by probation.
Savage reported an injury while working as a swab operator for RPM Swabbing Services Inc. His doctor put him in off-work status, and Texas Mutual Insurance Company began paying him temporary income benefits (TIBs).
Meanwhile, Texas Mutual Insurance Company received information that Savage had begun working for a second employer. A Texas Mutual® investigator followed Savage from his residence to a business in Seguin and videotaped him unlocking the front door and sitting at a desk. The investigator called the business and recorded a conversation in which Savage identified himself as vice president of marketing.
State law allows injured workers to receive TIBs only while they are unable to work. The law also requires injured workers to notify the workers’ compensation insurance company when they begin working again.
With every TIBs check, Texas Mutual Insurance Company includes a statement reminding the claimant to contact the adjuster if he or she returns to full-time or part-time work. Additionally, Texas Mutual® adjusters often contact claimants directly to determine their work status.
The Savage investigation was part of the Texas Mutual® “Zero Tolerance for Fraud” policy. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.
Texas Mutual Announces Provider Referral Line
March 7, 2005—Texas Mutual Insurance Company today announced the launch of its health care provider referral service for policyholders. The toll-free phone number, (800) 381-8067, provides a list of network health care providers for policyholders to recommend to injured workers.
Rockport Healthcare Group administers the provider referral network for Texas Mutual Insurance Company. When a Texas Mutual® policyholder calls the line, a representative will locate a qualified provider convenient to the injured worker’s home.
”This will be a great cost-saving tool for our policyholders and an added convenience for their injured workers,” said Lisa Corless, Texas Mutual® vice president of claim operations. “It will help ensure that injured workers find a doctor who is nearby and who can best treat their particular injury. Of course, all our network doctors are also on the Texas Workers’ Compensation Commission’s approved doctor list.”
The referral line can also help injured workers find ancillary health care providers, such as physical therapists or radiologists. Corless added that policyholders must remember that while they may suggest a network doctor to an employee, state law gives the injured worker the final say in choosing a treating doctor, provided the doctor is on the approved doctor list.
February 28, 2005—Texas Mutual Insurance Company announced today that Donna Fink is the new underwriting and marketing manager for its Houston regional office. Ms. Fink will oversee the company’s Houston region underwriting and marketing operations.
Ms. Fink has worked in several positions in the insurance industry for large carriers in Dallas and Houston. She is also a past vice president of the American Business Women’s Association in Katy, and she serves on the board of directors for the American Heart Association.
”She has a strong background in large accounts, and she understands the needs of smaller accounts, too, having been a small-business owner herself,” said Ken Lauber, Texas Mutual® vice president of field operations. “We’re very pleased to have her on our team.”
Green Industry Group Passes $3 Million Mark
February 4, 2005 - Texas Mutual Insurance Company announced today that the Texas Green Industry (TGI) Safety Group has grown to 101 members with over $3,387,000 in written premium, making it one of the company’s fastest-growing Safety Groups. Hotchkiss Insurance Agency (HIA) formed the group in February 2004.
”Doug Hotchkiss and his staff have done a fantastic job with this group,” said Ken Lauber, Texas Mutual® vice president of field operations. “They’ve dedicated the resources needed to help this group reach its potential. They attend trade shows and conventions, advertise in agent publications, and find every opportunity to help spread the word. With Hotchkiss behind it, I am confident TGI will continue to grow.”
Any Texas insurance agent may place a qualifying client into the group. TGI includes growers, landscape contractors, nurseries, and other green industry businesses. For a complete list of TGI-qualifying business classifications, click here.
For more information about the Texas Green Industry Safety Group, contact Sam Worth at Hotchkiss Insurance Agency by email at sworth@hiainc.com or by phone at (800) 899-3750 extension 7763. For more information about Texas Mutual® Safety Groups, click here, or call (800) 859-5995.
Texas Mutual Pays $40K Dividend
To Texas School Group
January 26, 2005 - Texas Mutual Insurance Company announced a dividend to the Texas School Group today. The Texas Mutual® Safety Group will receive approximately $40,606.
The group dividend is separate from the approximately $50 million in dividends that Texas Mutual Insurance Company paid to qualifying policyholders in July 2004. Some Texas School Group members may receive dividends under both programs.
Since 1999, Texas Mutual Insurance Company has returned over $170 million in general dividends and over $5 million in Safety Group dividends. The Texas Department of Insurance has approved every Texas Mutual® dividend plan to date.
Texas Mutual Insurance Company is the state’s leading provider of workers’ compensation insurance. Its Safety Group members receive a premium discount, based on an estimate of the group’s entire written premium. Employers interested in Texas Mutual® Safety Groups can find more information here.
Past dividends are not a guarantee of future dividends; however, when funds are available, Texas Mutual Insurance Company believes in rewarding its loyal policyholders whose low claim losses contribute to its success.
Three Texas Mutual Policyholders Cited for Excellence
January 14, 2005 - Texas Mutual Insurance Company announced today that three of its policyholders received Safety and Health Achievement Recognition Program (SHARP) awards from the Occupational Safety and Health Administration (OSHA).
The SHARP awards recognize excellence in occupational safety and health among small, private sector employers. OSHA grants a one- or two-year exemption from its programmed inspections to each SHARP award recipient.
Chaparral Industries Inc. of Odessa, Faith Manufacturing Company Inc. of Humble, and Superior Welding Inc. of Andrews were among 27 small Texas employers recognized by OSHA for their outstanding workplace safety programs. Chaparral Industries has been a Texas Mutual® policyholder since 1994; Faith Manufacturing since 1995; and Superior Welding since 2002.
January 11, 2005 - Texas Mutual Insurance Company reported today that Henry Prince of Houston pleaded guilty to workers’ compensation fraud-related charges. The Travis County 147th District Court sentenced Prince to six months’ deferred adjudication and ordered him to pay a $200 fine and $3,400 in restitution to Texas Mutual Insurance Company.
While he was off work for his alleged injury, a second company asked his former employer to verify his employment. The employer contacted Texas Mutual Insurance Company, which opened an investigation and verified that Prince had become gainfully employed while continuing to receive temporary income benefits (TIBs).
Investigators call this type of fraud a “double-dipping” scam. Double-dipping usually involves workers who collect TIBs for an alleged injury at one job, when in fact, they are working for a new employer. In effect, the scam allows them to get paid twice: once for working at the new job and again for being too hurt to work at the old job.
State law allows qualifying injured workers to receive TIBs only when their on-the-job injury prevents 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.
With every TIBs check it issues, Texas Mutual Insurance Company 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.
The Prince investigation was part of the Texas Mutual® “Zero Tolerance for Fraud” policy. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.