A change in the law governing successorship means that employers no longer will be able to avoid insurance premiums by closing a business and reopening a new one with a clean slate in regards to business taxes. Other changes will make it easier for L&I to prove fraud cases against workers, employers and health-care providers who knowingly cheat the industrial insurance system.
When the state legislature passed the anti-fraud measures in March, it also gave L&I additional resources to expand its fraud staff. Ten new investigators and auditors are being hired, and some existing L&I positions are being transferred to the anti-fraud effort. The agency recently reorganized its investigations, auditing and collections efforts and named Carl Hammersburg to head that program.
L&I's focus on combating fraud and abuse is in response to concerns expressed by employers and some workers. At rate hearings over the past 2 years, they told L&I that invalid injury claims and employers who don't pay the premiums put an unfair financial burden on companies that support the insurance system. L&I set out to overhaul the way it manages claims and how it uncovers, investigates and pursues fraud and abuse of the system by workers, employers and health-care providers.
The agency reassigned additional staff to combat fraud and abuse, and it adopted new procedures for investigations and audits. In addition, it requested legislation that would make it easier to prove fraud and harder to avoid business taxes. Backed by Gov. Gary Locke and supported by organized labor and the business community, the legislation passed in March.
"Our goal is to be the best workers' compensation system anywhere," said Robert Malooly, assistant director for L&I's Insurance Services Division. "One way we can do that is to work with employers to help them manage their claims and keep their rates low. Another way is to go after employers who don't play by the rules and knowingly and repeatedly cheat the system. With this new fraud effort, those employers will either get into compliance or move on to another state. We will not let dishonest employers shift their costs of workers' compensation claims to the honest employers and their employees."
With the additional staff, L&I will conduct more validity checks to make sure new workplace-injury claims are legitimate. The agency's auditors will perform more random audits of businesses to make sure they are accurately reporting hours worked and paying premiums. L&I investigators will crosscheck with other government agencies to find workers who are collecting L&I benefits while secretly working at other jobs. And new software programs will soon improve L&I's ability to detect duplicative and improper billings by health-care providers.
The new legal authority and additional staff will allow L&I to expand an anti-fraud effort that has been under way for some time. Working with local prosecutors, the agency has more aggressively pursued criminal fraud cases against workers and beneficiaries who knowingly collect benefits to which they are not entitled. And, for the first time ever, L&I recently began suspension proceedings against six construction contractors who refused to enter into payment agreements for the premiums they owed. Four of those contractors have since set up repayment schedules.
L&I's anti-fraud effort is one of five high-priority projects designed to reduce workplace injuries and hold down the cost of industrial insurance. In addition to its anti-fraud effort, these projects are designed to:
- Improve the speed, fairness and quality of workers' compensation processes.
- Get people back to work as soon as they are medically able.
- Involve employers earlier and more often in the claims process.
- Prevent workplace injuries and illnesses.
L&I provides workers' compensation insurance for about 155,000 employers who employ about 70 percent of the state's workforce.
