Published: October 05, 2008 02:12 am      

BrickStreet takes workers’ comp fraud seriously

FAIRMONT — BrickStreet Mutual Insurance Co. takes fraud seriously and will take every step necessary to stop it.

BrickStreet Insurance recently hosted a brunch for Marion County Chamber of Commerce members and business representatives about workers’ compensation fraud. The event was part of the chamber’s 12th annual Small Business Expo, held Oct. 2 at the I-79 Technology Park Research Center in Fairmont.

The presentation last week was the first stop of BrickStreet’s media fraud tour. Becky Neal, vice president of government relations, said BrickStreet will travel all over the state and has dates booked through December. This is the company’s way of letting people know that it’s taking the fraud out of workers’ compensation, she said.

“There is a solution with fraud and workers’ compensation,” Neal said.

Dave Plantz, director of the Special Investigations Unit, and Neal discussed BrickStreet’s work over the past few years on workers’ compensation fraud. The American Association of State Compensation Insurance Funds reports that workers’ comp fraud is one of the largest white-collar crimes in the United States.

BrickStreet’s fraud and abuse investigation and prosecution unit was formed in 2003, Plantz said. BrickStreet is headquartered in Charleston and has investigators who are responsible for the following areas: Fairmont, Kingwood, Charleston, Huntington, Logan, Beckley and Wheeling.

The unit’s mission “is to detect and deter potential fraud and abuse committed against BrickStreet Insurance and to thoroughly investigate and accurately report our findings.”

According to Neal, six out of seven of BrickStreet’s investigators are retired state police, which sets the company apart from other entities. Businesses can take control of their insurance policies and prevent fraud in the workplace, she said.

Fraud or abuse perpetrators can come in the form of employers, medical providers or claimants. Plantz and Neal focused on claimants as perpetrators.

BrickStreet’s Special Investigations Unit examines cases where individuals wrongfully go after benefits or aren’t truthful with the extent of their injuries, or where medical providers draw out treatment or have practices that are suspicious. Also, employers may incorrectly report how many employees they have or classify them wrongly.

There are several warning signs of fraud, such as suspicious timing of the injury and no witness to the accident. Other indications include sketchy details, a delay in reporting the injury to the employer, and a history of complaints with the employee.

Plantz said employers need to make a statement and take photos of the incident to be used in the investigation. Anything that the employer can do at the scene will help in the long run, he said.

When BrickStreet receives a workers’ comp claim, the investigators start by doing research. Before they begin the investigation and interviews, they first look into the claim for elements of fraud. Brickstreet tries to make this a quick process, Plantz said.

He explained the investigation process, from the research claim and claimant to the recommendation to BrickStreet or OIC.

In the 2006 calendar year, BrickStreet documented $268,317 in savings because of its fraud investigations. Money saved for 2007 measured approximately $1.8 million, and $219,111 for 2008 through May.

The total savings since 2006 come to $2.3 million, but Plantz estimated that it has probably reached $2.6 million or $2.7 million by this time of year.

Neal said workers’ compensation in West Virginia has come a long way since it changed from a state system to the private market. Workers’ comp is a wage replacement to help employers protect their greatest asset, which is their employees, she said.

Compared to the state system, BrickStreet has given fraud investigation a lot more attention, Plantz.

“I think it’s night and day difference (from) what it used to be,” he said.

At the end of the presentation, Plantz showed some raw video footage of fraud cases that BrickStreet has investigated.

“This is just an example of what we do every day,” he said of the clips.

To report workers’ compensation fraud, businesses can call the hotline at 1-866-926-3469 or e-mail reportfraud@brickstreet.com.

E-mail Jessica Legge at jlegge@timeswv.com.