WC Magazine

JUN-JUL 2016

WC is published six time a year and covers the trends and topics of interest to professionals responsible for the cost-effective resolution of workers’ compensation claims.

Issue link: http://theclm.wcmagazine.epubxp.com/i/708345

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Page 38 of 43

TheCLM.org June 2016 | July 2016 WC 39 to prevent not only the current claim from escalating, but also future claims. Lenkov: Dan, are Michigan workers' compensation fraud laws strong? Dan Hébert: Our fraud provision is quite weak. We do not have formal dis- covery and have what we refer to as "trial by ambush." e real remedy is to spring evidence of fraud on the plaintiff at the time of trial. Usually, it is surveillance film of them working or conducting activities inconsistent with their alleged disabilities. Assuming they cannot ex- plain it away, the result is a no-cause. Lenkov: Alex, I assume that what a defense attorney or carrier might think is fraud is not always something with which you agree? Berman: Fraud is a legally significant word, and its meaning in the context of a workers' compensation law can result in a variety of consequences. Michigan's Workers' Compensation Act includes criminal penalties for fraudulent claims. But if a client merely is exaggerating symptoms or disability, both sides usual- ly don't consider the issue of fraud. Lenkov: Is it easier to pursue fraud in some states than others? McPherson: Twelve states operate a state fund, and a handful have state- owned monopolies. In some states, such as California, the state law is more com- prehensive than the federal requirements. Musselman: We fight fraud whenever and wherever it occurs. However, there are certain jurisdictions that make it more challenging. at said, we will never allow a claim to go through and be processed simply out of fear of a certain jurisdiction. Lenkov: Do you ever decide to forego pursuing fraud because it is prohibitively expensive to do so? McPherson: Fortunately, I have not had this situation. Workers' compen- sation fraud is a crime and should be addressed. If fraud truly is suspected, we should follow the necessary proce- dures for investigating and reporting to the appropriate state agencies, as warranted. Musselman: No. As mentioned, fraud is the single largest issue facing carriers today. Workers talk. If someone is able to successfully gain benefits through fraud, their co-workers see that and are liable to do the exact same thing. We will pursue any inkling of fraud on any claim. Lenkov: What do you do when you suspect that a claimant is committing fraud? Kristy McPherson, Claims Program Manager, 7-Eleven Kristy has over 20 years of diverse experience in complex multijurisdictional claims handling, litigation management, and risk analysis. She is technically proficient in work- ers' compensation, general liability, product liability, liquor liability, property liability, construction defect, energy, and trucking. In her current role at 7-Eleven, she is the claims program manager for workers' compensation, general liability, auto, property, and envi- ronmental. She has been a CLM Fellow since 2016. Danial J. Hébert, President and Managing Partner, Charfoos Reiter Hébert Danial has been practicing workers' compensation litigation on behalf of employers and insurance carriers in Michigan since 1992. He is a fellow of the College of Workers' Com- pensation Lawyers, inducted in 2013. He is a frequent lecturer for the ABA Workers' Com- pensation/TiPS section as well as the Michigan Self-Insured Association. He has been a CLM Member since 2016. Rex Musselman, Iowa Mutual Insurance Group, Workers' Compensation Claims Supervisor Rex works for the Motorists Insurance Group headquartered in Columbus, Ohio, as the Workers' Compensation Supervisor for the Iowa Mutual Insurance affiliate. He has over 29 years in the in- dustry, 23 of which have been in management. He is responsible for Iowa Mutual's overall work- ers' compensation claims management and annual results, with specific regard to outcomes for claims volume, litigation management, SIU investigation, subrogation recoveries, vendor man- agement, agency outreach, and ongoing education. He has been a CLM Fellow since 2013. Alex Berman, Founding Member, Law Offices of Alex Berman P.C. Alex Berman is a renowned workers' compensation plaintiff's attorney in Michigan. He has represented injured workers exclusively for more than 30 years and has recovered millions of dollars for his clients. Meet the Panel

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