Tag Archives: Insurance

Workers’ Comp Fraud Prevention: State Of Colorado Amends Bill That Would Restrict Video Surveillance That Is Deemed “Intrusive Or Harassing”

The original intent of the bill was to restrict workers’ comp insurers’ use of video surveillance to only cases where the insurer has a reasonable basis to suspect fraud. It also would have imposed a significant fine on insurers that violated the rule. However, the legislation was amended after lawmakers raised concerns that it would seriously hinder insurers’ efforts to prevent fraud.

The amended version prohibits evidence from being introduced at workers’ comp administrative hearings if it is deemed that the surveillance was intrusive, intimidating or harassing. In addition, the evidence would not be permitted if the administrative law judge finds that the investigator, if questioned, misrepresented himself to the claimant and did not disclose on whose behalf he was conducting the surveillance. The legislation would also require insurers to present the surveillance videos to the claimant’s treating physician for review.

http://www.riskandinsurance.com/story.jsp?storyId=375682191

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Hospitality Industry Safety: Hotel Management Must Insure That ALL Staff Are Prepared For And Knowledgable Of Fire Safety System

 

“Sleepless in Seattle”: A true fire alarm tale reveals lessons “From the Field”

This last weekend, I stayed at a full service hotel in downtown Seattle. When I checked in, I was delighted to receive a room on the very top floor of the hotel (the 20th floor), as I was excited about having a spectacular view of Seattle. It was my first time visiting Seattle, so I was looking forward to an “adventure”. Yes, I was about to have an “adventure”.

The adventure begins

After a great dinner, I went to bed. At 4am, my “adventure” started. The fire alarm siren went off like an atomic bomb exploding inside my guestroom. It was very LOUD and CLEAR. Now, I am an experienced hotel security and risk management professional, so what did I do? Exactly what everyone who has any experience with hotel fire alarms would do…I stayed comfortably in my warm bed. I suspected that someone got caught smoking in a hallway, or an employee burnt a piece of toast, setting off the alarm.

Then it came….a barely audible PA announcement. “This is hotel security, there’s a fire in the hotel, evacuate the hotel using the South stairwell!” The announcement was made only ONCE, and it was hard to hear and understand, BUT it was enough to get my warm butt up and evacuating. By the way, which way is South? There was no compass in my guestroom to point me in the right direction.

I exited my hotel room and immediately met up with eight women who had just exited their rooms, but did not know where to go, or where the South stairwell was. They were standing a mere ten feet away from the stairwell door. I knew exactly where the stairwell was, as I am a trained risk management professional, and always make a mental note of all emergency exits on my floor when I stay at any hotel. (Truth be told, I had to use the stairs earlier to get a soda from a machine on the floor below. But don’t tell my wife, she thinks I actually was pre-prepared for the fire and that impressed her.)

We all evacuated the hotel down the stairwell. Yes, I’m talking 20 flights of evacuation stairs. I didn’t think that view of Seattle was so “spectacular” now. I do have to say I loved every moment of it though, as I was participating in an actual hotel emergency, but WAS NOT responsible for it. As a risk manager for the hospitality industry, I spend a majority of my time training, planning and preparing hotels for these types of emergencies. I was now being “a fly on the wall” in an actual emergency in all its glory.

Lessons learned

With every experience, come lessons to learn from in order to seek improvement. Here are the lessons I learned:

  1. If you’re going to evacuate a hotel, make more than one announcement on the hotel-wide PA system. Guests who are startled at 4am need more than one announcement to clear their head and have them understand what you want them to do. At least three announcements should be made in succession. 
  2. Mark all emergency exit stairwell doors. They should be marked with a sign on the actual door of the stairwell, both at eye-level and at ground level. The Seattle hotel had the mandated illuminated “Exit” signs high above the doors, but it did not have a simple “emergency exit” sign or “stairs” sign on the door to the stairwell. The guests I met in the hallway were literally in front of the stairwell door, but did not recognize it as such, because there was no marking on the door itself. People do not look up during a crisis. The illuminated “exit” signs could be concealed if smoke was in the hallway. As smoke rises, it would cover signs that are posted higher than three feet from the ground. This is why all hotels should post room numbers and exit signs also on the bottom of the door face. Currently, only a handful of counties and municipalities require this as code. 
  3. Train hotel staff how to use the emergency fire panel. I learned from talking to other guests that floors 3, 4, 5, and 6, along with floors 18, 19 and 20 were the only floors evacuated. Floors 7 through 17 were not evacuated and received no fire alarm siren at all. I have to surmise that hotel personnel who were operating the fire panel did not completely understand how to operate the panel properly, because the actual fire was on the 5th floor. A decision to evacuate floors 18-20 but not 7-17 made no sense whatsoever. 
  4. As a side note, I was absolutely shocked at how many adults actually wear pajamas to bed. I would have never guessed that many.

 

In retrospect

After the entire incident, I was pleased to discover that all of the things us risk managers stress over and over again actually do have merit.

Educate your staff on how to operate your hotel’s fire life safety system. Make sure every management, night audit, engineering and security employee knows how to operate the fire panel and PA system. Train all employees about their respective response roles in the event of a fire alarm and/or hotel evacuation. This must be a carefully orchestrated procedure in order to minimize risks to guests and staff alike. And keep in mind, as never fails, most hotel fire alarms do occur during the overnight shift when no one is expecting them and there are the least number of staff to respond.

Review your hotel’s Emergency Response Plan, and make sure it has been updated. Ensure all personnel actually read and understand the emergency plan on a regular basis. A yearly fire drill with evacuation is recommended.

Post-script

The actual fire was a small grease fire that occurred on a stove in the restaurant’s kitchen. The kitchen was on the 5th floor of the hotel. While the hotel probably did not need to be evacuated at all, there was a large amount of smoke, so I’m sure the limited hotel staff on duty decided to be safe than sorry.

(Todd Seiders is director of risk management for Petra Risk Solutions, which provides a full-range of risk management and insurance services for hospitality owners and operators. Their website is: www.petrarisksolutions.com. Todd can be reached at 800-466-8951 or via e-mail at: todds@petrarisksolutions.com.)

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Filed under Insurance, Liability, Training

Hospitality Industry Risk: Many Hotel Spa’s Are Underinsured With Spa Owners Liable For Injuries To Clients

(From a SmartMoney.com article)  With the growth of the spa industry, consistent standards have become an afterthought. Industry associations do exist, but membership is strictly voluntary. The biggest one, ISPA, represents about 3,200 spas worldwide, but its application process isn’t exactly grueling. Members must agree to abide by the association’s “standards and practices,” which include requirements such as clean treatment rooms and staffers trained in CPR.

They also have to adhere to a code of conduct, which is a list of spa-goers’ rights and responsibilities, says ISPA’s executive director, Lynne Walker McNees. But in the end, spa industry regulations vary from state to state, so there’s no uniform set of guidelines.

As a result, many spas carry inadequate insurance, says Mary Lynne Blaesser, a certified insurance counselor at the Marine Agency, which has provided coverage for about 15,000 spas. “In most states, the only insurance spas are required to carry by law is workers’ comp,” Blaesser says.Without professional or general liability in effect, an injured customer would have to seek recourse or reimbursement directly from the spa owner rather than an insurance company. However, most leases require that lessees carry general liability coverage for such things as trip and fall claims.

The combination of spotty insurance and almost nonexistent refund policies means one thing for dissatisfied customers: Good luck collecting if something goes wrong. And that applies even for the most egregious mishaps. Leandros Vrionedes, a personal-injury lawyer in New York City, had a client whose day-spa facial turned into a horror show. “The esthetician oversteamed the client and applied the wax immediately after,” Vrionedes says. “She wound up taking part of this person’s face off — several layers of skin were removed. The spa argued that it was the fault of the product and we didn’t have a case. We argued that it was the procedure.” After five years of legal wrangling, including trial to verdict and an appeal, the woman received an undisclosed settlement — which her lawyer describes as “not enough.”

Even when a spa does carry insurance, consumers may have a tough time obtaining compensation for injury.

“Some insurance companies will fight you tooth and nail,” Vrionedes says. Don’t assume, though, that you have no case just because of some lengthy waiver you signed when you arrived at the facility. According to Vrionedes, some of these documents will hold up in court, but others won’t — especially those that are all-encompassing. If the release “absolves the spa of absolutely everything in the world,” he says, courts will sometimes void the agreement.

http://www.smartmoney.com/spending/deals/10-things-your-spa-wont-tell-you-10378/?page=3

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“Workplace Accident Prevention” Needs To Be A Higher Priority In Hospitality Industry As Surveys Show Most Worker’s Compensation Carrier Decisions Based On Pricing

Survey results... found that price drives the choice of workers' compensation carrier for 3 out of 4 (71%) restaurant owners and other decision-makers.

(From a Hotelnewsresource.com article)  Workplace accident prevention apparently remains a persistent problem as nearly half (44%) of restaurant owners and managers reported at least one costly workers’ compensation claim in the past five years-and 10% percent reported five or more claims within the same period.

Despite this accident reporting, a majority (61%) of survey respondents who changed carriers at their last renewal reported switching because of price. Workers’ compensation insurance carriers track policyholders’ loss experience to help determine premiums, as accident frequency can directly affect restaurants’ insurance premium pricing. Service-driven workers’ compensation insurance carriers like EMPLOYERS focus on the potentially significant savings that could be realized through effective use of workplace safety and accident prevention efforts.

http://www.hotelnewsresource.com/article34605Restaurant

_Survey_Finds_Focus_on_Workers__Comp_Price_Trumps_Accident_Prevention_Savings.html

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Workers’ Compensation Claims Must Be Reported And Processed Quickly And Efficiently To Keep Insurance Costs Down

Reporting claims in a timely manner not only is cost-effective, but creating an encouraging reporting culture can also promote a successful claims management program.

It is illegal to conceal or fail to submit a workers’ compensation claim.

Workplace accidents happen due to unsafe conditions, inadequate training and ignoring near-misses. Although accidents can’t be eliminated entirely, injury prevention is an essential component of efficiency and profitability. The goal is to reduce both the frequency and severity of claims. A culture in which employees are encouraged to speak out about safety concerns without fear of reprisal is imperative in averting claims. When a claim does occur, a culture invested in identifying and addressing the root cause will benefit the company. The key to a successful culture change in workers’ compensation reporting is a shift in thinking and behavior that is consistently reinforced by management until expectations are realized.

In a January 2009 article in Proofs Magazine, William Penney says that 69 percent of injuries may never make it into the BLS Survey of Occupational Injuries and Illnesses. The most probable driving force in underreporting workers’ compensation claims is that employers pay the total cost of medical care versus health insurance which involves co-pays. Other factors include a lack of understanding of reporting requirements, economic and/or peer pressure, safety/bonus incentives, an attempt to maintain or gain government contracts or an avoidance of OSHA inspections. When an employee submits a claim under their personal health insurance, the claim does not affect a company’s experience modification factor or workers’ compensation premium.

 

It is illegal to conceal or fail to submit a workers’ compensation claim. Although it may appear that underreporting workers’ compensation claims is cost effective, studies have shown that this practice often increases costs. Unreported and untreated soft tissue injuries, especially back injuries, may become more severe over time and eventually require more medical care and possibly surgery. The National Council on Compensation Insurance (NCCI) reports that injuries reported within two weeks are 18% more costly than those reported within the first week and injuries reported in the fourth and fifth weeks are 45% more costly. Additionally, claims that are reported late are more likely to be litigated. The NCCI finds that injuries reported within 10 days are 22% more likely to be litigated whereas claims reported 31 days after the loss are 47% more likely to be litigated.

 http://www.rjfagencies.com/claims-culture-fall09.html?utm_campaign=FallNewsletter09&utm_medium=email&utm_source=link3

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Filed under Insurance, Liability