One of Axcet HR Solutions’ newest clients signed on with us to save money on health benefits. But one week after onboarding, the small business got a lot more than it bargained for – and Axcet came to the rescue.
When the Independence, Missouri-based hospitality services firm first considered a professional employer organization (PEO), the vice president and operations manager had recently suffered an injury that required surgery and rehabilitation. His physical therapist recommended Axcet as a way to cut health care costs. Neither of them knew then how quickly the decision to partner with Axcet would pay off.
One week into the contract, the client reported a work-related injury to Axcet’s Risk Management Department. A driver for the company reported he sustained a head injury while making deliveries on his route late in the day on a Friday. The driver was treated in the emergency room. After having all the pertinent diagnostic tests, he was diagnosed with a possible concussion and instructed to follow up with a concussion specialist the following Tuesday.
When the employee reported to the concussion specialist, he complained of headaches, blurry vision and loss of balance, all typical symptoms of post-concussion syndrome. Based on these complaints, the employee was taken off work and instructed to follow up with the specialist until his symptoms improved to the point he could safely return to work. So far, this seemed like a pretty typical workers’ compensation claim.
After two weeks of medical treatment with the specialist, the employee had improved enough that the doctor thought he could be released from treatment and return to work after his next appointment. However, when the employee reported for what everyone thought would be his last doctor visit, he complained of an increase in headaches, blurry vision and balance issues. He claimed he couldn’t do much of anything, given the severity of his symptoms. Shortly after this appointment, he also hired an attorney.
The doctor continued the off-duty work status and medical treatment. By this time, the employee had been off work for an extended period and had been drawing lost-time wages from the workers’ compensation insurance carrier since the initial injury date.
For an astute claims manager, a sudden change in medical condition and hiring an attorney are red flags. What appeared to be a conventional workers’ compensation claim was turning into a complex claim. Accordingly, Axcet began digging a little deeper into the situation to see if other factors were driving the increased symptoms and continued off-duty status.
Axcet’s investigation soon led to the discovery of this employee’s second career as an aspiring DJ. Axcet found multiple video clips posted to various social media platforms that showed the employee actively working as a DJ at nightclubs and private parties – all while complaining of symptoms that prevented him from returning to his day job. We even discovered a “live stream” video of the employee driving the company vehicle, a clear violation of the company’s safety practices and social media policy.
These new facts led to many questions from the client: “Can we terminate the employee?” “How do we stop the medical treatment?” “How do we stop the lost-time wages we’re paying the employee?”
Armed with the video evidence, Axcet’s attorney deposed the employee under oath to get a better idea of what problems he claimed from the alleged accident. The employee continued to lie about his medical condition and ability to return to work. However, once the video evidence was presented to his attorney, the workers’ compensation claim was resolved for a fraction of what it would have cost, and the client was able to terminate the employee without having the financial exposure of a retaliation/ discrimination lawsuit.
Not surprisingly, the client is extremely satisfied and grateful to have Axcet as a partner. Before Axcet, the firm’s only human resources outsourcing experience was with a payroll company. Now, with a PEO on board, the client is pleased to have access to previously unavailable resources.
The vice president and operations manager said, “We take care of anyone who’s legitimately hurt on the job, but there were red flags with this situation. Luckily, Axcet was in our corner and was able to weed out a bad employee. They proved the claim was fictitious while helping us send a strong message to other employees about being honest and how seriously we take every claim.
“We obviously would recommend Axcet to any company looking for additional HR resources. They are experts and saved us a lot time, energy and money. We went in looking at health benefits savings, but now realize they bring so much more to the table. We definitely made the right decision when we engaged Axcet and could not be happier.”
For professional claims management under your workers' compensation policy, turn to Axcet HR Solutions.
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