Claimant Fined, Ordered to Pay Restitution to Texas Mutual
March 30, 2010 - Texas Mutual Insurance Company reported today that a Travis County district court sentenced Jason Whatley of Borger, Texas on workers’ compensation fraud-related charges. The court ordered Whatley to pay a $500 fine and repay $13,488 in benefits to Texas Mutual.
Whatley reported a job-related injury while working as a driver for Frontier Fluid Service Inc. of Canadian, Texas. He claimed he was unable to work as a result of the injury, and Texas Mutual began paying income benefits to him.
Meanwhile, Texas Mutual uncovered evidence that Whatley was working multiple jobs, including maintenance worker and oilfield pumper, while receiving income benefits.
Investigators call this type of scam double-dipping because the claimant collects benefits for being too injured to work when he or she is, in fact, gainfully employed. Texas law requires claimants to contact their workers’ comp carrier when they return to work. Left unchecked, double-dipping and other workers’ comp fraud can lead to higher premiums for all Texas employers.
Court Orders Claimant to Repay $21K to Texas Mutual
March 29, 2010 - Texas Mutual Insurance Company reported today that a Travis County district court sentenced Lashantae Reeves of Houston on workers’ compensation fraud-related charges. The court sentenced Reeves to one year of deferred adjudication and ordered her to repay $21,000 in benefits to Texas Mutual.
Reeves reported a job-related injury while working as a clerk for Harrison Personnel Services of Houston. She claimed she was unable to work as a result of the injury, and Texas Mutual began paying income benefits to her.
Meanwhile, Texas Mutual uncovered evidence that Reeves was working as a customer service representative for a Houston law firm and as a health education coordinator for a Houston health clinic while receiving income benefits.
Investigators call this type of scam double-dipping because the claimant collects benefits for being too injured to work when he or she is, in fact, gainfully employed. Texas law requires claimants to contact their workers’ comp carrier when they return to work. Left unchecked, double-dipping and other workers’ comp fraud can lead to higher premiums for all Texas employers.
Texas Mutual Announces New Purchasing Group For Agriculture Industry
March 24, 2010 - Texas Mutual Insurance Company announced its new workers’ compensation purchasing group today: AgriComp. Any licensed Texas agent can submit qualifying clients for consideration.
AgriComp is open to qualifying seed merchants, cotton farming gins, feed manufacturers, fertilizer manufacturers, grain elevators, hay dealers, grain dealers, feed dealers and other segments of the agriculture industry. Group members get:
- A discount on their workers’ compensation insurance
- An industry-specific workplace safety plan
- Potential workers’ compensation dividends
For more information about AgriComp, visit texasmutual.com/agents/pr_agricomp.shtm.
AgriComp purchasing group applicants must be members of the Lone Star Agribusiness Association. The association advocates on behalf of its members, provides educational and networking meetings and communications, and develops solutions for members’ immediate and future needs.
“Our industry contributes to the $80 billion enterprise we call Texas agriculture,” said Ben Boerner, president of Lone Star Agribusiness. “This program gives our members a cost-effective way to protect their employees, their businesses and, ultimately, their bottom line with workers’ comp insurance.”
In most cases, workers’ compensation insurance protects employers from lawsuits arising out of on-the-job accidents. It also provides medical and wage replacement benefits for injured workers, for life if necessary.
Occupational accident policies and other forms of alternate coverage leave employers vulnerable to lawsuits, and they often put a cap on injured workers’ benefits.
Manufacturing Group Earns $874K Texas Mutual Dividend
March 23, 2010 - Texas Mutual Insurance Company announced an $874,253 dividend to the Texas Association of Manufacturers (TAM) workers’ compensation purchasing group today. The dividend was based largely on the group’s loss ratio.
TAM has earned $1,411,633 in dividends during the past three years. By committing to workplace safety and helping injured workers return to productive employment, TAM purchasing group members improve their chances of qualifying for future dividends.*
In addition to potential dividends, TAM members get a discount on their workers’ compensation premium. They also have access to industry-specific safety materials, including pamphlets, videos, DVDs, streaming videos and a written safety plan. The materials cover basic manufacturing safety rules, machine guarding, forklift safety and other topics that address the hazards manufacturing employees face on the job.
Any licensed Texas agent can submit qualifying clients for membership in TAM. For more information, visit texasmutual.com/agents/pr_tam.shtm or tamworkerscomp.com.
*Past dividends are not a guarantee of future dividends. The Texas Department of Insurance must approve all dividends.
Texas Mutual Victorious
on Appeal of Sanctions Imposed by Lower Court
March 17, 2010 - The Texas Fifth District Court of Appeals (Dallas) issued an opinion on March 16, 2010, ruling that sanctions imposed against Texas Mutual Insurance Company related to a workers’ compensation case were improper. The court reversed the sanctions judgment against Texas Mutual.
The Court of Appeals found that the trial court abused its discretion in awarding sanctions against Texas Mutual. The court found no evidence of fraudulence or document falsification and no evidence that Texas Mutual acted in bad faith, thus providing a full exoneration of Texas Mutual's conduct.
The court also held that summary judgment in Juan Narvaez’s favor required reversal and remand to the lower court.
In 2008, the trial court granted a summary judgment and sanctions against Texas Mutual in a case involving Narvaez’s workers’ compensation claim for what he said was an on-the-job injury. Texas Mutual had disputed the claim based on co-worker testimony that Mr. Narvaez was not hurt on the job. Narvaez appealed that denial in a case that was eventually tried in the 68th Judicial District Court in Dallas County.
“We are delighted, but not surprised, that the Court of Appeals recognized Texas Mutual’s good faith and overturned the district’s court judgment against our company,” Mary Barrow Nichols, general counsel and senior vice president for Texas Mutual, said. “We were confident that we handled this case appropriately and that the appellate court would fully vindicate the company, as it has done.”
- The full ruling by the Texas Fifth District Court of Appeals can be found at www.texasmutual.com.
Texas Mutual Announces Fraud Indictment
February 23, 2010 - Texas Mutual Insurance Company reported today that a Travis County grand jury indicted an Irving man on workers’ compensation fraud-related charges. Ronaldo Martins allegedly obtained $22,283 in workers’ compensation benefits he was not entitled to.
Martins reported a job-related injury while working as a driver for Texas Plywood and Lumber Company in Grand Prairie. He claimed he was unable to work as a result of the injury, and Texas Mutual began paying income benefits to him.
Meanwhile, Texas Mutual uncovered evidence that Martins worked for another company while receiving income benefits.
Investigators call this type of scam double-dipping because the claimant collects benefits for being too injured to work when he or she is, in fact, gainfully employed. Texas law requires claimants to contact their workers’ comp carrier when they return to work. Left unchecked, double-dipping and other workers’ comp fraud can lead to higher premiums for all Texas employers.
Note: A grand jury indictment is a formal accusation – not a conviction – of criminal conduct.
Texas Mutual Earns National Wellness Award
February 22, 2010 - Texas Mutual Insurance Company has earned recognition from UnitedHealthcare for its commitment to employee health and wellness. Ten other companies around the country earned the award.
“This award highlights the importance of a healthy workplace, and we are proud to receive this recognition from UnitedHealthcare,” said Texas Mutual Chief Operating Officer Lisa Corless. “Creating a culture of health and wellness is a priority for Texas Mutual and our 780 employees.”
Award criteria included executive support for the health program, the presence of wellness champions and innovation in wellness program design.
Texas Mutual’s employee wellness program includes online health improvement tools, health risk assessments, wellness coaching, fitness centers at each of its five locations, onsite flu shots, yoga classes, a walking program, Weight Watchers at Work and wellness incentives.
Ed Coates, senior manager of employee services at Texas Mutual, said the program’s goal is similar to that of the safety and loss prevention services the company offers its policyholders: help identify risks, and provide resources to reduce or eliminate those risks.
Coates added that the program has seen positive results, which have contributed to below-market increases in the company’s health plan expenses the past few years. Results of the program indicate:
- The number of employees scoring in the poor and fair overall health categories decreased by 4.7 percentage points. At the same time, employees scoring in the good and excellent health categories increased by about 4.6 percentage points.
- As overall employee health improved, sick leave usage significantly decreased, and in turn, productivity improved.
- Nearly 80 percent of participants responding to the health risk assessment believed that the wellness resources and opportunities provided by the company helped them develop and practice a healthier lifestyle.
“The most recent statistics indicate that our employees are improving their overall health,” said Coates. “Employees have access to valuable wellness resources, and they are motivated to make long-term lifestyle and behavioral changes. They are reducing their risk for cancer, heart disease and diabetes. They are improving their exercise and nutrition habits, and they are lowering their risk of experiencing serious health complications later in life. Ultimately, we see the payoff in terms of a healthy, productive workforce.”
Court Orders Claimant to Serve Jail Time, Repay Benefits to Texas Mutual
February 8, 2010 - A Travis County district court sentenced a Laredo man on workers’ compensation fraud-related charges. The court ordered Jose Perez to serve 60 days in jail and repay $7,388 in benefits to Texas Mutual Insurance Company.
Perez reported a job-related injury while working in the shipping and receiving department of a Brumley Professional Employer Services client company. Perez claimed he was unable to work as a result of the injury, and Texas Mutual began paying income benefits to him.
Meanwhile, Texas Mutual uncovered evidence that Perez was working at a distribution center in Laredo.
Investigators call this type of scam double-dipping, because the claimant collects benefits for being too injured to work when he or she is, in fact, gainfully employed. Texas law requires claimants to contact their workers’ comp carrier when they return to work. Left unchecked, double-dipping and other workers’ comp fraud can lead to higher premiums for all Texas employers.
Court Orders Claimant to Repay $11K in Benefits to Texas Mutual
February 5, 2010 - A Travis County district court has sentenced a Baytown woman on workers’ compensation fraud-related charges. The court ordered Pamela McCoy to repay $11,340 in benefits to Texas Mutual Insurance Company and serve five years’ probation.
McCoy reported a job-related injury while working as a warehouse supervisor for Sheff-Man LP of Cypress. She claimed she was unable to work as a result of the injury, and Texas Mutual began paying income benefits to her.
Meanwhile, Texas Mutual investigators uncovered evidence that McCoy was working for a chemical company in Houston, where she reported two additional job-related injuries and was again placed in off-work status.
Investigators call this type of scam double-dipping, because the claimant collects benefits for being too injured to work when he or she is, in fact, gainfully employed. Texas law requires claimants to contact their workers’ comp carrier when they return to work. Left unchecked, double-dipping and other workers’ comp fraud can lead to higher premiums for all Texas employers.
Texas Mutual Awards $300K in Safety Education Grants
February 4, 2010 - Texas Mutual Insurance Company has awarded a combined $300,000 in grants to Kilgore College, Midland College and College of the Mainland in Texas City. The grants will fund free workplace safety courses for employers, employees and the general public.
Texas Mutual has awarded more than $1 million in safety education grants since 1999.
“Texas Mutual has been very generous, and the benefit to Midland and surrounding communities is tremendous,” said Midland College President Steve Thomas, Ph.D. “Each person who has participated in the program made possible by this partnership between Texas Mutual and Midland College has used the free classes to learn how to make their workplaces safer.”
In addition to the safety grants, Texas Mutual hosts free workers’ compensation workshops across the state. The workshops include a presentation by a Texas Mutual safety professional.
The grants and workshops are part of the company’s ongoing commitment to preventing workplace accidents.
“On-the-job injuries carry monetary and, more importantly, human costs,” said Ron Wright, Texas Mutual Insurance Company president. “As the state’s leading provider of workers’ compensation insurance, we take seriously our responsibility to promote safe workplaces. Anytime we have the opportunity to help prevent accidents in the workplace through training and education, we consider it a sound investment.”
For more information about the workshops and safety courses, click here.
Texas Mutual Encourages Public to Follow Flu Prevention Tips
January 6, 2010 - Flu season peaks in January and February. For adults, the workplace is the most common place to catch the flu.
Texas Mutual Insurance Company, the state’s leading provider of workers’ compensation insurance, encourages the public to follow these tips to reduce their chances of getting sick:
- Get a flu shot. This is the best way to reduce your chances of getting sick, but talk to your doctor before you get a shot. Some employers offer flu shots. If yours does not, visit the Texas Department of State Health Services at www.dshs.state.tx.us/immunize/flu.shtm or the Centers for Disease Control and Prevention at www.flu.gov/individualfamily/vaccination/locator.html. Remember that seasonal flu shots do not protect you from the H1N1 flu strain.
- Clean your hands often. Wash your hands frequently, for at least 20 seconds, with soap and water or alcohol-based hand cleaners. Keep hand sanitizer at your desk.
- Disinfect your work area. Scrub your telephone, desk and keyboard with a common household cleaner.
- Keep your distance. Keep your distance from sick people by holding more teleconferences or virtual meetings. If you have to be in the same room with a sick co-worker, try to stay at least six feet away.
- Listen to your body. Fever, coughing, sore throat, runny or stuffy nose, headaches, body aches, chills and fatigue are common symptoms of seasonal flu. People who have the H1N1 flu strain might also experience diarrhea and vomiting. If you feel like you are getting sick, call a doctor immediately. Refer to your company’s policy to decide whether you should stay home.
CAA Names Texas Mutual Top Partner
January 4, 2010 - Texas Mutual Insurance Company, the state’s leading provider of workers’ compensation insurance, has been named a Top Four Company Partner by the Combined Agents of America (CAA).
CAA gave the award to the four companies it placed the most written premiums with in 2009.
“Texas Mutual’s professional attention to detail incites our 44 member agencies to place such a large amount of our business with this rock-solid company,” said Michael Schneider, CPCU, CAA chairman of the Texas Mutual liaison committee, and president of Cravens-Warren & Company in Houston. “They handle accounts from beginning to end, going beyond the underwriting to providing excellent loss control and claim services.
“CAA works with over 100 companies across the country, and we are thrilled that Texas Mutual earned its way to become one of our top four company partners in 2009. We look forward to a winning year for all of us in 2010.”
Steve Math, senior vice president of underwriting at Texas Mutual, expects the partnership to grow as Texas Mutual continues to adapt to meet policyholders’ and agents’ needs.
“CAA member agencies count on Texas Mutual for a cost-effective, stable source of workers’ compensation coverage,” said Math. “Our financial strength ensures we will be here to fill that role through all market conditions.”