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Tuesday, May 17, 2011

Sitcom on Worker Compensation Insurance related claims.

The penetration in Indian market is low and there are many forms which have not been sold to many.  When the spread is not there,  the business results are affected – spreading the risks of a few to many is the very basic of insurance.

The liability of the Employer towards employees especially in respect of accidents occurring in workplace has been codified for long and in India we have the Workmen’s compensation Act 1923 which has been amended from time to time.  The recent amendments have removed the gender bias and is now Employees Compensation Act which has brought within its purview the clerical employees and casual employees also. 

In US as also in many other countries, there is insurance providing wage reimbursement and medical benefits for employees who are injured in the course of employment.  This is known as Workers' compensation.  By seeking a claim under this, the employee mandatorily relinquishes the right to sue the employer under tort of negligence.  There exists many plans which plans differ between jurisdictions, provision  for weekly payments in place of wages, compensation for economic loss, reimbursement or payment of medical and like expenses.  Unlike a tort claim, general damages for pain and suffering, and punitive damages for employer negligence generally are not available in this form. 

This a very popular form of insurance and there have been many varied claims also.   Whilst there are not many who readily share their experience in Insurance,  here is something on how somebody is trying to cash their rich experience in handling worker claims.  Being insured on the job is no laughing matter, but some of the statements made to get a claim have been outrageous.  ‘stationary car suddenly coming in one’s way and causing accident’ would tickle one.

There reportedly is a new TV show made on the premise of how a very busy business lady has controls with the reins of the business, but is overtaxed by all of her other commitments. She has a daughter within the workplace that could help out more, but the mother refuses to give up control.   There is also the role of manipulative adjuster, a non professional acting defense lawyer and a person described as a loaf who is the victim of an at work accident – those experiences are sure to provide a sitcom (situation comedy) – a genre that features recurring characters in an environment which can be easily visualised such as the workplace that we commonly come across.

Workers’ Comp, reportedly is  a half-hour TV comedy about crazy employees handling absurd and often-fraudulent insurance claims from injured workers, is being filmed in Florida.   The independently-produced show centers on the family-owned Pinnacle Workers’ Compensation Insurance Co., which is modeled after a real professional employer organization (PEO) named NELCO, and one of its owners, Dori Sperko.  Sperko is being played by actress Morgan Fairchild.    This company has provided claims services after issues with their TPAs on high deductible plans for off-shore clients.

Claims are real and are occasioned by real accidents but many a times they could be manipulated, exaggerated or extrapolated to gain benefit when they did not exist. The managing of the claims had provided experiences of ridiculous descriptions and potent fradulent claims and imposters trying to make wrongful gains.  Some circles report that the show has excited hollywood. 

Quite often in Indian films, one would hear of people making wrong property claims and trying to turn rich.  In a couple of films, people would even try and put up a death claim, to get monetary compensation and those made hilarious comedy.  Besides fun, this exposition of experiences are sure to provide valuable knowledge to all those related with the Insurance industry.

Regards – S. Sampathkumar.

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