After obtaining all statements and completing the investigation, it was clear that suspect Carson had committed insurance fraud. On 6/3/08, the case was submitted to the Solano County District Attorney’s Office for prosecution.

On 9/23/08, Tamisha Carson was arrested and charged with 8 counts of insurance fraud:

¨ 4 counts of IC 1871.(a)(1)

¨ 4 counts of PC 500 (b)(1)

This is just one of many examples of a successful partnership between Intercare’s adjusters and SIU working cooperatively to maximize fraud detection and recovery for the client.  

Like everything else in our economy, except the stock market, California workers’ compensation rates are on the rise.  The WCIRB has recommended a 16% increase in rates due to rising medical costs related to workers’ compensation claims.  This increase is effective 1/1/09, and will have a significant impact on the employer community.  Many employers are aware of how the rise in rates may affect their bottom line, and are already looking for ways to increase their savings without sacrificing the quality or efficiency they expect in their claims handling programs.

  In this hardening market, employers are evaluating their needs and many are looking for alternative vehicles to manage their workers’ compensation risk.  Intercare’s strong industry presence can help employers explore alternatives to traditional, first dollar, workers’ compensation insurance.  Those options may include; stand alone self insured

Among the many changes that are occurring, including the rise in indemnity rates, a new permanent disability rating schedule, and the  WCAB’s transition to a paperless system, the most notable is the termination of Vocational Rehabilitation Benefits for injuries that are pre-1/1/04. 

Labor Code 139.5 closes the statute window for many injured workers to pursue their vocational rehabilitation benefits.  Though there is a gray area for those who are currently in a program with a signed plan, those who have not yet agreed upon a plan will not be able to reap the generous benefits of our legislative forefathers.  To prepare for battle against legislative intent,

defense attorneys and applicant attorneys are arming themselves with arguments for and against the repeal of Labor Code 139.5.  It is likely that applicant attorneys will try to argue that a “ghost statute” exists (Godinez v. Buffets Inc) while, defense attorneys will most likely raise the question of jurisdiction.

As of 1/1/09 the Rehab Unit will be deemed closed and obsolete. All future rehabilitation issues will be brought to the “Retraining and Return to Work Unit (RRTW).  It will be interesting to see how these changes further impact the landscape of Workers’ Compensation Rehabilitation.    

 

 

 

programs, captive insurance programs, or inclusion in industry specific self insurance groups (SIG’s). Intercare is experienced in providing claims administration and managed care services under all of these programs and maintains a reputation for excellence.

  Regardless of the risk management vehicle chosen, increased rates place greater emphasis on all aspects of claims handling, including: quality performance, flexible customer service, accurate risk data, effective medical management and strong communication between all parties involved in risk management.  These are the fundamental building blocks upon which Intercare has built its business and established its reputation as a premiere service provider.  With an insightful awareness of changes in the industry, and the tools with which to administer the best service at the best cost, Intercare will continue to serve employers as their needs change.

Points of Interest

¨ AMBITITION: Intercare introduces a New Director of Sales: Thomas Payne

 

¨ SRENGTH: Intercare renews key accounts.

 

¨ GROWTH: Sacramento Municipality Utility District and Esparza Enterprises join the Intercare Family of Clients.

Inside the Quarterly:

December 2008

Volume 1, Issue 1   k                                                   

Intercare HOLDINGS Insurance Services, Inc.

The Intercare Quarterly

Whether it is our fantastic customer service, our unparalleled audit results, or the genuine relationships between our clients and our adjusters, Intercare has left a significant impression upon our clients.  In 2008 we have had the sincere pleasure of renewing 96% of our service contracts, including flagship accounts like the County of Los Angeles (COLA) and the City and County of San Francisco (CCSF).  Intercare’s expert administration staff provides an assortment of services for each of the

accounts we have renewed, including: workers compensation claims administration, bill review and managed care services.  Intercare President, Michael Ramser, said “It is very rewarding to build a company on the foundation of providing the highest quality of service and to have our strategic client partners recognize our efforts and commit to a continued long term relationship. This is what Intercare is all about.”   

country in terms of customers served, and is headquartered in Sacramento, CA.  Intercare will be handling their workers’ compensation claims administration, bill review and managed care program.

These new partnerships  are evidence of Intercare’s   growth and stability in this shaky economy.  Intercare has worked hard to solidify a reputation for excellent customer service, utilization of state-of-the-art technology, and for providing the best care at the best cost. 

Intercare celebrates and welcomes the addition of two new partners, Esparza Enterprises and Sacramento Municipality and Utility District. 

Esparza Enterprises is a farm labor leasing company headquartered in Bakersfield, Ca.  Intercare will be handling their workers’ compensation claims administration, bill review and managed care program.

Sacramento Municipality and Utility District is the sixth largest publicly owned utility in the

Intercare truly delivers.”

Tom Payne brings almost 20 years of workers' compensation knowledge to Intercare including vocational rehabilitation, claims adjusting, risk management, and workers' compensation program management experience. 

Michael Ramser, President of Intercare added “Intercare has been one of the best kept secrets in the marketplace due to the fact that we have grown largely by word of mouth.

Intercare has been developing our sales team over the last year so that we can increase market awareness to fuel our future growth. Tom Payne is a great addition to our team and will help us build our company.”

Intercare is based in Roseville, California employing over 385 staff while generating revenues in excess of $33,000,000. Intercare has 9 offices in California and offices in Seattle, Chicago, Las Vegas and Houston. 

Intercare has announced the addition of Thomas Payne, as Director of Sales. Mr. Payne joins the Intercare team from Tristar Insurance Group, where he was responsible for new business development and client retention. Mr. Payne was quoted saying “ Intercare is a unique company in our market that is focused on delivering quality service and reducing our customer’s cost of risk.  Other companies talk about service and performance while

Thomas Payne

Director of Sales

tasks are handled efficiently to speed recovery and minimize financial exposure.  Intercare recently completed a routine client audit  and review, and the client had many positive things to say about our Nurse Case Management and Utilization Review staff; including praise for our “thorough notes, in depth reviews, and excellent push for return to work.”  The client further complimented our staff by saying our “case managers are top rate! Best of breed in the business!”  It is encouraging to have this positive feedback that reinforces our goal of providing the best care at the best cost. 

 

 

Intercare offers a broad range of services for our clients, including access to our Special Investigations Unit (SIU). 

Intercare’s SIU coordinates all claims investigations,  and reduces claims costs through increasing fraud detection and recovery.  Twenty five percent of all new claims have one or more red flags for potential fraud.  Intercare’s adjusters have been trained to recognize red flags and the proper procedure for forwarding the case to our SIU department.  

One of our SIU’s recent successes involved a woman named Tamisha Carson, who was employed as a drive-thru cashier for Taco Bell. 

On 4/24/08 Carson reported that a box of soda syrup fell on her left foot, causing her pain.  Her injury was not witnessed by her co-workers, however, she was unaware that there was a video camera positioned above her in the stockroom.  Upon review of the video for the alleged time period, it was clear that she actually placed the box of syrup carefully on her left foot and then called for help.  It was very clear that she “faked” the injury.  The Intercare adjuster immediately forwarded the case to our SIU for review, and an investigator was assigned to take interviews regarding the incident.  Carson lied about the facts of the injury. 

transfer of information.  Intercare and InterMed have been working together to provide fully integrated claims services since 1997.

 

 

 

 

 

 

 

This relationship has allowed Intercare and InterMed to work together towards a unified goal: to maximize client savings and provide quality patient

care.  Our mutual success is supported by so much

more than just “following the code”; Intercare adjusters and InterMed

 

 

 

 

 

 

 

managed care staff have worked together on countless claims, for multiple accounts and have

established thorough lines of communication and developed tested procedures to ensure all

Some may wonder what separates Intercare and InterMed from other TPAs and Managed Care Providers; and the difference is much bigger than you think!  Many entities chose to utilize separate TPA and managed care services, and this often results in higher costs due to inefficiencies between the TPA and the Managed Care Provider.  Independently, each TPA and Managed Care Provider may be very good at what they do, but when they come together, something is lost in the

experience, we are able to offer services in a variety of areas, including:

· Healthcare Professional Liability – Hospitals, Physician/Dentist Groups, Nursing Homes, Assisted Living Facilities.  Professional Liability services could include clinical risk management (consultation/education, risk assessments), claim/risk auditing, oversight services and mediation/trial attendance.

· Product Liability – Intercare has developed a team of experienced claim professionals and attorneys who have specific product knowledge and understand how to help our clients by focusing on their concerns about product integrity and the financial consequences of this type of claim.  Product Liability services can include mass tort litigation, product safety management (consultation/education, recall consultation, risk assessments), claim/risk auditing and oversight services.  We have handled claims from virtually every product segment with current specific involvement in power tools, chemicals, pharmaceuticals, food products, aerosol cans, heavy machinery, office furniture, and entertainment systems.

· General Liability – Services are offered for a number and variety of clients, including habitat ional, entertainment, fitness clubs, and public entities.

· Environmental Liability – Claims arising out of long term exposures including asbestos, silica, hearing loss, vibration, welding rods, and environmental contamination.  Our services have included full claims management as well as consulting services to help clients reconstruct coverage matrixes and develop a strategy for claim management.

· Employment Practices Liability – Services range from full claim management to attendance at mediations/trials.

· Consulting Services – Claim auditing and consulting services can include operational reviews, financial/reserve analysis, due diligence, and pre-quote/renewal assessments.  We can assist with best practice development and claim workflow analysis.

Whatever your needs are, Intercare is equipped with the experience and the tools to provide the services your company requires. 

In November of 2006, Intercare formed it’s Liability Claims Division which specializes in the handling of all lines of liability claims.  Services include nationwide claims management and adjusting services, direction and management of litigation, and claims and risk auditing.  Our clients include self-insureds, insurance companies, captives, and risk retention groups.

We believe a centralized claims management approach works best, delivering a single point of contact, consistent claim handling, and high levels of communications and client control.  We currently have centralized claim operations in Rosemont, IL and Bellevue, WA with a satellite office in Pleasant Hill, CA.  Claims are handled on a nation-wide basis from these locations where all of our claim handlers are licensed in all states that require licensing.  Services are provided in a boutique style where each program is built from the ground up to satisfy the specific needs of our clients.  Our seasoned claim handlers have an average of over 19 years experience in the industry and have worked together for over 12 years on average.

Because of our combined

3010 Lava Ridge Court, #200, Roseville, CA 95661     Phone: 1-800-771-5454     Fax: 916-677-2610     www.intercareins.com

Intercare HOLDINGS Insurance Services, Inc.

We're changing the way companies think about insurance...

Intercare’s SIU department evaluates more than the potential fraud of the injured worker.  Intercare maximizes fraud investigations by pursuing all possible fraud suspects, including physicians, vendors, employers, etc. The following account is an example of one of Intercare SIU’s recent triumphs over fraud:

On 12/03/08, Alejandro Silva, the owner of a Southern California restaurant, plead guilty to two counts of insurance fraud.   Silva will serve three years probation and pay $2,500 in restitution—his sentence of 180 days in jail will be stayed if Silva completes his formal probation. 

This arrest stemmed from an injury suffered by Jose Luiz Ventura-Lopez while working as a dishwasher in Silva’s San Diego-area restaurant on 04/22/01.  While washing dishes, Ventura cut his wrist.  He went to the local hospital for treatment.  Silva met Ventura at the hospital and told Ventura not to mention the accident happened at work and promised to

 

 

 

 

 

pay the medical bills.  However, when those bills became due, Silva did not pay the bills, and denied that

Ventura was even an employee.  Silva told the Intercare claims adjuster that all of his employees were family and he didn’t need workers’ compensation insurance, even though he was insured by HIH. 

The claim transferred to the California Insurance Guarantee Association after HIH was liquidated, Intercare currently adjusts HIH claims for CIGA. 

Ventura hired a lawyer and eventually his benefits were paid.  Intercare referred the case to the San Diego County District Attorney’s Office in 2006 and Silva was eventually arrested after failing to appear in court on several occasions.   

Formal sentencing is scheduled for 02/19/09.

 

REHAB UNIT CLOSED!