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Hard to believe but the year of our Lord 2012 is almost over. This week is Thanksgiving and before one is able to get a handle on that- Christmas is upon us. Yes, I said Christmas, as opposed to “the holidays”, where vendors all around are at the ready to shower claims personnel with gifts and they have a custom of taking claim adjusters to lunch as a means of appreciation, schmoozing, and by which they get to know the adjuster and establish a true client relationship.

In return an adjuster gets a great networking opportunity. In the dark days before the turn of the century, around the mid 90’s, a claims adjuster could accept gifts from an outside vendor without much interference from anyone. I remember those days as if they happened yesterday, that’s the spectacular thing about time and memory and that DNA that forms in what we call history.

Nowadays, in California, we are teeming with reform up the ying yang in workers' compensation claims handling. In fact, on every file that the insurer, the employer and the attorneys for each party service, we are forced to sign a Labor Code Section 4906(g) statement in which we acknowledge that it is a felony for anyone to give anything of value in exchange for anything that the claims adjuster might have to give and vice versa. In a great number of instances, the claims adjuster can’t tell what is legitimate and what isn’t. For example, who hasn’t been gifted a pen or a writing pad by an employer, vendor, or outside company? Can this be construed as something of value under the rules? Do the same rules apply to food or alcohol?

Here are some things that you should be aware of. Accepting an invitation to any meal or reception hosted by someone who is not your employer – and is in the same work comp claims business as you- is considered a gift under the rules. You can’t accept a meal. Refreshment-appetizers are okay but if a meal is served it’s a no – go. There is a common misconception out there that if the value of the food is $20 or less, then you can accept the invitation. I myself wouldn’t risk it. If alcohol is present you should automatically assume the value is higher than $20. If you are that kind of risk taker (and you shouldn’t be as the nature and title of our job is to mitigate risk) you should stick to just one drink. This would ensure you are under $20 and it also helps ensure that you behave! Others mistakenly believe that if a fork isn’t utilized to eat the condiments, then the food must have a value of less than $20. Unfortunately, utensils have no bearing on the value of the food. I’ve seen folks using toothpicks to eat expensive shrimp. Some people promise that they’ll attend an event but that they won’t eat. Good luck with that one. I hope your employer believes you.

The one exception to the rule is an invitation extended based on friendship. How do you define a friend? There should be an independent relationship with the friend outside the office. Also, it helps if the friendship predates your employment with the insurer. A good rule of thumb is to ask yourself the following question, If I were

Don’t get a reputation as someone who is always hanging around with outside vendors simply for a free lunch or the gratuities.

not a claims examiner, would this friend offer to pay for my lunch or the ticket to the ball game?” A common pitfall occurs when the friend pulls out a business credit card to pay for the lunch. This makes you a friend of the company he represents and would be considered a gift from his company, which is a prohibited source, under the rules.

Some people try to test the limits. They always will. I don’t recommend it. There is nothing to be gained by it but the loss of your employment. Since claims requires a certain amount of relationship building as part of the work, going to vendor lunches shouldn’t be outright prohibited but anybody going should ensure that nothing they say or do would give the appearance of a bias. Don’t get a reputation as someone who is always hanging around with outside vendors simply for a free lunch or the gratuities. It’s bad enough that as a claims adjuster you have a target on your back to begin with. You don’t need to move closer so the opposing side, an injured worker, or your own employer can get a better shot. Remember, as famed economist, Milton Friedman wrote, “There is no such thing as a free lunch.” There’s always a string attached. Always.

Jorge Alexandría is a U.S. Army veteran who received his B.A. in Political Science from Cal State Los Angeles, and graduated from Cal Poly Pomona with a Master’s in Public Administration. He holds both a California Workers Compensation Claims Professional (WCCP) designation and the State of California’s Self-Insured Administrator’s License. With more than 20 years industry experience, including various leadership positions, he is a leading expert in the field of risk management. He currently practices federal workers’ compensation of maritime interest. He can be reached at Riskletter@mail.com. The views and knowledge expressed in this article are Jorge Alexandría’s alone.