Controlling worker’s compensation claims

As an attorney representing employers in worker’s compensation cases and in my prior position as a Worker’s Compensation Magistrate, I have heard many employers complain about the mysteries of our worker’s compensation system. While many of the complaints are valid, there are several things every employer, no matter how small, can do to take control of worker’s compensation claims. The key is to establish a process for handling claims.

The first step is for the employer to formulate a policy regarding claims. Every employee should be given a copy of the worker’s comp policy and be required to sign a form acknowledging receipt of the policy. This form should contain a statement advising the employee that a false claim for worker’s comp benefits is fraud and a criminal act.

All supervisory personnel should become well versed with the company’s policy. In addition, they should be informed of what is expected of them when they report an injury. Providing supervisors in advance with a list of questions that will be asked when reporting an injury will help them know what information is required.

Every company’s policy must contain a provision that all injuries, no matter how minor, must be reported as soon as possible. This not only enables the employer to provide prompt medical treatment, but is an excellent way to reduce the chances of a fraudulent claim. If this rule is consistently and uniformly enforced, a delay in the reporting of the alleged work-related injury will raise a substantial question as to its validity.

Another useful tool is what is sometimes referred to as an “accident pack.” This consists of an injury report form, a list of approved medical providers, a summary of the company’s worker’s compensation policy, and the name and phone number of a contact person. This can be beneficial both to the injured employee and his or her supervisor.

Documentation of the circumstances of an injury, including witnesses’ statements, is essential and can be very beneficial in defending a litigated claim.

If an injured employee’s testimony at trial concerning how an injury occurred varies greatly from the documentation, his or her credibility will be questioned.

Under the Michigan Worker’s Compensation Disability Act, an employer has a right to direct the medical treatment of an injured employee for the first 10 days after injury.

It’s extremely important the employer exercise this right and have the employee treated by a physician that is well-versed in occupational medicine.

An employee’s own physician is generally sympathetic to the employee, and the employer may not have access to the physician’s medical records/reports. Directing and paying for treatment allows the employer to obtain copies of the physician’s records/reports.

A work-related injury should be immediately reported to the company’s worker’s compensation claim representative so that he/she can promptly investigate the claim and assist, if necessary, in properly reporting the injury to the Bureau of Worker’s Compensation in Lansing.

If a worker suffers a work-related injury and is restricted by a physician regarding his or her work duties, providing favored work that accommodates those restrictions can be very cost-effective for the employer and beneficial to the employee.

Studies have consistently shown that if an employee is off work for more than six months it becomes very difficult to get the employee back to work.

The following checklist can be utilized to ascertain whether a worker’s compensation claim is fraudulent.

The checklist is not necessarily definitive in this regard. However, the more items on the list that apply to a claim, the more likely it is that a claim is fraudulent.

1. Did the alleged injury occur on (a) Monday morning (b) late on a Friday afternoon, but was not reported until the following Monday (c) just after a holiday?

2. Did the alleged injury occur just prior to job termination, layoff or the end of seasonal work?

3. Was the alleged injury unwitnessed?

4. Was the alleged injury reported?

5. Did a considerable amount of time lapse between the time of the alleged injury and when the employee first sought treatment?

6. Are there different descriptions of how the injury occurred in the medical records, the employer’s first report regarding the alleged injury, or the witnesses’ statements?

7. Has the employee been treated by numerous physicians?

8. Has the employee received a release for work which is followed by the employee changing physicians?

An employer that adopts the above approach will undoubtedly have a better worker’s comp “experience” and can substantially reduce fraudulent claims and, therefore, worker’s compensation costs.

Robert Faulkner is president of Faulkner & Williams, PC, of Traverse City. He is a former Worker’s Compensation Magistrate and specializes in worker’s compensation defense litigation. BIZNEWS

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