A witnessed, sudden, accident presents far fewer problems than a claim without a witness. Yet, many un-witnessed claims are quite real, stemming from long term degenerative conditions. Many of these claims are filed and flagged as highly suspicious.
Employers Often Become Suspicious Long Before Claim Filing
There is little a carrier can do to investigate something that has not been alleged, much less filed – but there is much that an employer can lawfully do well before an injury is reported. When investigating or defending claims, the carrier, investigator and/or lawyer is often told by the employer of suspicions they had, even well before a claim is made, that something was about to happen. But what did the employer hear or see, what did they do?
Frequently, the employer hears more than they see. Complaints, requests for lighter work, erratic attendance, and distancing from co-workers should be noted as red flags. Nothing in and of itself that can or should be reported to a carrier – yet – but these are causes for concern.
Schedule Medical Exam at First Sign of Red Flag
When the employer becomes aware of one or more of these signs, they should have a few measures to deal with the potential disability before it transforms into actual lost time. The best measure is for the employer to be able to schedule a medical exam.
An employer can schedule some exams when certain federal laws apply. Drivers, in particular, often must be sent for an exam under DOT regulations, even though the worker has only expressed vague complaints or seeks lighter work. A report of a chronic condition may be cause for an exam under OSHA to determine if any work exposure is responsible.
Even if no federal laws apply, the employer may offer, but not insist on, an exam.
Slight Procedural Changes Can Greatly Reduce Claim Filing
A non-hostile neutral approach will result in more vital pre-claim information, which will translate into greatly reduced claim filings or greatly reduced claim costs. Honest employees appreciate the concern and slight modifications can remove most of the motivations to file a claim.
Those wishing to plan an exaggerated claim will discover that their greatest advantage – silence – is now missing.
Claim defense in a vacuum is not an option for employers.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. medsearch7@optonline.net
Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.
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