Lets start with the good news. Most employers are sitting on enough information to solve nearly all of their comp problems. The bad news is that information is notoriously lazy. Unless the employer takes the trouble to locate it, process it and forward it, the information will stay silent and indifferent to the employer’s rising comp costs.
Information That Turned Into Results
Two years ago a workers comp decision came down in New York. The case was no different from tens of thousands of others, in New York and nationally, which appear every year but with one difference – someone did something to find information and turn it into results.
The facts of the case are so common that normally they attract little attention. The worker had a back claim. Did the worker have any prior back problems? “No”, he said. No problems, no treatment, no lost time. All of which was false.
The carrier produced evidence of the prior back problem, treatment and lost time. Confronted, the worker explained that he simply didn’t recall all that. But he lost the claim and all benefits for concealment, even though his latest claim might have been otherwise genuine.
What does this have to do with employers? Aren’t the carriers responsible for investigations? Well….yes. Sort of. But a little help from the employer changes everything.
The employer usually has dozens of people who know the fabricating worker and speak to him/her daily. The employer also has, usually, a fairly thick file with hundreds of pieces of information of use. Let’s just consider one piece of information and how it can be used – a list of the prior employers on the original job application.
In the NY case there is no indication of how the carrier learned of prior back problems. It could have come from a co-worker, a set of charges from a group medical plan, or………..a prior employer.
Worst Workers Compensation Problems Are Caused By Worst Employees
Chances are that your worst comp problems will be caused by your worst employees. Bad work attitudes are the best predictor are bad claims. And bad attitudes are an en-grained feature which was present with all prior employers.
Your correspondent was once head of the legal team for a special investigations unit. It became normal procedure to locate and call prior employers for routine information. If the employer started to laugh when they heard the former employee’s name – bingo! They would inevitably relate tales of prior dubious disability problems.
If you carefully read the employer’s first report of injury you will notice that there is no request for a list of prior employers and no request for evidence of fraud. But that doesn’t mean that the employer can’t demonstrate some proactivity. An employer should let a carrier know that it can, and will, if asked, provide information which seems to contradict the size or credibility of a claim. And there is nothing wrong with suggesting that a list of prior employers might be of use.
All that information will be of no use unless it is introduced to the right people.
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. [email protected]
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