The workers’ compensation claims process is typically straightforward. Employees get hurt on the job. They report their injury. Their employer drafts an incident report and can even initiate the workers’ compensation claim on behalf of the employee in some cases. The worker may qualify for medical and disability benefits depending on the condition they acquired.
Unfortunately, workers’ compensation claims can be costly for employers. They can increase insurance coverage costs. Employers may have an interest in defending against large claims. Workers’ compensation is a no-fault system, which means that responsibility for the incident does not affect benefits eligibility. However, the medical condition or injury needs to be the result of employment. If an employer can prove that the worker sustained their injuries elsewhere, it may be possible to defend against the employee’s workers’ compensation claim.
How can businesses validate their claims that workers sustained their injuries elsewhere?
With testimony or video footage
Employees who do not have health insurance or who have coverage that imposes patient responsibility costs may want to use workers’ compensation instead. Unlike health insurance, which comes with co-pays, coinsurance and deductibles, workers’ compensation covers all necessary treatment expenses.
Other workers may have observed significant symptoms before a staged incident intended to explain the injured worker’s medical complaints. Surveillance cameras within the business may have captured the worker limping or demonstrating visible signs of their injury before they allegedly got hurt. Exploring what happened before the reported incident could help prove that the injury already existed at that time.
With a thorough medical examination
In some cases, it may be necessary to request an independent medical examination to validate claims about a worker’s injury. A neutral medical professional can conduct a lengthy evaluation to determine the severity of a worker’s symptoms and what may have caused their injury. In some cases, the reports generated by such examinations make it clear that the condition is not the result of employment but rather something that occurred outside of work.
Establishing that an injury did not originate on the job could be part of a broader claim defense strategy. Businesses aspiring to defend against questionable workers’ compensation claims often need assistance asserting their position, and that’s okay.