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Suspicious of claimed injury? Examine records carefully for prior problems

by on
in Employee Benefits Program,Human Resources

Too often, employees who suffer a minor accident at work milk that injury for extended workers’ compensation benefits.

That’s why it’s important to diligently pursue suspected false claims with your insurance carrier. That may involve alerting it to your suspicions and reviewing the employee’s medical records to see if what he or she is complaining about is really a preexisting condition and not the result of a more recent injury.

Recent case: Wendy Jenkins fell in her employer’s parking lot and hit her head on the pavement. She went to a doctor, who originally said she could return to work in a week. She didn’t and instead continued to visit various doctors, complaining of the pain. She also applied for temporary disability payments under the workers’ compensation system.

After months of payments, her employer appealed. It had noticed that most of her medical reports made reference to back pain rather than neck and head pain. The Court of Appeals of Ohio reviewed the evidence and sent the case back to the workers’ comp hearing officer. Jenkins will have to prove that her pain is related to the fall, and not preexisting back problems. (State of Ohio ex rel. Halleen Chevrolet v. Jenkins and Industrial Commission of Ohio, No. 06AP-1002, Court of Appeals of Ohio, Tenth Appellate Division, 2007) 

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