Georgia employers are increasingly concerned about rising workers’ compensation costs. Claims will be denied if employers are suspicious about their legitimacy. The following scenarios will give you some insight into what employers look for to avoid paying for questionable workers’ compensation claims. If an employee’s actions fit one of the categories below, an employer will typically view the employee’s behavior as a “red flag” for the possibility of fraudulent behavior.
- If an injury occurred late on a Friday afternoon, but was not reported until the following Monday, employers often think there is a possibility of fraudulent behavior. Many employers believe that injuries that take place on the weekend are masked until an appropriate time on Monday, when they can be reported as on-the-job accidents and covered under workers’ compensation.
- Accidents which “occur” just before or immediately after a strike, job termination, lay-off, end of the project or end of seasonal work are always scrutinized more closely. When a plant is about to close, this information travels quickly. Employers have the attitude that it is not surprising that “injuries” that people could work through before learning that they were about to lose their jobs become much more serious upon news of a reduction in force.
- Any accident that is not witnessed by other employees or any accident where there was a substantial delay in reporting will always be scrutinized closely.
- If an injured worker has an extensive history of previous claims, each additional claim will be investigated more closely by the employer and insurer. Georgia employers are extremely suspicious of individuals who they believe make a living filing workers’ compensation claims. Insurance carriers are able to request “Index Reports” which list a history of any workers’ compensation claims or personal injury claims that an individual may have made.
- If an injured worker gives a different description of the accident to his employer than he does to his doctors or if his medical history changes from office visit to office visit, this will be a red flag for the employer and their insurer. The claim will most likely be denied.
- If an injured worker receives a release to return to work from his or her authorized treating physician and immediately requests a change in treating physicians, many employers will believe there is a possibility that claimant is trying to “doctor shop” and may not really want to return to work.
TEN WAYS TO AVOID THESE PITFALLS IN YOUR WORKERS’ COMPENSATION CASE!
- Report all injuries to a supervisor or person in management with your employer as soon as possible after your accident occurs. Even if you think that you are going to recover fully from an injury, it is always best to report your injury immediately. Ask your employer to complete a written accident report and to provide you with a copy.
- If you are injured on a Friday and particularly if you are hurt before a holiday, it is essential that you inform your employer how the injury took place before you leave the work premises. Make sure your employer knows what parts of your body were injured. Ask your employer to send you for medical treatment immediately. Do not see a doctor under your personal health insurance. See a doctor whose bill will be paid by your employer’s workers’ compensation insurance carrier.
- If you are injured on the job and there are co-workers nearby, make sure that you let them know how you got injured and what parts of your body were affected in the accident.
- It is imperative that the report you give to your employer about how you were hurt and what parts of your body were hurt is the same as the report that you give to every doctor or hospital where you are treated. The employer and insurer will compare the reports to make sure that the history you give to each doctor is the same. If you go to the doctor and are not specific about where, when, and how you were injured, your claim may be denied.
- Keep track of dates on your calendar. That way, if necessary, you will be able to reconstruct who you spoke to about your injury, when you spoke to them and where and when you received medical treatment for your work related injury.
- When your employer offers to send you for medical treatment, make sure that the employer shows you the Panel of Doctors that they have posted. You have a right to choose one of the doctors from the Panel. Your employer does not have the right to send you to a specific facility of their choice.
- After your on-the-job accident, call a lawyer as soon as possible. Keep in mind, the earlier an attorney can give you advice, the smoother your claim will proceed. Your attorney should review the panel with you to make sure that you select a doctor who is best qualified to treat your injuries. Remember, once you have made mistakes with your medical treatment, these mistakes cannot always be undone.
- Do not give a recorded statement to an insurance company representative without speaking to an attorney first. An attorney will be able to tell you whether a statement is even necessary and will properly prepare you beforehand.
- Keep copies of the paperwork that you receive from every physician who treats you for your injury. Do not give your only copy to your employer. When you hire an attorney, it will be quite helpful if you can provide your attorney with the paperwork from your doctors. This will give her a good understanding of the chronology of the treatment that you have received.
- Never quit your job after you are injured. This will greatly reduce the value of your workers’ compensation case!