Workers Comp Claim: Is it Fraud or Malingering?
Posted by Debbi Kuhne on Mon, Jul 26, 2010 @ 03:35 PM
If I’ve heard it once I’ve heard it a hundred times --- “he wasn’t hurt that bad – he should be back at work” or “he must not really have been hurt at work”! Many employers feel a substantial number of claims are fraudulent, but statistics show that this isn’t the case. The problem is malingering after the injury occurs; it is much more prevalent, but also can be controlled.
Malingering can occur for many reasons. First and foremost is that if the treating physician or Occupational Health Clinic doesn’t have a copy of the construction workers’ job description, then they can only go by what the injured worker tells them. The injured worker can embellish their job as much as they want because there is nothing concrete to back it up. So, one way to combat malingering is to have job descriptions that you can easily provide to the Dr. or other medical provider. Another issue is that not all providers understand the importance of returning someone to work, to their regular routine, so it’s beneficial for you to have an established relationship with a local Occupational Health clinic that understands the work your construction firm does and understands you want your injured workers back on the jobsite as soon as possible!
But there are reasons that the injured worker may be malingering that have nothing to do with the injury itself. Is it possible that the injured worker was having issues with a co-worker, construction foreman, supervisor, or another subcontractor prior to the incident, and is now looking for ways to avoid returning to work?
If you suspect there is a reason the injured worker is malingering, you should be telling the claim adjuster! The adjusters at the insurance carrier do have to work within the confines of the State statutes, but they are experienced enough to know a “malingerer” when they see one and appreciate any insight you may be able to give .
So the next time there is a delay in getting your injured worker back to work, don’t jump to the idea that the whole claim was fraudulent, discuss your concerns with the claim adjuster, give them some insight into the employee and hopefully another “malingerer” will be returned to work!