Challenging a claim . . . ?

mjindra · August 2003

How often, if ever, do any of you challenge a claim by an employee? Our jobs have a lot of "wrist-action", but at this point our employees should be "seasoned" to this, especially if they're doing the stretching exercises and rotating like they are supposed to.

Last week we had a guy call in on Monday, saying his arms hurt, (he only works Monday through Thursday), he went to the doctor and received light duty. Having no light duty work for him, he spent a week on his butt at home.

After looking into this, the supervisor stated that this employee frequently complains of soreness / injury when working with a specific group of employees and they are just assuming he was ready for a week off.

Any suggestions from the HR gurus out there?

Balloonman · August 2003

If you think/know he is doing it to get the time off you need to make sure you have restricted duty available. Work he will not enjoy, or with that same group he wants away from. I would also find out when the arm got sore, see if he reported it in a timely manner.
In the past I have had the "injured" worker reorganize the MSDS, from alphabetical to by chemical category, or other tasks like that. Require specific work ability form from the doctor outline what the employee can and cannot do.
Then have fun.
My $0.02 worth.
DJ The Balloonman

mjindra · August 2003

Actually, we have another guy on light duty as of today, and he's running through the duties faster than . . . well, no need for analogies. We are paying him minimum wage, rather than his normal wage, the difference to be made up by Worker's Comp.

We will continue bringing the guys in, where we can keep an eye on them regarding attendance issues and overall drive.

I love your MSDS suggestion, something I've been dreading working on lately. I'm headed over to the Hr de har har page to start a post on LIGHT DUTY SUGGESTIONS.

Thanks!

LindaS · August 2003

When it comes to WC, it is EXTREMELY rare for me not to be able to find SOMETHING for them to do. They can come in and watch safety videos, stamp envelopes, sweep. I especially like the idea of the MSDS books!!!

If you have any questions regarding the validity of the claim, make sure your insurance carrier investigates the claim thoroughly. They may require an IME or a complete release of medical records, etc. to make their determination.

I get frustrated here in WI with employees being able to choose their own physician because there are certain ones who will provide work restrictions, etc. to employees for just about any reason - and it is ALWAYS WC.

psrcello · September 2003

I've challenged a number of claims, but not always successfully. I did a thorough investigation several years ago on an employee who allegedly fractured a vertebra in his back when he slipped on a patch of ice outside the building he worked in (it was night shift in the middle of the winter) - what actually happended was that he fell off a ladder while trying to rig up a wire antenna on the plant roof for the radio he played at his work station! Despite snapshots of the accident location, statements from witnesses and the supervisor, the workers' comp carrier accepted the claim.

My biggest frustruation is that in Nebraska, aggravation of a pre-existing personal medical condition because of work becomes compensable. In other words, we have employees who inspect pet food bags, and often end up with repetitive motion wrist strains. These become workers' comp, even if the employee engages in lots of other manual tasks (i.e., needlework, guitar or piano, heavy computer use) at home and developed carpal tunnel from those activities. Not much point fighting these.

mwild31 · September 2003

I challenge everything unless there's blood or broken bones involved. With that said, I also have several light duty jobs available if necessary. With all my heart, I don't believe in having employees sit home and collect time loss or even collect a 'make-up' check from worker's comp. (given when the employee has to work part time due to injury & L&I compensates with a gap check). I believe so strongly in this for two reasons: 1) How the checks affect the employee and 2) How the checks affect our experience factors - or more directly, our bottom line.

First, when the employee receives the checks, they are usually between 60-80% of their normal rate of pay - which means, as is true for most of us, when you live pay check to pay check - you need another source of income - or you go into debt - which has a definite impact on the business as the employee either asks for money when they come back or they have to find another job while they are recovering (which can delay the recovery time). Next, most employees are not trying to take advantage of the system and end up feeling bad that they are costing the company money - so anything they can do to help around the office they feel better about. The other employees, who don't have a problem with taking advantage of the system, quickly realize the type of company they work for and either leave or get with the program. I've seen it all happen too many times.

Second, I worked for a company - a long time ago - that didn't understand how time loss affected it's bottom line. Whenever someone hurt themselves, they did not fight the claim and were happy to see the employee go home & collect worker comp. checks. (All the while talking behind the employee's back about how they were 'faking it', etc.). What I was able to show the employer was how this practice took their checks to L&I from $12,000 in one year to $48,000 (and counting as we were only 3/4 of the way into the year) the next. And, how this high experience factor will continue to affect them for the next three years.

So, in your situation I would challenge the claim (get in touch with your worker comp. company and get the ball rolling) and I would also stop the time loss right away & continue to do so for any future injured worker. Your company won't see the benefit right away - but, they will gradually start to see the results to their bottom line - and make sure you take credit for it! x:-)

Challenging a claim . . . ?

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