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Should Management Refute Every Workers’ Compensation Dispute?

Should Management Refute Every Workers’ Compensation Dispute?

Updated June 9, 2021 Originally published October 09, 2015
Danny Sanchez, PT, CEAS

Should Management Refute Every Workers’ Compensation Dispute? http://blog.onsite-physio.com/workplace-wellness-programs/should-management-refute-every-workers-compensation-dispute @onsitephysio
As a workers’ comp professional, your natural inclination is to protect your company’s assets by fighting back every time an employee files a claim. After all, these claims can be terribly expensive. But a rigid policy that requires you to refute every workers’ compensation claim does not make good business sense. Some claims are clearly valid, so why would you waste time and money fighting them?

It makes more sense to save your efforts for the cases that should be refuted. Yes, there are employers (and insurers) that automatically refute every claim, no matter what. But this policy can backfire. If you gain a reputation as a company that disrespects workers by fighting valid claims, you’ll become an undesirable employer. It will be harder to recruit and retain good people.

Savvy workers’ comp pros focus on two areas:

  • Identifying and refuting fraudulent or exaggerated claims.
  • Working to reduce the number of claims filed in the first place.

Fraudulent Claims

Best practices demand that you treat every claim as valid at first. You need to gather relevant information about the reported accident and/or injury, so you have all the facts. Does the claim appear legitimate, or does something seem “off”? If it’s valid, does the injury actually require medical treatment? Part of this process involves looking for potential red flags – things that make you suspicious.

You are right to be wary. Fraud costs companies, their customers and the general public many millions of dollars every year. Workers may try to claim an injury that happened outside work or an injury they’ve had for years. They may “upgrade” the severity of an injury. Or they may entirely fake one.

And who hasn’t heard of cases where “disabled” workers have been discovered working other jobs, working on their house or playing golf?

And here’s another reason to be concerned: Speaking at the annual Association of Occupational Health Professionals in Healthcare conference recently, workers’ comp attorney Phil Walker said he believes claims will double in the next 10 years. Why? He sees an increase in displaced workers and “greedy doctors” looking to boost their incomes through phony workers’ compensation disputes.

Reducing Claims and Costs

Certainly you should refute claims you believe do not have merit. However, there are positive steps you can take to more effectively manage workers’ comp costs:

  • Analyze job-specific demands to create accurate job descriptions.
  • Promote a safety-first workplace. Train workers how to safely perform their job’s physical tasks. Consider offering injury prevention workshops, morning stretching exercises, etc.
  • Add post-offer employment testing (POET) to your hiring process, to help eliminate hiring mistakes and reduce the number of future workers’ comp injuries.
  • Promote a culture that does not tolerate fraud. Communicate your zero-tolerance policy to every employee. Make it clear you will prosecute perpetrators. Encourage supervisors and line workers to report red flags they witness or suspect.
  • Create a return-to-work program that enables -- and requires -- injured employees to return for modified duty as soon as they are medically able to do so. This tells people they cannot stay home indefinitely. It also keeps them engaged with their job and your company while they are recuperating.
  • Focus on on-site physical therapy that gets injured employees back to work faster and also teaches them how to perform necessary tasks more safely.

All these things save money, improve hiring and prevent future injuries. In the long run, proactive solutions can be far more effective than engaging in unnecessary workers’ compensation disputes when it comes to reducing claims and costs.

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