Many prospects and new clients we speak with have trouble with post termination Worker’s Compensation claims. Most employers have no idea about how they should respond to best defend themselves from this type of a claim which more often than not is fraudulent. Below I provide some effective tools that will help you move through this problem. Please call me with any questions.
From a defense position, the burden of proof should rest entirely on the Applicant to prove one of the following:
- That they complained of pain or otherwise reported evidence of impact to management prior to receiving the notice of termination/layoff.
- That they treated for one or more of the alleged conditions prior to their termination/layoff.
- And/or that they were in pain but unaware that the condition was casually related to employment until later being told by a “professional” (This is where an attorney sells them on their injury and provides justification for entering the legal system to claim their “reward”)
The most effective tools used to combat these allegations remain:
- Employer and subsequent carrier sponsored investigation leading to denial.
- Immediate medical intervention (required utilization of MPN resources).
- Denial of EDD/SDI benefits when notice received.
- Early legal intervention in the form of aggressive deposition; always work up topics of conflicting personal nature (background, hobbies, stigmas).
- Private investigation services at irregular intervals & once applicant has dropped their guard (employment & activities).
- Aggressive legal rebuttal of all Applicant directed treatment and blocking inclusion in the medical discovery provided they are independent of Agreed medical evaluations.
Item #’s 2,4,5 & especially 6 all impact information is used to persuade or prejudice CA Approved Panel Qualified Medical Examiners. They are used by all parties to weigh out the medical evidence and allegations of work related injury & extent before claims reach the court system. They often are asked to decide on the “Industrial Basis” for medical conditions that should be deemed degenerative, hereditaryor speculative including psychological or mental impairments. It is not uncommon to challenge the QME decisions on medial or background basis if strong agreements appear to have been ignored in their evaluation.
Post Termination Worker’s Claims Leniency at Protecting Employees
There is significant leniency built into the provisions of the comp system aimed at protecting employees. Without a strong influence and involvement from the Employer there is a high probability that any claim will not get the kind defense needed to block Applicants efforts to create the appearance of Work Related injury supported by an Applicants network of unapproved Dr.’s that are aligned with the attorneys to create and justify benefits and favorable settlements.
Bottom Line: When a claim is not intentionally managed on behalf of the Employer/Carrier the outcome will be costly to both. There are options at each step in the process but failure to remain diligent in the process of directing the claims and defending against the Applicants lien actions (medical evaluations, treatment and benefits) results in increased settlements/judgment’s, higher file costs and increased lien costs. It’s not an easy process but it’s not impossible either… as long as you have an Advocate that knows the game working on your behalf.
If you are facing a Post Termination Claim or claims that you believe or have been told cannot be resolved or denied, call me for a no obligation consultation.