Inside Retail Services News

Claims manager successfully challenges a questionable injury claim

It often takes a team of people to validate or challenge injury claims.
Take a recent case handled by Nancy Barnes, our Manager of Claims Administration.
A man filed a claim for help from the state for a back injury. The claim was vague to Nancy including the man delaying examination by a doctor. Nancy’s investigation included checking with the man’s employer to verify that an injury occurred on the job.
Working with the employer, Nancy learned the man wasn’t scheduled to work at all the week following the alleged injury and didn’t report any injury until the night he was scheduled for his next shift a week later. The man visited a doctor in an emergency room the night before he was scheduled to return to work.
A second doctor concluded the injury was not related to the man’s job. Based upon the second opinion, Nancy asked Labor & Industries to reject the claim, which it did. A key consideration in such cases is whether the injury was job-related “on a more probable than not basis.”
In this case, the sequence of events raised questions about the legitimacy of the claim. Such outcomes reduce waste in the state’s workers’ compensation system and reduce costs for employers and workers, who share premium payments under the Washington State system.

Only Washington Retail members have access to the services and resources available from Retail Services

Membership Requirements »

Retro is a safety incentive program. Let us help you drive down the costs of doing business in Washington State

Learn More About Retro »