Retro Director prevails on questionable claim
Maria McClain, the new Director of Retro Member Services, recently received a favorable rejection from an older injury claim she had challenged as the Senior Claims Analyst. She prevailed on this particular claim after an investigation was performed and no one could back up the story of a worker who had filed an alleged injury claim.
The former employee reported that she hurt her foot when it hit a clothes rack. She claimed several of her co-workers saw the accident. Initially, Labor & Industries allowed the claim and included full-time wages for a part-time employee during her recovery.
McClain protested the allowance and wage order, then requested and received an independent investigation meant to determine the validity of the injury claim. The medical review of the claim did not support the injury the worker reported. Also, the employer could not identify any employee who saw the accident and the available film footage did not verify the worker’s side of the story. The employee who claimed the injury also failed to appear at hearings to verify her story or answer questions.
In the end, L&I rejected the claim and reversed lost-wage payments. The case shows our Retail Services team’s proficiency in saving employers money when it reviews claims carefully to establish accuracy and integrity.