Inside Retail Services News

RS limits a questionable injury claim

Retail Services works with an attorney who can be called in to assist with appeals of questionable injury claims. This strategy often can help limit benefits extended on claims with questionable credibility.

One recent case involved an allowed claim for an alleged back injury suffered at work while lifting. At the same time, the employee reported he had a history of back problems and thought he injured his back while riding his motorcycle. Interestingly, this same employee filed his injury-at-work claim shortly after a co-worker filed a back claim using the same description of lifting on the job.

The employer notified the RS staff of his changing stories and RS immediately questioned the allowance and requested a medical exam. The case was closed after an independent medical examiner concluded that the claimant, who had been going to physical therapy, had pre-existing issues and no longer needed treatment. In the interim, the motorcycle rider quit the job but then retained a lawyer after protesting the claim closure. Although he quit his job, he was seeking time loss, more treatment and a permanent partial disability award. RS managed this claim with the help of a contract attorney.

In the end, the cost of the claim was more than $5,000. It could have been ten times that if the employer had not monitored the changing stories of the claimant and RS had not sought assistance from its attorney. When employers defend with legal counsel, claimants are sometimes liable to pay for medical expert witnesses when going onto the hearing process. They often drop their claims if their credibility is challenged in court with good supporting documentation from a doctor and the employer.

Though benefits were not completely rejected, they were contained with an attorney’s help on an appeal that revealed a claim without enough credibility. When questionable claims are allowed, it’s worthwhile to limit the financial exposure for employers.

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