Sunday, May 26, 2013

" Faking" work injuries.

In my 24 years of practice, I've represented employers, the Industrial Commission and injured workers. I think that I have a fairly balanced perspective when it comes to this industry.

In my experience, one of the most common misperceptions by injured workers, their families, employers and society in general is that injured workers are " faking " injuries. From my perspective, the ability and incentives to fake injuries are narrow margin.

First, the life of a claimant can be miserable. He or she can be considered a social pariah. Also, the benefits are not exactly rich. There is no pain and suffering, nor are damages paid to claimants. There are ONLY medical and compensation benefits.

For compensation, an injured worker receives  66 2/3% of his or her average monthly wage based on earnings prior to the injury. Period. He can be terminated while on workers' comp. His employer does not have to pay benefits during this time. He loses whatever job security he had before the injury. He is injured , unemployed, and usually uninsured. 

99% of the workers I have represented dislike being off work; it drives them and their families crazy. It reduces their self esteem and self worth. It increases boredom.  I think that all of us can relate that we would drive ourselves and those around us crazy if we were on a semi permanent vacation around the house. I have always relate the "idle hands " parable to my clients.

" Faking it" does not entitle one to benefits. Any time loss must be substantiated by a medical opinion. In other words, a physician must restrict the injured worker to a no, light, or full work status. Physicians now rely on diagnostic tests that did not exist 20 or 30 years ago, such as CT and MRI scans. These test allow physicians to obtain objective proof of injuries. Complaints are not enough. They must be substantiated, or benefits will usually be denied. 

It does not matter how badly one hurts, or complains; a claim is only as strong as its' underlying medical evidence. 

Finally, " faking it" requires a somewhat sophisticated and elaborate plan to fabricate an injury event and report that event accurately to layers of investigative and medical professionals. I do not think have ever seen a claimant successfully run this gauntlet . 

In summary, I encourage everyone to be open minded, examine claims on an individual basis and look at the objective medical evidence. A claim is like a puzzle where all of the pieces should fit together fairly well. Thanks.


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