Usually, there is little dispute over exactly how an employee’s injuries occurred. There may be a specific and easily identifiable cause for the injury. However, in many workers’ comp claims, there are some outstanding questions over the true causes of the injuries – and there may even be multiple legitimate causes. Read on and contact AllianceMeds today to learn more.
How does Workers’ Comp determine the true cause of injuries?
In many states, apportionment of responsibility for a permanent disability is based on causation. For example, the employee filed a claim for a degenerative back injury and if the medical evaluations determine that the back condition was caused 50% by the work injury and 50% by a non-work condition, responsibility would be assigned accordingly.
As such, a fair evaluation of the issue of causation in a workers’ compensation cannot be made without adequate medical information. For instance, if an employee files a claim for a shoulder injury, it is important to know whether or not they have recently sought medical care or filed another claim for a shoulder injury.
On this matter state laws are quite clear – workers’ compensation claimants must disclose previous injuries. For example, under California Labor Code Sec 4663(d) “an employee who claims an industrial injury shall, upon request, disclose all previous permanent disabilities or physical impairments.”
Failure to disclose a prior injury can result in fraud charges and/or loss of or reduction in benefits. In February 2021 the California Department of Insurance announced fraud charges against an individual alleging that he failed to disclose a previous work-related injury in an effort to collect workers’ compensation benefits that he did not deserve.
What are the consequences of not telling Workers’ Comp the true causes of injuries?
In New York, a court found that a claimant’s failure to disclose a motor vehicle accident during any of his independent medical exams was grounds for permanently disqualifying the claimant from future indemnity benefits.
In the California matter, two separate workers’ compensation claims were filed with different insurance companies for the same underlying injury. Beyond failing to disclose the pre-existing injury, the claimant also denied he had sustained any other relevant injuries.
In the New York case, the claimant sustained a work-related injury to his right hand. However, subsequent to the work injury, the claimant was injured in an automobile accident, but the claimant failed to disclose this fact during a subsequent independent medical exam.
The fraud charges and the disqualification of benefits are important reminders that a workers’ compensation claimant has a duty to disclose all previous injuries. Not only is it important for you to disclose all your prior injuries so as to secure the most effective treatments, but it is also vital that you do so so that your benefits are not denied. If you have any questions about how we can help, contact AllianceMeds today.