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Checklist of Possible Employer Concerns

Kegler Brown Labor + Employee Relations Newsletter

Updating Ohio employers on possible concerns that employers should consider when making decisions on how to handle various workers’ compensation matters.

Allowance -- Facts to consider before accepting a new workers' comp claim

  • Claimant is a new employee or accident occurs near end of probationary period
  • Accident is reported late (several days or more post-accident)
  • Accident is not reported until after claimant has been disciplined, discipline has been threatened or is sure to follow
  • Claimant has poor attendance record or frequent disciplinary problems; job performance declined just prior to injury
  • Claimant is bitter and/or resentful toward the employer
  • Claimant was recently terminated for violating an employment policy
  • Date, time and place of accident "unknown;" specific details of injury are general or not recalled
  • Inconsistencies between descriptions of work incident in accident report, medical reports and other statements and documents
  • Cross-outs, erasures and "white-outs" on medical, incident/accident and/or other reports and documents
  • Injury reported Monday morning, after the weekend or after a plant shutdown; accident occurred immediately after claimant's scheduled days off
  • Minor incident becomes major injury
  • Physical injury does not match incident or is inconsistent with nature of work being performed
  • Claimant refuses diagnostic procedures to confirm injury
  • Multiple parts of body injured (especially "entire back")
  • No witnesses to accident or witness statements are inconsistent
  • Claimant cannot be reached; is never home to answer the phone or is "sleeping and can't be disturbed"
  • Claimant refuses to cooperate by providing a signed medical release and/or list of doctors with whom he/she previously treated
  • Claimant has moved out of the state or country, or uses a mailing address other than his/her permanent residence
  • Injury coincides with layoffs, end of seasonal work, or plant closing (dollar amount of workers' compensation benefits is generally higher for an injured worker than unemployment benefits); or injured worker is in line for "early retirement" (supplemental pension)
  • Claimant terminates own employment just prior to or just after injury
  • History of similar problems; outside activities that could cause injury (i.e. sports, hobbies, etc.)
  • Claimant is known to engage in secondary or self-employment
  • Claimant was involved in a non-work related accident prior to injury (for example, a motor vehicle accident)
  • Claimant's wages were recently subject to garnishment or liens
  • Claimant does not have any other medical coverage
  • Claimant made major purchases just prior to injury, or recently purchased a private disability policy
  • Tips from co-workers
  • Immediate or nearly immediate representation by an attorney after injury
  • Spouse and/or other family members are "on workers' comp"
  • Claim and claimant have very little connection to Ohio
  • Same attorney/doctor combination have previously handled related claims
  • Claimant recently settled another workers' comp claim against a prior employer
  • Claimant fails a drug screen or refuses to undergo drug testing when there is reasonable suspicion of use
  • Claimant acts injured while knowingly being observed but acts normally otherwise
  • Claimant complains of extreme pain but doctors cannot find anything wrong
  • Claimant, while out on the road, deviated from the employment and was on a personal errand when injured
  • Claimant was engaged in horseplay when injured
  • Injuries appear to be self-inflicted
  • Claimant was not at work or in an area owned or controlled by the employer when injured
  • Claimant elected workers' compensation coverage in another state
  • Claimant's substantially aggravated medical condition has returned to pre-injury status
  • Claimant's medical condition is primarily caused by "natural deterioration"

Wage Loss -- Facts to consider before claimant is granted wage loss compensation

  • Claimant's restrictions do not prevent performance of the "former position of employment"
  • Claimant misrepresents the nature and extent of restrictions to prospective employers
  • Claimant requests non-working wage loss but has not done much to find other work
  • Claimant has not sought work with the "employer of record"
  • Claimant has not registered with the Ohio Department of Job and Family Services
  • Claimant obtains updated restrictions from doctor even though no new exam performed
  • Claimant refuses a job offer, fails to follow up on good leads for other work or voluntarily limits income
  • Claimant finds another job, requests working wage loss but does not continue to look for other suitable work that would eliminate the wage loss

Temporary Total -- Facts to consider before claimant is granted TTD compensation

  • Employer is able to accommodate claimant, offer transitional (light duty) work within restrictions established by claimant's doctor (make written offer)
  • Claimant's condition has become permanent (maximum medical improvement)
  • Claimant is working at a second job (fraud?)
  • Claimant is engaged in activities that are inconsistent with a claimed inability to do his/her regular job
  • Injured worker changes physicians when a release to return to work is issued
  • Claimant repeatedly postpones BWC 90 day exams
  • Claimant is incarcerated
  • Claimant complains of extreme pain but doctors cannot find anything wrong
  • Claimant delays/postpones treatment for one medical condition while he/she is receiving TT for a different condition (e.g., does not see doctor for allowed psych condition while off work after back surgery)
  • Claimant acts injured while knowingly being observed but acts normally otherwise

Permanent Total Disability -- Facts to consider before claimant is granted PTD compensation

  • Claimant keeps filing PTD applications even after having been denied compensation by the Industrial Commission
  • Claimant may be seeking PTD compensation simply for growing old
  • Claimant refuses offers of vocational rehabilitation from the BWC or from the employer
  • Claimant has failed to exhaust all efforts at rehabilitation, retraining and/or re-education before seeking PTD compensation
  • Claimant retired from the workforce for reasons entirely unrelated to the work injury
  • Claimant complains of extreme pain but doctors cannot find anything wrong
  • Claimant acts injured while knowingly being observed but acts normally otherwise

Other general concerns to consider in connection with pending claims

  • Claimant is dead (claim abates)
  • Deceased claimant's widow/widower has re-married
  • Claimant attempts to exclude weeks from AWW/FWW calculation where unemployment was not beyond the claimant's control
  • Claim is dead
  • Claimant has suffered a new, serious incident/injury to the same body part(s) previously injured
  • Claimant's pre-existing medical condition(s) contributed to injury and/or delayed recovery from it (handicap reimbursement)
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