Workplace injuries fraud?

A recent study showing workers injured early in their employment are more likely to file future workers compensation claims than other workers has experts weighing the root cause of repeat claims.

Some compensation and safety experts say the study, which showed that workers injured soon after they joined an employer are more likely to file multiple lost-time workers compensation claims during their time on the job, shows a need for a better grasp on safety and training, but others say fraud could be the cause.

“This is something that comes up a lot; people making assumptions about an injured worker versus why they are getting injured,” said Diana Stegall, Tucson, Arizona-based president of The American Society of Safety Professionals, saying employers should focus on the types of injuries and work performed rather than zero in on repeat claimants as possibly fraudulent.

Defense firms, however, say early-employment and repeat claims are red flags for fraud in some instances, according to Bernard J. Finnegan, an Oakland, California-based senior partner and certified specialist in workers compensation with the defense firm D’Andre Law LLP.

The study, published in October’s issue of the American College of Occupational and Environmental Medicine, found a correlation between employment duration before the first lost-time workplace injury and future lost-time injuries.

Researchers at Johns Hopkins School of Medicine in Baltimore sought a “simple” predictor of the future risk of multiple lost-time injuries by analyzing data of employees of an academic medical center who suffered 5,906 injuries tracked between 1994 to 2017.

Time served was the major indicator, according to the study.

Not factoring in employment history or underlying risk factors, researchers found that workers who suffer an initial injury on the job within six months of employment are more than twice as likely to have three or more lost-time injuries during their entire duration of employment.

Michael Stack, Kennebunkport, Maine-based CEO for workers comp consulting firm Amaxx LLC, said the results likely reflect a need for improved training rather than fraud, which he says represents a “small percentage” of comp claims.

“When anyone is hired, the injury rates are four to six times more frequent in the first month of the job than someone who has been doing the job for a year,” he said. “In general, people get hurt when they are doing a new task. …To say all of these (early injuries) are fraudulent is irresponsible.”

Johns Hopkins researchers, who did not peg the reasons behind the repeat claims, also found that for each year employed before the first lost-time injury the probability of having three or more lost-time injuries decreased by 13%.

Ms. Stegall said some of the early accidents — which she also says are likely legitimate in most cases — are the result of a common way new hires are trained for work.

“Many times, the training for new hires is – they sit them in a room, plug in videos, have them go through online learning … There is no engagement,” she said. “You have to ask when you have these injuries, what’s the environment overall” with regards to safety and training, she said.

And more can be done at the point of hiring, said Mr. Stack, adding that employers can better know the “bad apples” before they are hired — making fraud less of a risk. “When you look at hiring a lot goes into it,” he said. “Engagement with the employee” can prevent fraud, he added.

Return to work programs after an injury are also a focus for prevention of repeat claims, he added.

“Can they perform their job safely and is it more physically demanding than it needs to be?” are some common return-to-work questions employers must address, according to Mr. Stack.

But the findings of the study could also be explained by fraud, said Mr. Finnegan of D’Andre Law.

“You look back and you see the same pattern over and over again,” he said. “We usually find that they are serial offenders” not just with the current employer, but possibly with other employers.

Repeat claims are also litigated early — an injured worker with a lawyer is another red flag, Mr. Finnegan said.

Yet the exceptions would be more serious injuries, such as amputations, which are less likely to be fraudulent than musculoskeletal injuries, he said.

Source: Business Insurance

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