Questionable workers’ compensation claims are on the rise, with fraud, preexisting conditions, and fake illnesses listed as the top reasons for false filings. Businesses want to be sensitive to employee injuries and illnesses, but they also must protect their bottom line. Losing an employee to a workers’ compensation-related injury can be expensive, especially if the employer can’t replace the employee while the case is being investigated.
In addition to physical injury, many businesses deal with psychological claims, whether they’re related directly to the injury or as part of the emotional trauma of recovery. Cynthia K. Thurston, attorney-at-law at McCollum Crowley Moschet Miller & Laak, Ltd., was recently interviewed for an article in Workers Compensation magazine, which is a publication of CLM. Here are a few important takeaways from the article.
Psychological Claims and Businesses
Psychological issues can often accompany a physical injury, especially if the injury puts a normally active person out of commission for a while. However, those claims have been on the rise in recent years, leading employers and insurers to scrutinize each incident. In at least one state, permanent disability claims related to psychological distress from an injury are no longer allowed under the law, which has led to an influx of claims related to the trauma caused by the incident that caused the injury.
To validate psychological claims, Thurston and her clients often work to determine whether or not there is a history of a psychological condition in the claimant. This generally means reviewing medical records and pinpointing any red flags. If those issues are found, it then becomes necessary to conduct surveillance on the patient to observe behaviors that might be different outside of a physician’s care. One of the best ways to address those concerns is to request a medical evaluation by an independent counselor.
Opioid Addiction and Psychological Addiction
Over the course of her work, Thurston also sees psychological claims tacked onto workers’ compensation incidents when employees have a history of chemical abuse. This is only complicated by the fact that often prescription medications will be prescribed for serious injuries, leading to an addiction over time. When these situations arise, Thurston finds it best to assign a nurse case manager who can work directly with the claimant to reduce dependence on opioids.
For Thurston and other attorneys, independent medical evaluations (IMEs) are the key to determining whether substance abuse is related to psychological claims. Thurston finds that attorneys will add psychological claims onto other claims being listed in a case in order to get a higher monetary award. IMEs can proactively address that from the start, helping reduce an employer’s risk of falling prey to fraud.
Although every workers’ compensation claim isn’t fraudulent, today’s employers need to be aware of the problem. Thurston recommends an independent medical evaluation for any psychological claims attached to a larger workers’ compensation case, since they can often determine whether an employee is legitimately suffering from mental issues related to the injury. An IME can also help determine whether a patient’s issues are related to an opioid addiction so that those issues can be addressed as quickly as possible.