The Florida legislature is extraordinarily friendly to insurance companies and their lobbyists. Unfortunately, the legislature is unfriendly to injured workers. It regularly accepts the myths that insurers spread to avoid paying workers’ compensation claims.
Insurance company lobbyists like to complain about workers’ compensation insurance fraud. When they complain, the legislature makes it more difficult for honest injury victims to collect workers’ compensation. Workers’ compensation insurers would rather pay lobbyists than claims. The strategy results in higher profits for insurance companies and fewer benefits for injured workers.
Some workers do make dishonest claims for workers’ compensation, but the problem has never reached the “crisis” proportions alleged by the insurance industry. In reality, workers’ compensation insurance premiums are very a small percentage of employers’ payroll costs. Fraud has a minimal impact on insurance company profits and almost no impact on employers’ payroll costs.
Nobody condones workers’ compensation fraud. In Florida, it is illegal for any person to “knowingly make, or cause to be made, any false, fraudulent, or misleading oral or written statement for the purpose of obtaining or denying any benefit or payment” under the Workers’ Compensation Law. In addition to risking criminal prosecution, workers are barred from receiving benefits if they “knowingly or intentionally” engaged in fraudulent acts “for the purpose of securing workers’ compensation benefits.”
The small number of workers who actually commit fraud make it possible for insurance companies to accuse large numbers of injured workers of fraud in the hope that they can avoid paying benefits. Fortunately, there are some acts that injured employees can take that will help them avoid being accused of fraud.
Document the Circumstances of Your Injury
Insurance companies accuse workers of fraud when they suspect that an injury occurred on the worker’s own time. Insurance investigators may ask friends and neighbors for information about how the injury occurred. If someone tells an investigator that the employee was once injured in a softball game or fell out of a tree while trimming branches, the insurance company may try to attribute the injury to a nonworking accident.
To establish that an injury is work-related:
1. Take note of other employees who saw the accident that caused the injury. Don’t be shy about telling them that the accident was painful. It may be necessary for the employees to give statements or testify later. If you call their attention to the injury when it happens, they’re more likely to remember it.
2. If you can, take pictures of the place where the accident occurred and of any equipment that was involved. Take those pictures as soon as you can.
3. If the injury caused visible symptoms (such as cuts or bruises), take pictures. Make sure the camera keeps a record of the date the picture was taken.
4. Report the injury to your employer immediately.
5. Ask for a medical examination immediately. Make sure to tell the treating physician how the injury occurred.
Insurance company employees are suspicious by nature. Your best defense against unfounded suspicion is to have a legal representative on your side. Ask a Florida workers’ compensation lawyer for advice if anyone seems to doubt that the injury is work-related.
Don’t Engage in Activities that Are Inconsistent with Work Restrictions
Insurance companies often claim that injured workers are “malingering.” They accuse workers of collecting temporary disability benefits when they are healthy enough to resume working.
Assume that an investigator is watching you, and perhaps making a video of your activities, at all times. Injury victims sometimes think that they should test their limitations to determine whether they are getting better. A victim who tries a light workout in the gym or who unloads something heavy from a car trunk might be providing evidence that the insurance company will use to claim that the victim is malingering.
A treating physician is in the best position to decide whether an injury victim has recovered sufficiently to lift work restrictions. Resist the temptation to do more than your physician has cleared you to do. Always obey lifting, climbing, and other restrictions, even if you aren’t at work.
Follow the Treating Physician’s Orders
Nobody likes to visit the clinic. It’s easy to make excuses to miss treatment. It’s particularly tempting to miss physical therapy sessions. Physical therapy is important but the exercises can be painful. Stopping a course of treatment, however, creates two problems, in addition to hindering recovery.
First, when an injury victim stops treating, the insurance company will inevitably accuse the victim of malingering. Following through on treatment recommendations, including home exercises, is a great safeguard against accusations of fraud.
Second, when an injury victim misses a doctor’s appointment, the insurance company may be able to stop paying benefits. Injured workers jeopardize their claims when they miss doctor’s appointments.
Be Honest About Earlier Injuries
Insurance companies will scour medical reports for evidence that the worker was treated for the same injury at some earlier time. They use those records to argue that the injury was not work-related.
The fact that a worker was treated for a similar injury in the past does not mean that the new injury did not occur at work. In addition, an accident at work might aggravate an earlier injury. Workers are generally covered by workers’ compensation when an old injury was worsened by an accident in the workplace.
The best way to prove that an injury is work-related is to be completely honest. An employee who lies about or denies an earlier injury will almost always be accused of fraud. Don’t worry about the impact that the earlier injury will have on a workers’ compensation claim. An attempt to cover up the fact of the earlier injury will usually fail. The attempt will be seen as evidence of guilt and will jeopardize the workers’ compensation claim.
Workers with pre-existing injuries should tell their workers’ compensation lawyer about them. The injury victim’s lawyer can use medical records to make it clear that your workers’ compensation claim is based on a new work-related injury or a work-related aggravation of an existing injury.