Workers' Compensation Claims Common Questions and Stories
Spooner Inc. is Ohio's leader in Workers' Compensation, Safety, Unemployment, and FMLA/Short Term Disability Administration.
In the world of Workers' Compensation 95-97% of claims are legit. They're just people who got hurt on the job, and want to get back to work as quick as they can. But what about the other 3-5%? We deal with a lot of the 3-5%, so we have some interesting stories. We just wanted to share a couple of claims stories with you guys and just some of things that we've seen over time.
A common question employers ask is "if someone slips in the parking lot walking into the office - do they have a claim?" The first thing we ask is who owns the parking lot? If the company owns the parking lot it would be a claim. The employee is within the course and scope of their employment, they are walking in, and slip and fall. That is a worker's comp claim.
If some other third-party company owns the building and is leasing it, then it can potentially be a property and casualty claim.
But just because you're on company property, walking into the building doesn't mean you always have a claim. There was this one case where a woman left work for the day, and after getting home she realized she left her paystub in her locker. She wanted to go back and get it. When she returned to work, about 15-20 minutes later, she slipped and fell in the parking lot. Since returning to work was not in the course and scope of her employment, she did not have a claim.
Another common question we receive regarding claims within workers' compensation would be "our employee got hurt, but does not want to seek treatment - is that a claim?" In this case, we tell the employer to wait a little while - if the employee ends up seeking treatment, it is a claim.
Our clients also tend to ask "If someone has a heart attack and falls and hits the ground, do they have a claim?" Now, if the person has a heart attack and falls - they do not have a claim. If they have a heart attack and hit their head on the company's property - they have a claim. The heart attack itself isn't the claim, but hitting the head would be.
What if someone is filing a claim and is not telling the truth?
Our claims department really goes above and beyond the call of duty when it comes to handling our client's claims. While we want legitimate injured workers to get the care they deserve, and get back to work - we will investigate the claims you're making to be true.
In one case, we had a woman who had a very legitimate injury to her knee and had some surgery done. Soon after her surgery she said she was depressed because she was no longer physically able to do what she was before, she didn't have support from family or friends. Our psychologist checked her out and believed the claims she were making were true. She said all the right things.
We knew when this case came across our desk that it was going to be expensive and if it was legitimate, they could be paying for her care, theoretically, forever. Pulling a last minute try, our claims department went onto Facebook the week of the hearing, and saw she made posted a picture, mind you this is a person who claimed to not have any hobbies or family support, of her killing an 8-point buck, and she said "I just had the best weekend with my family and friends and I just can't believe good hunting makes me feel and gets me in the right frame of mind."
We found this to be a bit peculiar for someone making the claims as she was. To add insult to injury, we contacted the state for the registration and she did indeed register that 8-point buck. When we brought this information to the hearing, they ended up denying her claim.
If you're hurt, get fixed. If you're not, don't elaborate or exaggerate a claim. That's ultimately our our goal.
Spooner Incorporated is here for you for any of your workers' compensation and claims needs.You can reach out to us by visiting our contact page.
