Written By: Andres Gomez
Alarm Bells – Issues that prompt a closer look at accidents
There are certain things that we come across in claims that immediately set off alarm bells that should prompt a closer look at the accident and whether it should be accepted as compensable or not. While the following is not an exhaustive list, these are a few of the alarm bells we see most often.
Unwitnessed Accident
The alarm bells that arguably go off most often is the occurrence of an unwitnessed accident. While in and of itself, the lack of witnesses should not prompt a denial of the claim, it should definitely prompt a closer look at the facts and lead to a deeper investigation. Under the Louisiana Workers’ Compensation Act, the employee will have a more difficult time proving the occurrence of an accident when such is unwitnessed. The courts will consider the “Bruno” factors when looking at unwitnessed accident. These are:
- No other evidence discredits or casts serious doubt upon the workers’ version of the incident.
- The workers’ testimony is corroborated by the circumstances following the alleged incidents.
- The history provided to the treating physician.
- Whether the plaintiff immediately notified the employer of the accident.
- Timely submission of an accident report.
- Prior history of similar complaints.
Judges will typically look at the initial medical records in determining whether there is any corroborating evidence versus evidence casting doubt on the employee’s story. Accordingly, always take a close look at the initial medicals following the accident to make sure that the story is consistent. Additionally, always remember to get statements from co-workers that they did not witness any accident, especially if they interacted with the claimant shortly thereafter.
Late Reporting
Somehow, after people get terminated, they remember that they have been in pain for the last six months when they pulled their back lifting something and now feel like the need an attorney. The late reporting, similarly, does not necessitate the immediate denial of a claim but it does warrant a close look at what happened and why there was a late reporting to begin with.
New Hires
While a new employee can certainly be injured, it is always important to look at these more closely and a good practice is to immediately pull an Index (ISO) Report to see if this individual has a pattern of accidents at work. If they do, they know the system and will generally try to exploit it.
Remember, these are alarm bells that should prompt a closer look at a case, not an automatic denial. If you find suspicious situations, make sure you are noting it in your notes and, if a claim is being denied, note why and what information you relied on to support that.