Q & A: Employers ask about claims
Q. “I was in a jam and recently hired a truck driver without doing a thorough background check. In less than 90 days, he is out of work with a back injury. I have reason to believe he misrepresented himself during the interview. Is this grounds for getting the claim denied?”
A. We have all been in the situation of needing a warm body to do a job. Unfortunately, this often leads to Workers’ Compensation claims. Hiring practices are a key element of controlling your Workers’ Compensation costs. While we cannot predict the outcome of the claim, you would be on much firmer ground in contesting the claim if you had done a conditional offer of employment, a medical history questionnaire and a preplacement medical exam. Documenting everything in writing and following all the proper procedures gives a much better foundation for your case.
Q. “An employee recently tripped and fell and injured her hip. She is a diabetic and has arthritis. How can I be sure that the claim only includes the treatment for her injury and not the other conditions?”
A. Co-morbidity or the presence of one or more disorders or diseases in addition to the injury and the effect of such additional disorders complicates any claim. This is often a good time to involve an independent nurse. He or she has the ability to discuss the situation with the treating physician as well as working with the injured employee in a way that is supportive and not threatening.
Q. “An employee recently complained about breathing problems and asked to work from his home. The job cannot be done effectively offsite, but I don’t want to invite a Workers’ Compensation claim. What should I do?”
A. In a recent Rhode Island case, Mulloy vs Acushnet Company, an engineer claimed his asthma was aggravated by chemicals used in the company’s plant and argued that the company violated the Americans with Disabilities Act by refusing to allow him to work remotely. The district court found after examining the job description and actual duties that working in the presence of machinery was an essential job function.
While a reasonable accommodation may include job restructuring, the law does not require an employee to accommodate a disability by foregoing an essential job function of the position or by reallocating essential functions to make other workers’ jobs more onerous. While this case deals with the American Disabilities Act, you can expect more and more employees to request an accommodation to work at home. Workers’ Compensation is no exception. To preserve your right to say “no”, you might want to amend your job descriptions to require physical presence as an essential job function.