California definitely has some of the nation’s strongest employee protection laws. But that doesn’t mean that companies should get the short shrift, either.
When defending unemployment compensation claims, it’s vital for companies to develop strategic partnerships with defense firms experienced in dodging common pitfalls while defending illegitimate claims for benefits.
Write your own playbook
Your employers’ playbook should position your defense counsel as a strategic partner by detailing the initial steps to take when presented with a potentially fraudulent workers’ compensation claim. Pay particular importance to the employee’s documentation. If it seems implausible, a deeper dive is definitely in order.
Beware of red flags
It goes without saying that companies should pay out all legitimate employee claims for compensation for their on-the-job injuries. But unfortunately, not all workers’ comp claims deserve a payout.
Here are some common red flags to alert you to potentially fraudulent claims for compensation:
- Workers claim an injury on a Monday (especially after long weekends)
- No coworkers can corroborate witnessing the injury
- The claim was filed on the heels of a pink slip or disciplinary action
- Injury reported after a project ends or seasonal employment ceases
There are many more red flags to wade through when disputing the accuracy of a claim for workers’ compensation. Your legal team should be very familiar with these and other notorious red flags that may indicate a claim’s illegitimacy.
Some claims harder to dispute than others
To meet the burden of proof for a disputed claim to be paid out, workers must show that their injury was caused by at least 51% of their work duties and not other non-work activities, which may have exacerbated the injuries.
A broken disc from a witnessed fall on a construction site typically will be legitimate. However, claims of only soft tissue injuries that don’t resolve within days or weeks may not be. Any nebulous and impossible to prove subjective claims of pain from headaches, soft tissue injuries and psychological distress may need greater scrutiny.
Want to learn more about building your own playbook?
Prepare for defending fraudulent claims by establishing your own company playbook. This can allow you to get ahead of the fraudsters by recognizing and identifying any red flags that can indicate the illegitimacy of their claims.