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Archive for March, 2018

Is PTSD a Valid Basis for a Workers’ Compensation Claim?

PTSDWe’ve all heard of PTSD or Post-Traumatic Stress Disorder. It first came into the lexicon in association with military personnel who had witnessed trauma that affected them psychologically or physically, but the term has now been extended to apply to anybody that has been exposed to a severe shock such as an accident or a terrorist attack. Just as injuries that can happen outside of work can also happen on the job, the same is true of PTSD. This means that if a traumatic event occurs in the workplace an employee requires treatment or is unable to function as a result, it is a valid basis for a workers’ compensation claim.

It is important to understand that there is a significant difference between PTSD and other mental injuries that might result from an unpleasant workplace. An employee who finds themselves experiencing anxiety because of a disruptive co-worker or depression because of losing their job is not entitled to workers’ compensation benefits. Hating your job is not the same as PTSD. Post-Traumatic Stress Disorder that is work related is very specifically a psychological injury that is caused by a psychological stimulus that represents an abnormal working condition: a person cannot successfully be approved for workers’ compensation benefits because their boss favors other employees over them but may be able to if they witnessed their boss physically attacking another employee.

PTSD can also be a result of having suffered a physical injury or illness on the job. In other words, an employee who suffered a horrific burn, or who fell off a scaffold and was badly injured, as a result, could conceivably suffer the symptoms associated with PTSD in the aftermath. These symptoms include:

  • Having flashbacks or nightmares in which they relive the accident
  • Becoming fixated on the accident
  • Withdrawing emotionally and becoming depressed or anxious as a result of the accident
  • Being in a constant state of anger or stress following the accident
  • Having difficulty sleeping after the accident

PTSD is generally treatable through medication, therapy, or a combination of the two. Workers’ compensation benefits can provide for these medical expenses, as well as for temporary disability if the condition prevents you from returning to work. For more information on filing a workers’ compensation claim for your PTSD diagnosis following a workplace event or injury, contact us today.

How Do Insurers Investigate a Workers’ Compensation Claim?

investigate a workers' compensation claimThough the vast majority of workers’ compensation claims are filed by people who have suffered legitimate injury or illness on the job, there is a small percentage of people who file fraudulent claims. As a result, workers’ compensation insurers need to investigate suspicious filings to make sure that they are valid. Though it may feel intrusive to those who simply want to get better or get the compensation they deserve, the work is also necessary: workers’ compensation fraud perpetrated by both employers and employees account for 25 percent of all insurance fraud. The news media has covered some of the most notorious of these crimes, including a woman who claimed to have been disabled and then appeared doing something strenuous on a daytime television game show, and another employee who was videotaped water skiing.

To rout out this type of crime, investigators use several different investigative techniques, including:

  • Video and audio surveillance – Investigators can follow an individual worker around and record evidence that shows that they are not as disabled as they claim to be.
  • Social media surveillance – Investigators can review social media postings that provide contradictory evidence of disability.
  • Interviews with colleagues and others – Investigators are able to question friends and family members, co-workers, and others in a claimant’s community to determine whether their claims are legitimate.
  • Background checks and medical records research – Investigators can look into a claimant’s medical records to determine whether their reported illness or injury was actually a pre-existing condition. They can also pull records on previous insurance claims.

Though workers’ compensation insurance investigators may seem like the enemy, it is important to understand that workers’ compensation attorneys also investigate insurers and employers to make sure that claims are being appropriately paid. It is also important to note that there are limits to how far investigators for workers’ compensation insurance companies are allowed to go while pursuing their investigations. They are not permitted to be deceptive in their approach, and those that have used deceptive tactics have faced successful legal action.

Workers’ compensation insurance fraud is a crime that costs all of us. It drives up the rates of workers’ compensation insurance premiums and makes it more challenging for those who have been legitimately hurt on the job to get the compensation and benefits that they deserve. If you have been hurt on the job, contact us today to set up a consultation to discuss your case.