"Cutting Loose Never-Ending Comp Claims"

In the May 2022 issue of CLM Magazine, the publication for the Claims and Litigation Management Alliance, Blake Staten authored an article detailing strategies to move challenging workers’ compensation claims to a reasonable and cost-effective closure via settlement.

Finding a way to get an employee back to work when income benefits are being paid is a strong strategy to move a claim to closure. This may include finding a suitable, light-duty arrangement and detailing it in a job description that a doctor can review and approve. Once the approved job is accepted by the claimant, insurers and employers can typically suspend income benefits and have an opportunity to negotiate a favorable settlement.

Surveillance and doctor conferencing are two other courses of action that can change the trajectory of a claim. Claimants are not always truthful when communicating with the authorized treating physician and may exaggerate their injuries to retain benefits, and surveillance evidence proving these exaggerations may be used to conference with the physician to evaluate the claims closer. For example, a claimant using a cane but found on video running up and down a basketball court would merit further evaluation. However, some states may have restrictions on unilateral or direct communications with an employee’s physician, and Georgia courts are unsettled on the issue.

Finally, an independent medical evaluation can be an effective tool for incorporating another expert medical opinion into the claim – especially when the authorized treating physician becomes indecisive as to the diagnosis and future treatment. “With another physician’s supporting opinion in hand, the authorized treating physician might then agree to the evaluating physician’s opinion, which would serve to dramatically change the employer/insurer’s position on the claim, especially where income or lost-time benefits and an inordinate amount of medical treatment have been provided,” Staten said. “Under such a scenario, a problematic, expensive, and potentially complicated claim has been mitigated to what most likely can now become a reduced and cost-effective closure – well worth the expense of a physician’s evaluation.”

For the full article, please click here.