Workers’ compensation insurance is no-fault. The California Department of Insurance explains it clearly: “An injured employee does not need to prove that the injury or illness was someone else’s fault in order to receive workers’ compensation benefits.” With that being said, an employee is not automatically entitled to benefits. Unfortunately, there are cases in which workers misrepresent the cause of the accident and/or the nature or severity of their injuries. Here, our Sacramento workers’ compensation defense law firm explains the most important things employers should and should not do if they believe that an employee is lying about an injury.
Employers Should Acknowledge the Claim
When an employee reports a work injury, the first step for employers is to acknowledge and accept the claim. To be very clear, the initial acknowledgment does not imply agreement, confirmation, or approval of the injury’s validity. Instead, it merely shows a commitment to follow legal protocols and respect the employee’s rights. Even if the employer is convinced that the worker is misrepresenting that accident and/or their injuries, the matter should be handled professionally.
Employers Should Investigate the Matter
Facts determine whether or not a workers’ compensation claim can be approved. A thorough, unbiased investigation is paramount. How exactly an investigation should proceed depends on a number of different case-driven factors. As a general rule, an investigation will include gathering detailed information about the incident, including witness statements, the work environment, and any relevant documentation. Employers in California should approach this investigation with an open mind—seek to understand the situation and avoid jumping to conclusions.
Employers Should Raise Concerns to Their Claims Administrator and/or Insurer
During the course of an investigation, an employer may uncover inconsistencies or find evidence that raises legitimate concerns about the claim’s authenticity. If this occurs, it is important to communicate these concerns to the claims administrator or insurer. Of course, this should be done with care and professionalism. A California employer should always ensure that all concerns are based on factual findings from the investigation.
Employers Should Not Refuse to Initiate the Claims Process
Employers must not refuse to initiate the workers’ compensation claims process, even if they have doubts about the claim’s validity. Refusing to start the process can lead to legal complications and is against the workers’ compensation regulations in California.
Employers Should Not Retaliate Against An Employee Based on Allegations
California workers’ compensation regulations prohibit retaliation. Retaliation is defined as adverse action taken against an employee because a claim for benefits was pursued. Examples include demotion, dismissal, salary reduction, or any negative change in the terms and conditions of employment. Do not take adverse action against an employee based only on allegations that they are lying.
Call Our California Work Injury Defense Lawyer for Immediate Help
At Yrulegui & Roberts, our Sacramento workers’ compensation defense lawyers are skilled, sophisticated advocates for clients. Preparing to defend a workers’ compensation claim on the grounds that a worker is misrepresenting their accident or their injuries? We can help. Contact us now for your strictly confidential, no-obligation initial case review. Our legal team provides workers’ compensation defense services in Sacramento, Sacramento County, and all across the surrounding region.
