On February 3, 2021, the California Department of Insurance announced workers’ compensation fraud charges against a Kern County man accused of bilking an insurance company. According to the allegations raised by the agency, this man unlawfully failed to disclose a previous work-related injury in an effort to collect workers’ compensation benefits that he did not deserve.
The charges are an important reminder that workers’ compensation claimants in California have a duty to disclose previous injuries. In defending a claim, insurers and employers have a right to request relevant medical information from the claimant, including workers’ compensation records. Here, our California workers’ compensation defense lawyers provide a more detailed overview of the duty to disclose.
California Workers’ Compensation Benefits: Apportionment of Responsibility is Based on Causation
In some cases, there is little dispute over how exactly an employee’s injuries occurred. There may be a specific and easily identifiable cause. However, in many other workers’ compensation claims, there are some outstanding questions over the true cause of an employee’s injuries—and there may even be multiple legitimate causes.
In California, apportionment of responsibility for a permanent disability is based on causation. As an example, imagine that a Central California employee filed a workers’ compensation claim for a degenerative back injury. If comprehensive medical evaluations determine that the back condition was caused 50% by work and 50% by a non-work condition, responsibility would be assigned accordingly.
California Labor Code Section 4663(d): Disclosure is Required Upon Request
An insurance company, claims administrator, or employer cannot fairly evaluate the issue of causation in a workers’ compensation claim without adequate medical information. For instance, if an employee files a workers’ compensation claim for a shoulder injury, it is important to know whether or not they have recently sought medical attention (or filed any other claim) for a shoulder injury.
On this matter, California law is clear: Workers’ compensation claimants must disclose. Indeed, under California Labor Code Section 4663(d), “an employee who claims an industrial injury shall, upon request, disclose all previous permanent disabilities or physical impairments.”
In the case of the Kern County man charged with workers’ compensation fraud, the California Department of Insurance essentially filed two workers’ compensation claims (with different insurance companies) for the same underlying injuries. Beyond failing to proactively disclose the pre-existing injuries, the man falsely denied that he sustained any other relevant injuries. Insurers and employers can and should request all relevant medical information from workers’ compensation claimants.
Speak to Our Central California Workers’ Compensation Defense Attorneys Today
At Yrulegui & Roberts, our California workers’ compensation defense team have deep experience representing insurance companies, claims administrators, and employers. If you have questions about workers’ compensation defense and a claimant’s duty to disclose, we can help. To arrange a confidential review and evaluation of your legal case, please contact us right away. We offer workers’ compensation defense services throughout the San Joaquin Valley and Central California, including in Fresno, Bakersfield, and Sacramento.
