The Claims Management Reality

CASE HISTORY #2

CLIENT:  MUNICIPALITY

CLAIM:   MULTIPLE INJURIES

Claimant is a volunteer fireman for this municipality. During the past three years of employment, he has filed over seven worker’s compensation claims. On the last claim, he was out of work for over six months, claiming head and back injuries from the fire injury.

NOTE: Municipal employees are paid full wages when out on disability - causing a lack of concern in returning to work.

Through an independent medical exam, we were able to get a return-to-work date for this claimant. We recommended that he sit in the main office and be under constant supervision to avoid further injuries. Against our advice, he was sent on an errand, and within one and one half hours after returning to work, he was involved in yet another worker’s compensation injury - a motor vehicle accident. We now have him under surveillance. We believe the claims are fraudulent. The client agrees. Our goal is to get the claimant back to work as quickly as possible.

BENEFIT: By reducing the amount of lost time from work, we lower the reserves set up by the carrier.