When an employee files a workers' compensation claim, they might mistakenly believe that they have an injury that is the result of their work, they may believe that the injury is more severe than it actually is, or they may even file a claim while trying to conceal the fact that they are not injured. For this reason, an independent orthopedic evaluation is often necessary.
1. The Employee Claim Process
After the employee believes that they have been injured at work, they are advised to file a workers' compensation claim as soon as possible. The employer is concerned with making sure that only valid claims are accepted because each claim can lead to the employer's insurance premiums going up. The insurance provider also does not want to make payments when it is not warranted as this might hurt the insurance provider's bottom line. However, it can be difficult to determine if an injury is fake, inflated, or didn't occur while on the job. For this reason, an attorney investigating the case will need help from an independent orthopedic evaluation.
2. The Role of an Independent Examiner
Your independent examiner may be able to determine if the injuries were the result of a pre-existing condition, such as arthritis. They may determine that the worker can work at full capacity even despite the injury. They may discover that the treatment that the workers' compensation insurance provider would pay for is not necessary for the work-related injury. Even if the worker was injured initially, no further treatment may be necessary. Even if the worker was not able to work before, the independent medical examiner might argue that the worker is now able to return to work for light-duty work.
3. Uncovering Fake Injuries
In other cases, the independent medical examiner might discover that the injuries were faked by the claimant. Legal professionals and independent orthopedic evaluators will most often become involved when there are no witnesses to the accident or when your employee behaves in a strange way such as refusing the appropriate medical treatment or becoming injured right before the holidays.
When an injury is suspicious, this doesn't mean that the employee is necessarily faking the injury and an independent medical evaluation can clear this up so that the insurance provider can determine whether the employee should receive compensation for their injuries or if the claim should be denied or the benefits reduced.