When an employer fights a workers’ compensation claim, that dispute usually involves some dispute over the medical evidence and or a legal dispute as to whether an employee is covered by workers’ compensation.
But everyone once in awhile, employers deny claims purely because they don’t believe the employee was hurt at work. So, how does this happen and how can an employee protect themselves when it looks like their employer wants to railroad their workers’ compensation claim?
The presumption of fraud and confirmation bias
The insurance industry has grossly exaggerated the prevalence of workers’ compensation fraud. However the myth of workers’ compensation fraud is ingrained in the popular mind. That fraud myth is particularly ingrained into the human resources and employee health professions. Employee health and HR people tend to be responsible for initially investigating work injuries. Often this presumption of fraud leads management to seek out information about an injury that favors their views. The fancy term for this is confirmation bias.
So how does confirmation bias play out when a work injury is being investigated. Let’s say the injury is unwitnessed, the employee doesn’t exactly recall what time the injury occurred and that the employee had a subpar employee review. All of these facts can be woven into a story about why the injury didn’t happen and/or that the employee just made up their injury.
How an employee can protect themselves
The first thing an employee can do to protect themselves is to immediately report their injury and report it through the required channels. Legally an employee needs to report the injury as soon as practicable to someone in management
The worker should also make a report in writing via email, text or direct message to document what happened for themself. It doesn’t necessarily have to be a boss or manager, it can be a co-worker, friend or family member. Anything that would document when you got hurt, where you got hurt and what you were doing.
I want to emphasize that legally you aren’t required to report in your injury in the manner required by employer in order to have a work injury covered in Nebraska. But if you want to win your workers’ compensation case against an employer who doesn’t believe you got hurt, you should do as many of those things as possible as it makes it easier to prove you were hurt at work. The fewer of those things you do, the more expensive, time consuming and less certain it is you will be able to get a good outcome in your workers’ compensation case.
Unfortunately, a denied claim means you should contact an attorney. At least in Nebraska, an attorney has broad powers to investigate a workers’ compensation claim. In practical terms, that means an attorney for employee with a denied workers’ compensation claims can request company documents and even take statements from coworkers, supervisors and managers about why a claim was denied. An attorney can take apart an employers denial and more importantly persuade a court that an employee was hurt at work.