The Myth Of The Bad Employee

Most workers' comp claims are not fraudulent--but many employers believe otherwise.


In fact, the longer workers stay away from the workplace, the less likely it is that they will return. Research confirms that there is only a 50 percent chance that an employee who has been absent for 12 weeks will return.

While injured workers need encouragement and nurturing, the employer's reaction--or lack of action--often aggravates the situation. Harboring feelings that injured employees are the "villains," the employer focuses on resolving the resulting production issues and has little or no contact with them.

The injured workers' sense of self worth spirals downward and distrust build. Litigation begins to look like the only alternative.

A report by the Chicago-based American College of Occupational and Environmental Medicine, Preventing Needless Work Disability by Helping People Stay Employed, notes that "only a small fraction of medically excused days off work is medically required--meaning work of any kind is medically contradicted. The remaining days off result from a variety of non-medical factors such as administrative delays of treatment and specialty referral, lack of transitional work, ineffective communications, lax management and logistic problems.

"These days off are based on non-medical decisions and are discretionary or unnecessary. Participants in the disability benefits system seem unaware that so much disability is not medically required. Absence from work is ‘excused' benefits are awarded based on a physician's confirmation that a medical condition exists."

Simply put, the claims become exaggerated when a worker gets hurt, gets frustrated, is not getting better and no one is talking to him. Eventually good workers slide into self-destructive behavior. Too many employers believe that these workers are malingerers, or crooks. Rarely do they recognize that the real threat is not the cost of the claim, but the loss of a valuable, competent employee who is unnecessarily out on disability that the system has regrettably created.

Workers' compensation is not "found" money. Unlike personal injury settlements, workers' compensation is a "no-fault" law and lump sum settlements are usually based on estimates of how long employees are likely to be unable to work.

Each state varies in the maximum and minimum amounts required for weekly temporary disability benefits, as well as in how any permanent disability is determined.

In addition to the physical pain and the loss of their self-image, injured workers can face financial difficulties. No one who has been out on workers' comp has improved their life.

To avoid this debacle, early intervention is key. Employers need to understand that workers' compensation is not strictly a financial issue, but a people issue. Bringing injured employees back to work as soon as possible in a medically approved capacity is the cornerstone of preventing long-term disability. When the people component is managed well there will be better financial outcomes.

Pennachio, CWCA (Certified WorkComp Advisor), is co-founder and director of learning at the Institute of WorkComp Professionals, Asheville, NC. He is also president of a workers' compensation insurance agency and a licensee and trainer for Injury Management Partners.

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