Unfortunately, there are often reports of cases in which employees in California and elsewhere take advantage of the system by filing fraudulent claims. Sometimes the validity of the claims are difficult to challenge, and experienced employer defense may be required to protect the business owner from unnecessary increases in insurance premiums. A case that went all the way to the special workers' comp branch of the Supreme Court in another state demonstrates just one of the tactics of some workers filing fraudulent claims.
The worker who filed the claim was a nurse manager in the employ of a mental health management concern. In 2012, his employer required him to attend a conference that would help him in his task of determining patients' suitability for admission to the psychiatric unit. The worker claims that the session leader at the conference told the attendees to picture themselves in the positions of patients when asking them about any history of physical, emotional or sexual abuse.
The worker, who claims to have suffered such abuse as a child, says this experience at the conference caused him to become emotionally overwrought. He asserts that he has suffered from Post-Traumatic Stress Disorder ever since, rendering him unable to work. His claim for workers' compensation benefits was rejected by his employer. At a subsequent trial, the court determined that the worker's PTSD did not arise from a workplace incident but rather from a bad experience in his youth. The decision was later confirmed by the Supreme Court.
California business owners typically have multiple responsibilities and may struggle to find time to deal appropriately with each workers' compensation claim. However, failing to assess each claim may be detrimental to the bottom line. Although an experienced workers' compensation attorney can provide effective employer defense in cases of employee fraud, he or she may also provide guidance in assessing claims and identifying potential insurance fraud.
Source: safetynewsalert.com, "Can nurse get workers' comp benefits for PTSD?", Fred Hosier, Jan. 27, 2016