There Can Be Many Secondary Benefits to Being Off Work
I was reading a parenting magazine the other day about how parents sometimes tell little lies to their kids in order to get what they want. These aren’t major lies, but little ones that have a common goal of getting your younger child to leave a playgroup, or to eat something they really don’t want to eat.
I thought about how in the claims world it is often the claimant that tells fibs about their injury or pain in order to get what they want, which is often the goal of stretching their time off away from work. So why would some people lie about their injury? Isn’t the goal about getting better so you can return to work?
The answer here is yes–most people are honest and just want to get their injury over with. But there are others that will stretch the trutha bit in order to remain out of work. We call this “Secondary Gain.” This can be a very important part of the claim, whether it is in litigation or not. So what are some red flags to look for that could indicate a person has secondary gain issues?
The claimant has an infant or young child.
Daycare is very expensive! For many people, daycare costs are more than their house payment. It is not uncommon to pay over $2,000 a month to have 2 children in daycare during the workweek
It is easy to understand how claimants that have kids are more likely to attempt to stretch their time out away from work. In addition to their wage loss checks, they have other savings that include decreased daycare costs.
This is an unforeseen cost to the claim overall. If my injured worker, who is already receiving wage loss benefits, is also able to save $2,000 a month by being able to watch their own kids while off of work, they really have little incentive to rush back to work. They are making more money by not working than by actually working.
For example, I had a claimant that was off work with an ankle injury while his wife gave birth to their first son. Soon after, his employer mentioned to me that this person was not dropping off his medical slips at their HR office, and he was not as quick to return my calls to check up on how he was doing and how he was feeling. It seemed like whenever the employer had a light duty job open up, he was a lot harder to get a hold of.
Then I noticed in the medical records that he seemed to be moving backwards, complaining about increased pain and how his treatment was no longer helping him, when just before the birth he had mentioned how he was feeling better and was excited to return to work.
He did not tell me about the birth of his son, and as soon as I found out I was able to piece the puzzle together as to why his claim was suddenly at a standstill. Be vigilant about this issue, and use an IME or surveillance to your advantage in this scenario so you can keep the claim moving forward.
The claim is in litigation
Plaintiff attorneys know that the longer a person is off of work, the more wage loss benefits they accrue. This increases the value of their claim, resulting in larger settlement exposure. If a claim becomes litigated over any issue, you can guarantee that the worker will try to stay off work or totally disabled as long as possible.
Again use the IME and surveillance to your advantage. Call the employer and try to create a light duty job if none was previously available. This will decrease your wage loss exposure, and if an injured worker refuses a light duty job that was offered to them within their medical restrictions, you can end that wage exposure and keep a strong defense throughout the course of the litigation.
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