Investigating and Handling Suspect Claims

A. Be Organized and Prepared

At hearing, commissioners want accurate Average Weekly Wage (per wage statement), temporary total dates, documents in order, organized defense.

B. Reputation of Company and Counsel with Commission

Affects whether or not Commission will exercise its discretion to hear issues raised belatedly, may limit amount of permanent partial awarded, may discourage commissioner from imposing fines.

C. Defending Cases

Money well spent! Investigation, recordation, and communication will pay off.

1. Being prepared lets defense lawyer use ingenuity.
2. The confident defense lawyer — ammunition leads to victory.
3. Send all previous medical records to independent medical examiner for opinion.

D. Accidental Injury Defense

Claimant’s statements to hospital and first treating doctor may indicate no accidental injury.

E. Causal Relationship Defense

Investigate for prior or subsequent cause for complaints. No aggravation by accident.

F. Intoxication Defense

No accidental injury if injury caused by intoxication, but can be tough defense to prove. Often, automobile accidents involved. Result of blood alcohol tests and police investigation are key evidence. Hospitals routinely do drug screen tests, if suspected to be cause of accident.

G. Consolidation of Cases

Consider getting all pending priors in one hearing, even if unrelated.

Back to Workers’ Compensation Resources

In addition to aggressively pursuing defense of our clients’ interests, each spring, we present a free seminar to update employers, insurers, third-party administrators, and others on recent developments in workers’ compensation law. If you wish to be added to the mailing list for next year’s seminar, contact Marilyn N. Harvey.

The Gallery Building Suite 130 5712 Cleveland Street Virginia Beach, VA 23462 Ph: (757) 466-0464 Fax: (757) 466-8242 Email: