Uncooperative Injured Workers: A 60-Second Seminar in Workers’ Compensation Claims Handling

Allow us to begin today’s blog by asking a question. “What happens when an injured worker is uncooperative in their claim for benefits?”  Presumably, the answer depends on the issue at hand and the degree of non-cooperation.  There are many forms of uncooperative behavior, ranging from failure to provide requested information during a compensability investigation to repeated failure to attend scheduled medical appointments.

Claims adjusters sometimes respond to an uncooperative claimant by denying liability.  However, if the claim was previously accepted, a suspension of benefits would be in order.  Regardless, if a denial or suspension is warranted, the claims administrator must be certain all activity is fully documented, including actions performed by the adjuster addressing the situation.  Experience has shown that the claims department is often blamed for not trying hard enough to resolve disputes.  A single attempt is insufficient.  Multiple attempts must be demonstrated, even when it is obvious that the fault lies with the worker.

A suspension of benefits is less harsh than a denial of liability and is the appropriate remedy for most situations involving non-cooperation in accepted claims.  When filing a Petition To Suspend we recommend that the petition be accompanied by a draft Order for the judge to sign stating, that unless an objection is filed within 10 days, all benefits are suspended as of that day without further order.

Another form of non-cooperation occurs when an injured worker fails to pursue a claim.  Obtaining dismissal for lack of prosecution is exceptionally difficult, as the applicant attorney will object, often asserting the injured worker has disappeared, but should not be deemed to have relinquished their claim.  Judges are somewhat reluctant to dismiss these cases as disappearance can be attributed to a variety of reasons, including incarceration (either domestic or foreign), illness, mental incapacity, and immigration issues.  However, disappearance can also be attributed to abandonment, laziness, or even death.  Much to the chagrin of employers, appellate case law has demonstrated that when an applicant reappears after their case had been dismissed, the claim is often reinstated by the WCAB.  Therefore, as a cheaper and more realistic alternative we recommend simply closing the file when an injured worker has disappeared, subject to reopening if need be.  This action is like what frequently occurs when an adjuster closes a file when a lifetime medical award is not being used.

Should any of our friends and clients require legal assistance as to uncooperative claimants, do reach out to the experts here at Friedman + Bartoumian.