What’s in Your Tool Kit? Investigating Georgia Workers' Compensation Claims
By: Scotty Hoffman
It is never too early following a workplace accident to secure and review as much information and evidence as possible concerning the accident. Better informed employers and claims professionals have a greater chance of managing favorable outcomes from the accident for employer and employee alike, including potentially less costly claims. Depending on the accident and posture of the claim (if one has been filed), there are different investigative tools in the toolbox available in workers' compensation claims to help obtain as much relevant information as possible to manage, mitigate and posture potentially costly claims toward closure.
At the time of the accident, best practices and protocols include documenting the accident or mechanism of injury, the time, place and any witness observations. It is vital to obtain this information as soon after the accident as possible as memories fade with time, and employer witnesses may leave to work elsewhere. An accident report should be completed as soon as practicable regarding the circumstances of the accident. The panel of physicians should be presented to the employee and it is wise to have the employee acknowledge in writing that they received a copy of the panel for their selection of physician. Similarly, video surveillance or CCTV footage should be saved immediately as often these systems write over footage on a regular basis to preserve storage space.
Once the claim has been opened, the focus often shifts toward the claimant’s medical history. If there has been no hearing request filed and the claim is not actively litigated, the Board rules require the parties to exchange all medical records relating to the accident, and a WC-207 can be sent to providers to secure medical records as well, although these records are typically from the date of accident forward. A non-party request for production of documents can be sent to medical providers and typically returns a much more complete set of medical information if the claim is in active litigation. A WC-12/Request for Board records can be filed to obtain all documentation filed in other Georgia workers' compensation claims involving the claimant, and the Board’s response often contains information on prior types of injuries along with limited medical records.
Insurance services office (ISO) claim index reports and medical canvasses are typically lower cost, but often highly rewarding tools to use to obtain information on the claimant’s insurance claim history and prior medical treatment in a certain geographical area. It is a good practice to keep an eye out for workers' compensation claims filed in different states and motor vehicle accidents on the ISO report, as well as treatment with orthopedic or pain specialists on a medical canvass. This information can be kept in your back pocket for later use if there has been no hearing request filed, or subpoenas can be sent to the insurance companies and medical providers to secure those records.
Once a hearing request is filed, additional information regarding the claim can be gathered directly from the claimant in the form of written discovery, such as interrogatories, requests for production of documents and requests for admission. Additionally, the claimant’s under oath testimony concerning prior medical treatment, injuries and the claim can be secured via a deposition. That testimony can be compared to information already in hand to evaluate the claimant’s credibility and lead to other non-party avenues for securing discoverable information via RPDs.
In specific claims, using an investigative service to secure video of the claimant can provide the evidence needed to leverage a more reasonable settlement, especially where the footage shows the claimant acting far different or in excess to what is documented in the post-injury medical records and/or their deposition testimony. Helpful surveillance footage is not a guarantee, but careful planning and forethought before using surveillance – such as when the claimant will be out of the house for a medical appointment – is always a best practice to give the investigator the best chance of capturing useful footage.
The items outlined above do not comprise a complete list of all the methods and tools available in a workers' compensation claim, but knowing what to use depending on the posture of a claim will typically lead to a better chance of a favorable outcome for the employer and claimant alike.
Attorney Contact Info
Scotty Hoffman
scotty.hoffman@swiftcurrie.com
404.888.6285