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Workers’ Compensation Claims: The Initial Hurdles

In general, a claimant for workers’ compensation benefits must first prove that the injury was sustained in the performance of his or her duties as alleged.  The claimant must describe the occurrence of the injury as well as the time, place and manner of the incident.  Witnesses are helpful in confirming that the injury was suffered in the performance of the claimant’s duties, but note that the lack of witnesses does not necessarily lead to the denial of the workers’ compensation claim.


A proper evaluation of the workers’ compensation claim would also include corroboration of the claimant’s statements with the surrounding facts and circumstances and his or her subsequent course of conduct.  Claimants should be cautioned that significant inconsistencies between statements and investigative evidence may cast serious doubt upon the validity of the claim and lead to the denial of workers’ compensation benefits.


Evidentiary Evaluation of a Claim


Take for example a claimant who alleges that he suddenly slipped on his employer’s floor and injured his back.  He claims that he just poured himself a cup of coffee and suddenly found himself on his back and in great pain.  Assuming there were no other witnesses, the claimant’s statements must then be evaluated by investigating the details of the surrounding facts and circumstances.


Suppose investigative photos reveal where the claimant fell on his back but there is no spilled coffee on the floor.  Additional photos also show a small puddle of water several feet from where the claimant fell but no other debris or obstacles on the floor.  There are a few inconsistencies here.  There is no spilled coffee on the floor despite the claimant’s statement that he had just poured himself a cup right before his fall.  In addition, the only debris or obstacle that the claimant may have slipped on was some distance away.  These type of inconsistencies may cast serious doubt upon the validity of the claim.


Taking this a step further, suppose investigators locate a witness who had observed the claimant a few minutes before the injury happened.  The witness co-worker tells the investigators that he was walking by and saw the claimant walking back and forth in the room, muttering to himself and seemed agitated.  The witness then saw the claimant lay on the floor and get back up, only to pace again.  The witness stated that he was going to check in on the claimant but needed to complete a quick task first.


As you can see, the claimant’s allegations here are now in serious doubt.  The claimant could not provide specific details as to how the fall and injury occurred.  The photographic evidence also did not support the claimant’s statements.  And now, a witness appears to have observed the claimant behaving in an odd manner right before the injury.


Details and evidence are crucial to a workers’ compensation claim.  A skilled workers’ compensation attorney will know how to ferret out the important details and gather the supporting evidence.  Consult with a lawyer to properly evaluate your options and to assist you in documenting, establishing and filing your workers’ compensation claim.

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