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2 times a business can seek to end workers’ compensation benefits

On Behalf of | Aug 6, 2023 | Fraud

Companies that hire workers in New York have to protect themselves from liability. One of the many requirements the state imposes on employers is an obligation to carry workers’ compensation insurance in case someone gets hurt on the job.

Some companies purchase a policy provided by an outside insurance organization. Other businesses with sufficient resources and operational success may meet the state standards for self-insuring. Regardless of which approach an employer utilizes, a sizable claim by an injured worker will lead to direct expenses for the organization either in the form of medical payments and disability benefits or increased workers’ compensation premiums.

Sometimes, employers have the option of seeking to end benefits because of a worker’s misconduct. The two situations below are among the most common scenarios that may lead to the early termination of a worker’s benefits for this reason.

When a worker hurt themselves on purpose or due to impairment

The investigation into a worker’s injury may take weeks to complete. The business may need to look at security camera footage, interview other employees and possibly even look into someone’s social media activity. In scenarios where a business can prove that someone got hurt because they were under the influence of drugs or alcohol on the job or where there is reason to believe that someone hurt themselves on purpose to defraud the workers’ comp system, their employer may be able to end their benefits because they do not technically qualify for coverage.

When a worker does not follow medical recommendations

Professionals managing the care for an injured employee may recommend physical therapy, modifications to someone’s daily life or even surgery. Patients generally have an obligation to either abide by a doctor’s recommendations or actively seek a second opinion. Simply choosing not to follow through on a doctor’s recommendations might make someone’s lingering symptoms at least partially their own responsibility. Employers can successfully defend against future medical claims and ongoing disability benefits when a worker has proven medically non-compliant and does not adhere to the recommended treatment protocol.

Employers who understand the scenarios in which they can minimize their responsibility to a worker can more effectively control their costs. Learning about these situations in which a worker may be at least partially to blame for their own medical issues may help employers more effectively resolve claims filed by those employees in ways that are both fair and appropriate.

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