To Certify or Not to Certify – That is the Question
By: Michael Reidy | 9/17/2011 | Category: Workers Compensation-Practical Advice
All workers’ compensation injuries are not created equal. The indemnity and medical expenses associated with one individual’s rotator cuff strain may be a small fraction of the expenses associated with the exact same condition in a different employee. What sometimes starts out as a rather innocuous sprain may lead to a monumental workers’ compensation claim; therefore, the decision to certify or reject a claim is fraught with peril. Employers must recognize that the value of a workers’ compensation claim depends on several factors, many of which are unrelated to the injury. The injured worker’s education, socioeconomic status, level of job satisfaction, marital status, financial prudence or lack thereof, and psychological health all need to be taken into account.
When I began my workers’ compensation practice as the in-house claims administrator for one of Cleveland’s auto companies, I will never forget two injured workers who were in my office within a week. I learned of the first employee’s injury, a hand contusion, not from the employee but from his lawyer’s letter. Before the employee had come to my office, he had already retained a lawyer and was “gearing up” for his claim. The injury was only a contusion, but the “writing on the wall” was clear from the outset. As it turned out, the claim featured unnecessary medical expense, an inordinate amount of lost time, and an attempt to maximize permanent partial disability. This employee was a general laborer in the casting plant who was a high school dropout with financial, as well as marital, problems. His personnel file demonstrated he knew how to “work” the company’s attendance policy and it also demonstrated alcohol-related issues. It was clear this individual’s degree of job satisfaction was incredibly low. His attitude was “you owe me.”
The following Monday, another employee was in my office with his dominant hand wrapped as large as a boxing glove. This gentleman was a first generation immigrant from Germany who was a highly skilled machine repairman at the upper end of the pay scale for the auto company. He had been married for over 40 years and lived in the same modest house in a west side Cleveland neighborhood. He had been educated in “the old country” as a machinist. He was in my office to explain to me that on Saturday while he was working overtime, his right little finger was caught by a machine and was amputated and never found. I asked the gentleman who his physician was and how long the doctor estimated he would be off work. The gentleman indicated that he was at the hospital on Saturday, took Sunday off, and returned to work the morning he was in my office. His supervisor had given him a clipboard and provided him with an inspection job relating to preventive maintenance on the company’s machines. On Monday, he was back to work full time, missing a finger on his dominant hand, whereas “contusion boy” would attempt to stay on temporary total disability for two and a half months.
The goals of both of these injured workers were apparent from the start and led to an entirely different handling of their workers’ compensation claims. The contusion was fought “tooth and nail” within the bounds of the law, whereas the amputation gave rise to no disputes. The bottom line is that it is not the injury alone which dictates how the claim will proceed through the system; it is also the sociological and psychological makeup of the injured worker. The difficult task for the decision-maker is to weigh these factors at the outset and make the right call.
Please feel free to contact Mike Reidy or any of the experienced workers’ compensation attorneys at RBS with questions or concerns regarding claim certification, or any other workers’ compensation issue on your mind.