A Scandalous Proposal: Using Empathy to End Groundless Workers’ Compensation Claims

Ever wonder why so many workers are intent on pursuing worthless claims? And why those workers sometimes receive money for “nuisance value?” You are not alone.

The abuse of and over-reliance on the workers’ compensation system is no secret. The problem is so pervasive that insurance companies and administrators developed strategies to address fraudulent claims…everything from creating policy absolutely refusing to pay nuisance value, to requiring confidentiality agreements, to employing private investigators, to squealing on claimants to other government agencies (not recommended, by the way.)

News flash – none of these strategies is working. The frivolous claims, malingering workers, and contrived testimony just keep on coming. Especially now, facing a weak economy and high unemployment, people without health insurance are desperate for medical care and disability benefits. Having always worked and supported their families, many are new to this world of desperation, so they turn to the glimmer of hope they see on billboards and TV ads across North Carolina…workers’ compensation! Of course! A ticket out of this train wreck!

For workers who put all their eggs in the workers’ compensation basket, just imagine their distress to receive the Form 61 Denial of Claim. Naturally, if they think they have no options, they must challenge it by turning to litigation. Stop! What if the injured worker knew of other options more likely to yield fruit? In other words, what if an insurance adjuster did not just send a Form 61 Denial but went a step further, guiding the worker toward other government or private programs? By employing the classic parenting trick of “redirection,” adjusters and claims handlers might prevent a Form 33 hearing request, also known as a workers’ comp tantrum.

Enter Anders Newton’s scandalous new proposal:

Limit groundless workers’ compensation claims by listening to, empathizing with, and informing the worker.

Could compassionate and informative communication at the outset of a claim actually steer a worker in another direction? Armed with knowledge about other options, might that worker accept the futility of pursuing a workers’ compensation claim and go elsewhere? It might be worth a try:

  • Step 1: Ask the worker about his or her needs. Parrot those concerns and express empathy about the tough situation.
  • Step 2: Explain the limitations of workers’ compensation, the risk of sanctions, and the thorough nature of the investigation into the accident. Include details like the evidence gathered and an explanation of the nature of the denial.
  • Step 3: Steer the worker toward other sources of relief in North Carolina. One great website is NCCare360, where users can enter their location and find both public and private groups offering a wide array of assistance. For medical treatment, this list (written in English and Spanish) provides sources of free or low-cost medical care. Also, the NC Department of Health and Human Services hosts a help line at 1-800-662-7030 to counsel callers about sources of assistance. Medicaid, for example, may be available to cover medical expenses, even in certain cases with a modest deductible when individuals fall above the normal income cut-off.

If a worker knows that workers’ compensation is not his or her only hope, the likelihood of litigation – and litigation costs – may decrease. Like you, the workers’ compensation team at Anders Newton is frustrated by increasing numbers of groundless claims and is working hard to minimize defense exposure. Contact us at 919-516-8400 if you have questions about workers’ compensation claims.

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