Investigating Workers’ Compensation Claims
By: Steven Babitsky, Esq.
Early thorough investigation of workers’ compensation claims can make the difference between paying out hundreds of thousands of dollars and effectively denying and defending the claim. All too often the claim is “accepted” at face value with little investigation. Here, the insurer or self-insurer accepts liability and is on the hook for the remainder of the life of the claim. It is only months or years later that someone actually asks:
- How did this injury actually happen?
- Was it really work-related?
- Should this claim have been accepted initially?
Attorney Kevin M. Gillis of the Portland, ME firm of Norman, Hanson & DeTroy presented at the SEAK 32nd Annual National Workers’ Compensation and Occupational Medicine Conference.
He outlined the initial steps that need to be taken during an effective investigation of a workers’ compensation claim:
A. Statements from Claimants
- Description of Injury
- Identification of Witnesses
- Circumstances of Injury
- Claimant’s Background and Employment History
- Medical History and History of Injuries
- Recreational and Athletic Activities
B. Interviewing Witnesses
- Eye Witnesses
- Supervisors and Management
C. Information from Personnel File
- Educational and Employment Background
- Criminal History
- Evaluations and Disciplinary History
- False information provided
D. Viewing the Scene
Kevin Gillis Esq. is a trial lawyer at the Portland, Maine law firm of Norman, Hanson & DeTroy. Kevin has been representing employers, insurers, third-party administrators and self-insurance groups in the areas of workers’ compensation, employment law, and insurance regulation for more than 30 years. His experience includes the resolution of literally thousands of workers’ compensation matters at the hearing level, and several appeals before the Maine Supreme Court. He has a great deal of experience in litigating workers’ compensation matters not only before the Maine Workers’ Compensation Board, but also before the U.S Department of Labor under the U.S. Longshore and Harbor Workers Compensation Act. Kevin has also defended employers against claims of employment discrimination under the Maine Human Rights Act and under federal discrimination laws. His experience includes the handling of jury and non-jury trials in the Maine Superior Court. He has also argued several appeals to the US Court of Appeals for the First Circuit, and is one of the few lawyers in Maine to have argued before the US Supreme Court. A frequent lecturer at industry meetings, Kevin is co-author of Maine Employers’ Guide: Workers’ Compensation. Kevin has been recognized for legal excellence by his peers by being selected in the 2008 through 2010 versions of Best Lawyers in America.
The SEAK 33rd Annual National Workers’ Compensation and Occupational Medicine Conference will be held on July16-18, 2013 on Cape Cod, MA.
Steven Babitsky is the conference leader.