Legal Question in Workers Comp in California
An employee was overheard by another co worker stating he hated his job and wanted to file a fraudulent workmans comp claim. He came into the office stating he hurt his back but then he stated he has had back problems all his life. Are we liable?
2 Answers from Attorneys
Will probably require litigation. Make sure the employee that overheard the other co worker is available at trial if it goes that far so it isn't hearsay.
An Employer has ONLY 90 DAYS from the date of the notice of the injury to deny the claim, and then the employer IS liable if it isn't denied.
A 'delay' notice should go out, a statement signed under penalty of perjury should be obtained from the co-worker and a general investigation with written statements from supervisors and co-workers about what was and wasn't actually seen and heard should be secured IMMEDIATELY.
Each day of the 'delay' status has $10,000 on the table for which YOU ARE liable until the date you issue the denial of the claim. So get the evidence from the people in the workplace, if it holds up that nobody saw any way for the worker to be injured and the co-worker who heard the plans to file a false claim is credible, get it to your insurance adjuster and demand a denial notice be sent out ASAP.
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