IWIF’s Claims and Legal team worked together to successfully defend this claim. The team established that the claimant in this case had arthroscopy performed in 2004, and that the MRI offered in court was actually taken prior to the alleged date of injury. The team also secured a witness from the employer who testified that the claimant never filled out any of the paperwork after the alleged injury occurred. On cross-examination, the claimant admitted neglecting to advise anyone of the alleged incident until sometime later. When pressed, the claimant could not even remember when the incident was reported. The claim was disallowed.
IWIF claims and legal professionals worked together to successfully defend this claim of accidental injury. The claimant in this case alleged an injury as result of a fall in June 2012. Specifically, the claimant professed to tripping over a chairlift and falling while carrying a food tray downstairs. During the hearing, IWIF was able to elicit numerous inconsistencies in the claimant’s account of the events, including the fact that the claimant had only worked for the employer for two-and-a-half days, not the several weeks that was claimed. Additionally, IWIF was able to use records from Sinai Hospital, where the claimant went for treatment, to point out further inconsistencies in the claimant’s story. The Commissioner denied the claim.
Employer’s TIP:Remember, prompt and thorough investigation of the claim starts with you. Report injuries immediately. The more information IWIF has to prepare for a possible hearing, the stronger our case. Please work with your claims adjuster by staying involved throughout the claims process.
Compensable Injury – An injury caused by an accident arising from the employment and in the course of the employee’s work. The employee is entitled to receive compensation.
Maximum Medical Improvement (MMI) – The point at which the condition of an injured person is stabilized. No further recovery or improvement is expected, even with additional medical intervention.
Temporary Total Disability (TTD) – A condition where an injured party is expected to recover, but is unable to work at all during the recovery period. Compensation is paid at 2/3 the average weekly wage, not to exceed the state maximum or go below minimum.
Temporary Partial Disability (TPD) – A condition where an injured party's capacity to work is temporarily impaired, but he or she is able to continue working in a reduced manner and is expected to make a full recovery. Compensation is paid at 50% of the difference between the average weekly wage and the present wage earning capacity not to exceed one-half of the state’s average weekly wage (TTD rate).
Permanent Partial Disability - A condition where the injured party's earning capacity is impaired for life, but he/she is able to work at any gainful employment for his/her remaining lifetime. Maximum permanency rates vary by weeks/length of the award and the affected body part(s).