A 56-year-old education assistant claimed to injure her elbow while pulling a gate open at work. Some five months later, this California woman claimed to aggravate the injury to her elbow, at which time she first filed a workers’ compensation claim.
When ICW Group’s Claims Examiner contacted the injured worker, she avoided any questions about her injury history, ultimately opting to retain legal representation.
ICW Group initiated a deeper investigation into the claim for a few reasons:
- It was an unwitnessed injury incident;
- The injury was reported on delay; and
- There was clear hesitancy by the worker to discuss whether the elbow was previously injured.
This investigation revealed that this woman had sought medical treatment for her elbow about five months prior to when she claims to have injured it at work.
At the time of her deposition, this worker denied any problems with her elbow before the alleged incident at work. Further, when specifically asked whether she had ever been seen at the medical facility ICW Group’s investigation discovered, she denied ever doing so.
Pre-existing conditions and workers’ comp
An aggravation of a pre-existing injury condition may be compensable under a workers’ compensation claim. In this case, however, it was apparent that this worker was intentionally trying to hide the history of problems with her right elbow in hopes of having work comp coverage foot the bill.
The matter was referred to the Los Angeles County District Attorney’s Office. Following their investigation, criminal charges were filed against the education assistant. This worker is presumed innocent until found guilty in a court of law. ICW Group will continue to cooperate with law enforcement as this matter moves forward.
