To malinger is to pretend to be ill or otherwise incapacitated to escape duty or work. Malingering is in fact a legitimate psychiatric diagnosis. It's frustrating when you know in your heart that a Workers Compensation claimant is milking the system, and you may feel helpless because the claim has slipped into a quagmire of doctors, lawyers, and unaccountability.
The problem with the vast majority of Workers Compensation claims is the lack of accountability. Adjusters are too busy with other claims. You have other problems to handle. The attorneys and investigators are consumed with other cases. It shouldn't come as any surprise that 80% of all litigated Workers Compensation claims get to that stage because nobody has communicated with the employee, who is scared, confused, and frustrated by the system.
If you run a business, you can reduce malingering significantly if you attend to it at its beginning. The best defense against malingering is active involvement in the employee's claim, starting the minute you receive notice of a claim.
Someone in your organization (let's call him or her the firm's rep) should be responsible for ensuring that any employee making a Workers Compensation claim is promptly taken to a doctor, and for immediately informing the Workers Compensation claims department of your insurance company in writing and by telephone. The rep should transport the employee to the physician directly (unless, of course, it's a serious situation that requires the services of an emergency medical transport), and should stay at the doctor's office until any necessary examination and treatment are completed. The rep should then take the applicant home or back to work, as directed by the physician.
While at the doctor's office, the firm's rep should ask the physician about the status of the claimed medical condition, what the recommended treatment is, and what might be a reasonable return-to-work date-all in the presence of the employee. If the employee or physician objects to the disclosure of such information, advise them that you are ensuring Workers Compensation compliance, that you need to make sure the employer has sufficient resources to cover for the lost manpower, and that you'll be interfacing with the Workers Compensation carrier to ensure that all reasonable and necessary benefits and medical bills are paid.
If a claim is made from off premises (for instance, if you receive a claim form in the mail), contact the employee immediately and forcefully offer to take that employee to the doctor at that very moment. Do not wait for the insurance company to do so! Waiting for the insurance company to do this work will result in information and control over the case's medical aspects being lost. These days, medical control is paramount.
Resist any excuses the employee may make for not going to the doctor. If the objecting employee is represented by an attorney, ask him or her whether it wouldn't be wise to get a second opinion (which you will provide at no cost, of course). If the employee already has a doctor, offer to take him to his next appointment so that you can meet the doctor personally, with the employee. Offer to transport the employee to the doctor from wherever he is. If you can get the employee to the doctor, request the information just described: about diagnosis, return-to-work status, and reasonable treatment.
In any case, personally follow up with the employee at least every two weeks, and more often if possible (ideally, face to face-but if necessary by telephone). The point of this is to make sure that the employee knows that you're monitoring him closely when he leaves work for a claimed work injury. Follow up with the claims adjuster just as often to provide information that you gather in your visits with the employee and doctor, and to obtain any other information that may be crucial to returning the employee to work as early as possible.
Obviously, this is not going to work in all cases, but anecdotal evidence suggests that these techniques may reduce malingering claims by up to 70%. Remember, the sooner a worker returns to work, the lower your Compensation premiums will be. Taking an active interest in a Workers Compensation claim in this manner demonstrates to employees not only that someone is watching for possible fraud, but that they have an ally who cares enough to give personal attention in the event of a genuine injury.