Legal and Forensic Evaluations
In the ideal world, worker’s compensation claims would be simple and straightforward. Either the injured employee would return to work or create a plan to do so as soon as possible, or the need for retraining would be obvious. Either way, the path forward would be clear.
But claims are not always that easy. In some cases, the process can drag out for years with vocational rehab counselors offering conflicting recommendations. Employers may have questions about the validity of certain aspects of the claim or want reassurance before moving forward with filing a lawsuit or issuing a protest. That’s where legal and forensic evaluations come in.
What are Legal and Forensic Evaluations?
When the worker’s compensation process has become murky or there’s some question about a claim, there may be a request for a legal and forensic evaluation. Reviewers performing the evaluation never actually meet with the injured worker; instead, they conduct an extensive exam of the entire claim, looking for errors or places where further inquiry might have led to a different result.
“It’s a deep dive into what’s happened. We’re looking to identify what could be done or what more could have been done from a vocational angle.” – Kevin Leneker, co-owner and founder of Single Handed Consulting.
Who Can Request an Evaluation
The Department of Labor and Industry (L&I) can request a legal and forensic evaluation. So can an employer or an attorney working on behalf of either the employer or the employee.
Why Employers Request Evaluations
When employers ask for an expert review, it’s often because they have a concern about some aspect of the claim. They may be considering filing a lawsuit or protesting a decision, but before they do so, they want to make sure they have a legitimate case.
Employers are also motivated to learn whether retraining is the only option for their injured worker. Costs of medical bills, time loss, and retraining have a substantial impact on businesses, driving up insurance premiums and affecting morale. By the time such an evaluation takes place, employers have often already spent significant sums and would like to avoid further costs if a viable alternative exists.
How The Process Works
Evaluators examine every aspect of a claim looking for mistakes, particularly when it comes to transferable skills that may make the worker employable. Sometimes, they see a recommendation stating the injured worker couldn’t return to their job of injury, which would take them into a retraining situation.
However, after looking at the file, Single Handed Consulting’s evaluators may find that mistakes were made in the initial assessment and the person is actually employable based on their job history. Factors like how long the person has been out of work and the state of the local economy at the time of injury all play into recommendations about employability and the dollar amount an employee should receive.
Results of Evaluations
Once the review is complete, evaluators submit a report to L&I either upholding previous recommendations or suggesting new directions, both medically and vocationally, for the injured worker. At that point, it’s up to the Department’s discretion to decide on the next steps.
How Employers Benefit
A recommendation that goes in an employer’s favor can save them huge amounts on vocational training. When two years of time loss plus retraining costs is added up, it can easily reach $100,000. Consequently, the outcome of a review can save employers’ both time and cost. Single Handed Consulting specializes in finding skills that could be transferable to another job.
If the results go the other way, employers still save through pre-empting expensive legal battles that they are unlikely to win. An expert opinion from Single Handed Consulting that everything was done correctly can leave no room for litigation.
Legal and forensic evaluations are relatively rare, but they can make a big difference in how a worker’s compensation claim impacts a business.
Learn more about how we at Single Handed Consulting can help you by contacting us today.