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Misrepresentations in Hiring and Subsequent Claims for Workers' Compensation

Imagine that a few years ago, you were in an accident and injured your back. As a result, you went to a chiropractor and a physical therapist and you felt that the situation was under control. Years later, you are sitting in an office filling out an application for a new job. You are asked a number of questions about your medical history. You forget to mention your back problems, you think it is no longer relevant, or you decide that you do not want your employer to know. You get the job. One day, while working, an accident occurs and you find out that your old back problem has been aggravated. You cannot work and need physical therapy, so you submit a claim for workers' compensation benefits. During the review process, your employer discovers that you have had problems with your back before. Your employer notices that you did not disclose this information on the pre-employment health questionnaire. Your employer tells you that you cannot get workers' compensation now because you lied at the time of hiring and did not disclose your pre-existing back injury.

This type of situation is not uncommon. People neglect to disclose important information about their health or simply choose to hide it. When workers' compensation benefits are needed, the issue ultimately arises. The employer argues that they should not be responsible for the aggravation of the injury because they did not even know about the injury. How could they prevent aggravation of an injury of which they were not aware? Furthermore, they argue that they would not have hired the employee if the true medical conditions were known. They say that they have no obligation because employment was obtained by fraud.

These are some of the arguments an employer may, or may not, utilize in this situation. The question is, will the employer succeed with these arguments? It depends. Each state has its own workers' compensation laws and its own rules when it comes to the effects of misrepresentations made at the time of hiring. In some states, misrepresentations at the time of hiring regarding your health or physical condition will prevent you from obtaining workers' compensation benefits, in other states, it may not.

If states wish, they may pass laws that clearly state whether or not misrepresentations at the time of hiring affect an employee's ability to make a later claim for workers' compensation. Some states have done just that. Most states, however, have not passed such laws. In those states, it is up to courts to decide what impact misrepresentation should have. Courts look at the workers' compensation statutes to determine what the legislature intended. By looking at state statutes and other information, a court will typically determine the policy priorities of the legislature. Is it more important to make workers' compensation accessible and easy to get, or is it more important to discourage people from lying to their employers about their health? Courts may consider questions such as these, and many more, in order to determine if misrepresentations at the time of hiring should affect an employee's ability to get benefits.

In states that have ultimately decided that misrepresentations at the time of hiring can bar workers' compensation benefits, most have adopted a test to determine if an individual should be precluded from getting benefits. Not everyone who lies about their health is prevented from getting benefits. If you fail to disclose the fact that you had a particular disease, for example, and then a box falls on your head at work, your misrepresentation about the disease will not necessarily prevent you from getting benefits for your head injury; the issues are unrelated. In some cases, however, anymisrepresentation at the time of hiring could be viewed as fraud and could cause problems that go well beyond a denial of workers' compensation benefits.

In general, in order to bar someone from obtaining benefits, it must be shown that the misrepresentation was intentional, that the statement was an important factor for the employer (i.e., that they relied on the information in their hiring decision) and that there is a causal connection between the statement and the current injury. If all of these factors are shown, the individual may have forfeited their right to workers' compensation for this injury.

Although several states use a test like this, there are many more states with entirely different schemes for dealing with this type of dilemma. Many states have laws more favorable for employees because they want workers' compensation to be able to fulfill its function of providing quick and efficient remedies for workplace injuries. Since the matter varies so much from state to state, an employee who is worried about misrepresentations they may have made should consult an attorney to learn more about their state's views.

Will Misrepresentation at Hiring Prevent Me from Claiming Workers' Compensation?

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Will Misrepresentation at Hiring Prevent Me from Claiming Workers' Compensation?

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