Benefit of the Doubt

Caroline Ward-Kniaz and Al Weir, team members of the TRIUNE Health Group Vocational Department, collaborated and provided documentation to bring this file to an optimal resolution.

The case involved a 63-year-old Injured Worker (IW) who was referred for Job Placement 19 months post-injury. He had undergone right bicep tendon repair and left knee arthroscopy. He had also sustained a right shoulder tear, left shoulder strain and had left Carpal Tunnel Syndrome. Despite the multitude of issues, the IW was released to lifting up to 60 pounds and no overhead lifting over 30 pounds. The employer of record could not accommodate these restrictions.

The IW had been employed as a loader operator for over 20 years with one employer. He did have a high school diploma and resided in a small town. His appearance was less than professional and he struggled with writing and spelling. The referral source was advised that this would be a difficult placement file given the IW's age, limited education, limited work history, geographic location and hourly wage of more than $29.00 at the time of injury. Despite the barriers, placement efforts were pursued. Job Seeking Skills Training was provided, various resumes developed and a Rehabilitation Plan agreed to.

At TRIUNE Health Group we believe in the dignity of all people and tend to trust that we are receiving a good faith effort until we have cause to believe otherwise. For this reason, we perform routine verification of IW/potential employer interactions and make every effort to validate information reported by the IW in job placement meetings. In this case, a pattern of IW deception related to the extent of his physical restrictions emerged. The IW also misinformed potential employers about his driving abilities, what he would accept in wages (always consistent with his pre-injury wage) and as already noted, physical restrictions exceeding those imposed on him. It was noted by several potential employers that the IW did not appear to want a job. The IW was counseled to cease this behavior, but it persisted.

The information was shared with our Account and the IW's TTD benefits were terminated. The case was settled and we were advised that the verification documentation solidified the defense of the file which never went to trial.