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Q: Gout as bogus workman's comp claim ( Answered,   2 Comments )
Subject: Gout as bogus workman's comp claim
Category: Business and Money > Small Businesses
Asked by: bogus8-ga
List Price: $20.00
Posted: 04 Oct 2003 01:48 PDT
Expires: 03 Nov 2003 00:48 PST
Question ID: 262660
A fellow employee has foot pain, went to the Dr. and was diagnosed
with "gout" and has taken the next two weeks off, on anti-flammatory
medication and was to stay off her feet. While driving to my mother's
I passed this employee the very next day after diagnosis, walking with
her brother and her baby niece on the road with no sign of discomfort.
 I was very surprised and
started thinking.  Knowing her work habits and negitive attitude
towards working, could she collect on Workman's Comp and should I
inform my employer of what I saw? I'm in the middle here but I am more
on the side of my employer since I know her percentage rate will
increase if there is a claim and I feel it is a bogus claim if one is
filed.  How
should I handle this?
Subject: Re: Gout as bogus workman's comp claim
Answered By: pafalafa-ga on 04 Oct 2003 05:26 PDT
Hello bogus8-ga,

Interesting situation you've posted here.  As I'm sure you know,
there's no absolutely right or wrong answer.  You've asked for an
informed opinion, and I'm certainly willing to give you one.

If you find that, for some reason, my answer doesn't meet your needs,
just let me know by posting a Request for Clarification, and I'll be
glad to assist you further.



There's a strong case to made for not voicing your suspicions, largely
because there are some important elements about the situation that you
simply don't know:

--You don't know if your co-worker has even filed (or will file) for
worker's comp.

--You (presumably) don't know the full details of either her medical
condition or her doctor's suggested course of treatment.  Gout can be
mild or debilitating -- it's certainly possible that she can be
suffering from gout, but not have a constant, obvious limp or other
signs of great discomfort.  "Staying off her feet" means different
things to different people, but is a less draconian recommendation
than, say, full and complete bed rest, where one only gets up to go to
the bathroom.

Imagine if you, yourself, were advised to "stay off your feet" for two
weeks.  Do you really think you would interpret that as never taking a
walk at all?  Or never venturing outside for a short stroll?

It's possible that your co-worker is experiencing exactly what she
said she is:  a case of gout that is keeping her, for the most part,
off her feet, but for which an occasional short walk can be tolerated
without causing obvious discomfort, and without violating doctor's


On the other hand, your co-worker may simply be malingering.  It's
certainly not an unheard of situation.  From what I've seen of
disputed cases of sick leave or workers comp, however, your employer
would need considerably more evidence than you currently have that
your co-worker is faking her illness, or exaggerating the need to be
out of work.

The fact is, workplace managers are generally aware of the possibility
that someone is faking it.  Should your co-worker file a workers comp
claim, it's likely that your workplace has procedures in place to
evaluate the credibility of the claim, and to decide on the best
course of action, given whatever information and uncertainties exist. 
They will consider her entire personnel history -- including any
history of prior claims – looking for what the lawyers call a “pattern
of malingering and fabrication....”

I don't think the information in your possession -- that you saw her
taking a stroll -- would be a deciding factor one way or another.

It seems unlikely that management would act strongly in this case,
especially for an absence of only two weeks (if she were faking her
way through, say, six months of paid leave, management might be
motivated to have a professional investigator look into her situation
-- but for two weeks, they are unlikely to take such a drastic step).

If you're curious about such investigation services, you can visit the
site of Blackhawk Investigations here:

Blackhawk is typical of the types of professional investigation
services that exist largely to check out workers compensation claims,
or similar claims of illness or injury.


Bottom line -- leveling a charge against a co-worker, or even raising
a suspicion to management, has little to recommend it.

If word were to get out that you voiced your concerns, it could sour
your workplace relations with this person for a really long time. 
Even if you don't particularly care for her company, you may need to
rely on her in the workplace sometime down the road.  Is it really
worth the risk of ruining your working relationship by voicing
suspicions that don't have a lot of supporting evidence to back them

Nor is it outside the realm of possibility that you would be exposing
yourself to a possible lawsuit, if your co-worker feels libeled by
your accusations.

It's difficult to do sometimes, but this seems a case where the best
course of action is just swallowing hard, and keeping quiet.


I hope this sort of information and advice is useful to help you in
your decision.  As I said earlier, if there's any other information
you would like, just let me know, and I'll be happy to assist you

Good luck.

Clarification of Answer by pafalafa-ga on 04 Oct 2003 06:45 PDT
By the way, my search strategy for this question was a Google search on:

worker compensation claim

worker compensation malingering

worker compensation investigation
Subject: Re: Gout as bogus workman's comp claim
From: probonopublico-ga on 04 Oct 2003 03:57 PDT
A lot of folks are too ill to work (if they get paid for being off)
but well enough to do the things that they want to do.

If this woman has a sick note then she has a legitimate reason for
being off but ...

A quiet word with your employer would not be amiss.
Subject: Re: Gout as bogus workman's comp claim
From: research_help-ga on 04 Oct 2003 11:29 PDT
I happen to suffer from recuring gout. It is excrutiating pain in your
foot during an attack - so someone suffering legitamitely would not be
able to go for a casual walk.  Also, there are prescription NSAIDS
(non sterroidal anti inflammatory drugs) that can decrease the pain
within 2-3 days so 2 weeks off seems way too long for a recovery.

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