Apportionment With the recent changes in the apportionment law, AOE/COE investigators need to delve more deeply into the past medical and employment history of the claimant so that the proper apportionment can be applied to the claim. If the investigator believes, once again, that the defense attorney will take care of this aspect of the case, they will more than likely be mistaken. Applicant attorneys are very good at coaching their clients. While not telling them to lie, they will certainly inform them what the defense attorney will be looking for and what type of questions they will be asking. Moreover, when you perform an AOE/COE investigation the investigator is typically at the claimant’s house and, therefore, the employee might have direct access to their past employment paperwork, insurance information/cards, physicians names, addresses and all other relevant information that they might “forget” when present for the taking of their deposition. I have read statements where the investigator asks about previous doctors, but not about their addresses, Health Plans, spouses health plans etc. To maximize the potential for apportionment, a thorough employment and medical picture has to be painted. Lastly, it is more likely that an investigator can gather crucial information not only because of where the statement is taken, but also because the claimant is not defensive. The setting is more informal, as there are no lawyers or court reporters to intimidate them. Psychiatric Claims – Affirmative Defenses The filing of a psychiatric claim has become less commonplace ever since the law changed the percentage of industrial stress required to make the claim industrial in nature. The old standard used to be 10% related to work, which seemed extremely low. However, on July 16, 1993 the law changed to provide that an employee filing a psychiatric injury must prove by a preponderance of the evidence, that actual events of employment were predominant as to all causes combined (unless resulting from violence). In addition, the law requires that the employee must have been employed for at least six months. Although this new law tightened and restricted the amount of stress claims being filed, it was only as good as the investigation utilized to counter the subjective complaints made to the applicant’s psychologist or psychiatrist. For example, most applicants will provide their physicians with a glowing assessment of their personal lives outside of work, while at the same time depicting the employer as a modern-day Hun. |