Denial of Workers’ Compensation Benefits for Lying on a Greenville or Spartanburg Employment Application

An employee who suffers a workplace injury that aggravates a pre-existing injury is still entitled to workers’ compensation benefits for the aggravation.  Neck and back injuries are common pre-existing conditions that can be aggravated depending on the employee’s job, however, medical conditions such as asthma can also be considered existing conditions that may be aggravated on the job.  There are limits on the kind of benefits that the employee may receive for preexisting conditions, and the employer may refuse to compensate the employee entirely if the employee was untruthful about a pre-existing condition during the application process for the position.

 

ADA Limitations

As an initial matter, employees should take note that the federal Americans with Disabilities Act (ADA) protects employees by limiting an employer’s ability to question a candidate for employment about a disability or a pre-existing condition at certain times in the employment process.  The ADA applies to private employees in South Carolina if they have 15 or more employees.  Because of the ADA, employers cannot ask questions that may reveal a disability until after an offer of employment, even a conditional one, has been made to the candidate seeking employment.  Employers cannot even ask whether the applicant has ever claimed workers’ compensation before for a work related injury, until after an offer for employment has been extended.

 

After making the employment offer, employers may choose to avoid direct questions seeking information on a candidate’s medical conditions or disability, and instead ask about the candidate’s ability to do the job.  These can be questions about a potential employee’s ability to lift objects up to a certain weight, climb ladders, and in some cases, depending on the nature of the position, employers may require a medical exam.  It is during this stage that potential employees may be tempted to provide less than truthful answers so as not to lose the job, especially for injuries that the employee has sought treatment or undergone rehabilitation and believes he has recovered from.

 

The Employer’s Defense

Lying about the existence of a pre-existing condition can later affect you negatively as the employer uses it as a basis not to pay your workers’ compensation benefits.  Some employers include a warning to potential employees on their medical questionnaires before an employee is hired, informing potential employees that lying on the forms can resulted in a denial of a workers’ compensation claim, or termination from employment.

 

There have been cases in South Carolina that support an employer’s position on this matter and deny an employee’s claim for workers’ compensation benefits if an employer can show that;

  1. the employee intentionally lied about the preexisting injury,
  2. the employer relied on the lie as a substantial factor in hiring the employee, and
  3. once the employee is injured, the injury is found to be causally related to the lie about the pre-existing injury.

This can happen where an employee lied to the employer during the hiring process and said that he did not have a history of back problems, and that he could perform the duties of the position, most of which included heavy lifting.  Relying on this representation by the employee, the employer hired the employee and the employee later suffers serious back injuries after lifting a heavy package as part of his employment.

 

If the employer cannot prove all three of the conditions listed above, the employer cannot use the employee’s false statement on the application to deny workers’ compensation benefits.  For example, even if the employee lies about a prior injury, but the employer cannot show that it substantially relied on this misrepresentation when hiring the employee, or the resulting injury is not related to the pre-existing injury, then the employer cannot use the misrepresentation as the basis for denying workers’ compensation benefits.  If a medical doctor can state that an employee’s injuries would have occurred to the degree they did just from the workplace injury, and independent of the pre-existing injury, then the employer cannot prove the connection needed for the third part of the defense.

 

Answer the Questions Asked

Employees should remember that if they are applying for a job that they can perform with reasonable accommodation on the employer’s part, an employer cannot legally refuse to hire them based on a disability.  Therefore, considering the potential loss of the protection of workers’ compensation benefits if a potential employee lies on an application, when asked, the potential employee should properly disclose all pre-existing injuries that may be relevant to the position for which he is seeking employment.

 

However, the kinds of questions asked in the medical questionnaire or conditional offer can make a difference to whether an employee’s answers are seen as willful or intentional lies, or as simply answering the questions asked.  For example, if the medical questionnaire asks generally whether a potential employee is a smoker, drinks alcohol or is diabetic, but never asks about physical injuries, an employee who fails to disclose a prior back injury may not be determined to have lied about his pre-existing condition, even if it is aggravated in a workplace injury later on.

 

Beware of Workers’ Compensation Fraud

It is also not a good idea to try and pass off a past injury as having being fully caused by an accident at a current employer’s workplace.  The employer in most cases requires the worker to go to an employer doctor for assessment, and a doctor would generally be able to identify pre-existing injuries and differentiate them from a more recent injury.  Trying to pass off an old injury as a new one can result in being accused of workers’ compensation fraud.  Workers’ compensation fraud could result in more than just a denial for benefits, as the employee could be prosecuted.

 

Speak to a Workers’ Compensation Attorney

Pre-existing injuries or disabilities are not an automatic barrier to receiving workers’ compensation benefits if you are injured on the job in Spartanburg, South Carolina.  Consulting a dedicated Spartanburg workers’ compensation attorney is important to ensure that you receive all the benefits the law guarantees you for your injuries.  To get started on your claim or receive an evaluation of your claim for benefits, contact the workers’ compensation attorneys at Greenville’s Bryan Ramey & Associates.