Is Proximate Cause Part of Workers Compensation Claim Investigation?

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Term Of The Day – Proximate Cause

The issue of Proximate Cause is one we see often in workers comp.

It is an act which sets off a natural and continuous sequence of events that prod

Graphic Of Man Proximate Cause With Foot Injured
StockUnlimited

uces injury. It is basic cause and effect- anytime you act, you start a series of events to occur, and responsibility for an injury should be placed on the negligent act that produced the injury.

The key point in the definition is that without that act, no injury would have resulted. This is where workers comp claims get tricky. Finding the true cause of an accident can become complicated. With many of the claims in workers comp dealing with Proximate Cause, drugs and alcohol are factors.

What if someone gets hurt on the job and it is discovered that they had been drinking or had taken drugs? The claim now has to go further to discover what the proximate cause of the accident was, and if it would have still occurred if the worker had been under the influence or not.

Many states, for example Ohio, have a workers’ compensation law that says an injury is not able to be compensated when the proximate cause of the injury is the employee’s intoxication or drug use. In most cases, though, it is found that the drugs or alcohol were not the causes of the injury.

Coming up, I will write a post with a few actual cases of proximate cause.

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Table of Contents

James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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