At some point during your workers’ comp claim, there is a fair chance that adjusters will hire an investigator to double check if your injury is genuine. In order to retain the workers’ compensation benefits to which you are entitled, this blog post provides a list of things you should NOT DO.
Before we forget, though, it’s important to remember that you should also read up on the work comp laws related to your specific state, because these laws usually vary for each of the fifty states.
Were you injured on the job and have not reported it to your employer? If so, stop reading right now and report it immediately! Most states provide that an employee has to report the work injury within 30 days to qualify for work comp benefits. That’s a generous window but it would really help your case if you actually report it immediately, or at the latest, within 24-48 hours of your work injury.
And we’re not even talking about just verbally telling your boss or your HR department about the accident. You must ensure that a First Report of Injury is filed. It’s quite common for injured workers to overlook this and it has caused major problems. One of the best reasons is that the longer you delay in letting your employer know about your injury, the more likely they will become suspicious.
Tell your doctor everything you can about the details of the injury you suffered from your accident at work. When the work comp doctor asks “how are you?” don’t respond with “I’m okay” or “fine.” Be aware that it’s not simply about exchanging pleasantries but rather he/she is actually asking from a medical perspective.
Recall as best you can exactly what happened and be absolutely honest about your symptoms or injuries and any changes related to it, no matter how minor you think they are. Don’t skip any details - be sure to provide a thorough and accurate medical history. A lot of patients think that pre-existing conditions may discredit their claim, but being genuine and sticking to the facts lends integrity to you and your case.
The point is, if you are not feeling better, let your doctor know. Don’t downplay your injury or put off medical treatment either. The insurance company or your employer will think your injury is not as serious as it is. Furthermore, if your injury is getting worse, no need to exaggerate (more on this below). Just be honest and straightforward about the entire thing.
Yes, it can be tempting to exaggerate your injury or symptoms in an attempt to strengthen your work comp injury claim - but DON’T DO IT! If your employer, doctor, or adjuster finds out it may mean the end of your work comp case.
Always remember that work comp doctors will perform several tests to examine your injuries and they will definitely know whether you’re exaggerating or not. Worse, you will potentially destroy your medical record by being labeled as a ‘malingerer’ which means someone who fakes or exaggerates injuries.
This essentially not only weakens your claim but you may create cause to dismiss it altogether. Bear in mind that insurance fraud is illegal in all 50 states.
Choice is a fundamental right and, depending on the state, that includes choosing the doctor who will treat your work injury. This is a common mistake especially in large companies where there are staff doctors or those on retainer for work-related injuries. While it may be well-meaning, it’s imperative that you select a doctor that you know and trust will help you get back to work. You must know that neither your employer nor their insurance company can force you to go to a specific doctor of their choosing.
If you’re choosing your own doctor, though, make sure they are certified to handle work comp cases. There are websites such as Workers-Compensation-Doctors that are 100% devoted to listing doctors qualified to work in this area of practice.
A lot of patients tend to think of treatment to be like aspirin - take one or two and you'll be better. That’s a big no-no that can totally diminish your work comp claim.
To put it simply, follow your doctor’s advice. If your doctor requires you to undergo therapy or do follow-up tests, it is imperative that you comply even if you think you are feeling better. It is also quite normal to feel better during treatment but your injuries or symptoms may return or even worsen once treatment is discontinued.
If you wrongfully assume and end up discontinuing care, your employer or the insurance company might think that you did not need to file a work comp claim in the first place making it easy for them to argue that your injuries are not as bad as you made it out to be.
Your treating doctor may allow you to return to light-duty work. If so, it would be best to follow that advice. Failure to do so will make your employer think you simply do not want to get back to work.
However, if you have any concerns or if you think you cannot perform any of the duties being asked of you, discuss it with your doctor. If your doctor still feels otherwise and sends you back to work, do so but document any discomfort, pain, or other symptoms that arise so they can make adjustments to your duties as necessary.
Patients sometimes tend to think they are actually feeling better even when they’re not. In such cases, they become tempted to do more than the doctor allows them to. And it’s not necessarily limited to when you’re inside the workplace.
It could be menial tasks such as carrying a heavy bag of groceries, picking up a heavy package you just received, over-exerting your body to get something for your top shelf, etc. If your doctor hasn’t given you clearance, wait for necessary help. Those who are living alone are always encouraged to seek a friend or a relative’s assistance to look after them while recovering to their pre-injured state.
What’s worse is that if you get caught in the act of picking up a heavy package by an overzealous insurance adjuster or you overexerted your injured limb by getting an item from the warehouse and forgot about the CCTV camera at the end of the aisle - they may sound extreme but these rare instances may end up discrediting your work comp claim altogether.
Insurance companies may ask you to sign a medical authorization or give a recorded statement. Don’t do it. In fact, patients are not required to do any of those even if the insurance company tells you they can’t proceed with your work comp claim unless you sign certain paperwork.
You may hear all kinds of reasons such as “it is part of our procedures,” or “your employer requires your signature before you get paid,” or “we need your recorded statement to push through with the claim.”
Just know this: there is no state rule or law that requires you to sign a medical authorization or give a recorded statement. While it may in fact be the insurance company’s policy or procedure, that does not necessarily mean you must do so.
The workers’ compensation system is full of obstacles and pitfalls and has caused patients to become frustrated, intimidated, or just plainly unsure of what to do - more so when the insurance company accuses you of workers’ compensation fraud. Remember that it is part of insurance companies’ jobs to look for loopholes in your case in order to deny your claim. Therefore, it is important to follow the tips mentioned above so as to avoid any hiccups in your work comp claim.
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