Without workers' comp benefits, it can be difficult to make ends meet after a work injury. Unfortunately, too many injured workers make simple, but costly, mistakes during the workers' comp claims process. If you're injured at work, it's important to understand your legal rights and responsibilities. Here are some practical tips on how to get the most out of your workers' comp claim.
The first thing you should do after a work injury is immediately report it to your boss. Every state requires workers to give notice of their injuries by a certain deadline, which varies significantly by state. If you miss the deadline, you might lose your right to collect workers' comp benefits. In some states, you'll also need to file a workers' compensation claim form by a certain date in order to officially start your claim. To learn more about these requirements, read our article on filing workers' comp claims.
You should seek medical treatment as soon as possible after your injury. Prompt medical care can lead to a quicker, fuller recovery. It also serves as important medical evidence in your workers' comp claim by documenting your accident and describing your injuries and physical restrictions. If you delay in getting treatment, the insurance company could argue that you weren't as seriously injured as you say you were—or that your injury never happened at all.
In many states, workers must initially treat with a doctor chosen by the insurance company. When you treat with the insurance company's doctor, there is a potential conflict of interest. These doctors are paid primarily by insurance companies and may not always have your best interests in mind. For example, the doctor might minimize your injuries and treatment so that the insurance company won't have to pay you as much. (If you're lucky enough to live in a state that lets you choose your own doctor, this usually won't be a problem.)
Because your treating doctor will play an essential role in your workers' compensation case, you should switch doctors if you think you're not getting the best treatment. Each state has its own rules and procedures for changing doctors, which vary significantly. For example, there might be a waiting period before you can switch, or you might be limited to only one change during the course of your workers' comp claim. And, in some states, the insurance company will select your new physician or you'll be required to choose from a network of approved doctors.
Injured workers should understand the available benefits through the workers' comp system. While each state has its own rules for eligibility and amounts, the following benefits are typically available:
Because insurance companies are for-profit businesses, you shouldn't rely on the adjuster to fully explain your state's benefit system or all of the available benefits. If you have questions, contact your state workers' compensation agency or a workers' comp lawyer for help.
Unlike a regular doctor's appointment, an independent medical examination (IME) does not focus on treating your injury. Instead, the insurance company hires a doctor to perform an examination, review your medical records, and issue a report. This report summarizes the doctor's opinion on your diagnoses, work restrictions, and the relationship between your injury and your work. Frequently, insurance companies schedule IME's when they want to terminate or reduce your workers' comp benefits.
If you are scheduled for an IME, you must attend the appointment (or risk termination of your workers' comp benefits). It's important to prepare for the IME by reviewing your medical records and anticipating tricky questions from the IME doctor. See our article on how to prepare for your IME to learn more.
If the insurance company questions your credibility, it might hire a private investigator to follow you around. The investigator will watch you at home and in public places—hoping to catch you doing something that contradicts your workers' comp claim. For example, suppose you tell your doctor that you can't lift more than five pounds. If surveillance footage shows you carrying boxes into your house, the insurance company will use it to argue that you're lying about your symptoms. However, the footage can easily be misinterpreted—the boxes might be lighter than they appear or you might have experienced a serious increase in pain afterward. If you think you are under surveillance, talk to a workers' comp lawyer about how you can minimize the impact of surveillance footage.
It's always in your best interest to keep copies of paperwork concerning your workers' comp claim, including work restrictions, letters from your employer or the insurance company, and completed forms (such as an accident report). While your doctors will create medical records documenting your treatment, work restriction slips are not always put in your medical records. Many of these records are essential for getting your workers' comp claim approved and paid.
Insurance companies are for-profit businesses. They frequently deny legitimate workers' compensation claims in an attempt to save money. However, you have the right to appeal the insurance company's denial. Many workers who received initial denials end up receiving at least some workers' comp benefits after filing an appeal.
While every state has a different process and requirements, an appeal typically requires filing a written form with the state agency by a certain deadline. Once the state agency processes your appeal, a judge will typically schedule one or more hearings to assess and resolve your dispute. Because workers' comp appeals are complicated and require extensive legal and technical knowledge, you should seriously consider hiring a workers' comp lawyer at this point. (For more information, read our article on workers' comp appeals.)
Unless you have a workers' comp lawyer, you must attend every legal meeting or court date during an appeal (such as mediation, scheduling conferences, and hearings). If you do not appear at a scheduled legal appointment, you risk losing some or all of your benefits. Even if you have a lawyer, you will need to show up for some key events (such as your deposition or an independent medical examination). If you have to miss an appointment, it should be for a good reason and you should notify the insurance company and the state agency beforehand.
You might not need a lawyer if your workers' comp claim is very simple or if the insurance company voluntarily pays your claim. However, consider hiring an experienced lawyer if the insurance company:
It can be difficult to navigate the workers' comp system, including when to accept a settlement offer and for how much. A lawyer can properly value your claim, negotiate with the insurance company, and represent you in an appeal, if necessary.