During a workers’ comp claim, it’s important for claimants to avoid behaviors that may compromise their case when under investigation by insurance companies’ investigators. Making certain mistakes could prevent individuals from recovering full compensation for work injuries, which is why claimants should know how to avoid them. The following are some of the specific mistakes […]
During a workers' comp claim, it's important for claimants to avoid behaviors that may compromise their case when under investigation by insurance companies' investigators. Making certain mistakes could prevent individuals from recovering full compensation for work injuries, which is why claimants should know how to avoid them.
The following are some of the specific mistakes to avoid while on workers' comp.
As soon as individuals sustain work-related injuries, they must report them to their employers as soon as possible. In Iowa, you are required to report your injuries within 90 days of sustaining them to receive workers' comp benefits. Otherwise, they risk a claim denial.
Generally, it's best for employees to report to the employer within 24 to 48 hours of the injury. In addition to speaking with the employer and providing verbal notification, employees must complete a written report.
When filing a workers' comp claim, injured employees should also know what not to say to a workers' comp doctor when speaking to them about their injuries. For example, it's crucial not to undermine the nature of an injury by telling a doctor that the patient is "fine" and feels "okay," which indicates that injuries aren't serious while failing to detail how they specifically affect the individual.
Instead, it's best to be as detailed as possible about any injuries sustained and the incident that caused them. Employees should try to remember as much as they can about the accident and discuss their symptoms in depth. Even if an employee believes their injuries are minor, doctors may discover that they indicate a more serious condition that could develop later if left untreated.
Additionally, injury victims should provide details about their medical history. While some may believe that pre-existing conditions could hurt their claims, they may not directly impact the case, and being honest about their history can actually help support their claims.
In some cases, people involved in work-related accidents may fake certain symptoms or otherwise indicate that their injuries are far worse than they actually are, any of which attempts could seriously compromise a workers' comp claim. If insurance adjusters, doctors, employers, or others discover that a claimant is lying about symptoms or injuries, this could prevent claimants from recovering compensation.
Workers' comp claimants should keep in mind that workers' compensation doctors will conduct multiple tests to make a proper diagnosis of injuries, in which cases they'll be able to determine whether a patient is being truthful about their injuries. Medical professionals may also label patients in medical records as "malingerers," which are individuals who exaggerate or fake injuries and symptoms.
Iowa enables employers and insurance carriers to choose their workers' comp doctor to receive both a diagnosis and treatment from them. There are however situations when an employee has a right to have their care switched to a non-company chosen physician.
It's in patients' best interests to follow their doctors' advice whenever given, particularly in workers' comp cases. For example, patients should take any prescribed medication that helps them recover from their injuries. They should also make appointments and visit doctors however frequently medical professionals would like to see them. Follow-up tests and therapy may help patients make a full recovery and prevent complications from developing due to discontinued treatment.
Even if a patient feels fine and chooses to discontinue treatment as a result, this could look bad to both insurance adjusters and employers as they may believe the workers' comp claim is unnecessary.
Some cases may involve injuries that aren't severe enough to cause permanent disability and prevent employees from returning to work. While some more extensive injuries may prevent workers from returning to their former jobs following a work accident, doctors may enable patients to resume light-duty work.
If an injured employee chooses not to return to work even when medical professionals deem them capable of doing so, this could give employers the impression that the employee doesn't want to continue working.
In the event that injury victims worry that they will be unable to resume certain work despite having a doctor clear them, employees can discuss any potential issues with their doctor. When performing work, employees can then record any pain or discomfort they experience on the job, which could help doctors and employers determine how to adjust work duties.
Some workers' comp cases may involve injuries that don't appear as serious as they are to the victim. Over time, for instance, a patient may recover to the point where they believe they're capable of performing certain physical tasks that they're actually not ready to complete. In these instances, claimants may perform certain tasks or duties that go against what their doctor permits.
For example, individuals may choose to carry heavy items and put stress on the part of the body that sustained the work injury. This could not only exacerbate the injury and prolong the recovery process, but it could also look suspicious to insurance investigators if they catch this behavior. In the process, injury victims could worsen their condition or lead to claim denial.
If individuals require any assistance to complete tasks that go beyond their doctor's restrictions, they can consult family, friends, or other outside help in the meantime until they recover.
Many cases may involve insurers requesting claimants to provide a recorded statement or sign a medical authorization, neither of which is required. Although insurance companies may even indicate that they are unable to continue the claims process without a claimant's signature, no state or federal law mandates this.
Some insurance companies may state that they are unable to proceed due to their policy, but the fact is that individuals will benefit from taking more time to prepare their statements.
Depending on the nature of a case, it may also be in claimants' best interests to consult with a workers' comp attorney to discuss their case and a potential statement.
Avoiding all of these and other potential mistakes will help individuals successfully complete the claims process and minimize the risk of having their claim denied, along with accusations of insurance fraud.
Workers' comp claimants should also have a good idea of how long a workers' compensation investigation takes, which can help them plan for the process.
After reporting an injury and beginning the claims process, the insurance company involved will begin investigating the claim. This involves the claims administrator consulting with both the employee and employer and looking closely at medical records, injury and accident reports, and other forms of documentation.
Throughout the investigation, claimants should comply with the insurer's requests for documentation and insurance when reasonable. If employees become concerned about the investigation at any point, they may benefit from speaking with a qualified workers' comp lawyer to discuss their case.
Employers and insurance companies typically need to determine whether individuals qualify for workers' comp benefits, often within two weeks to a month after filing the claim. However, insurers may be able to request extensions as needed.
Failure to meet the deadline in place could lead insurers to pay a financial penalty. Some states may also automatically approve a claim if insurers don't meet deadlines.
In most cases, injury victims receive notice regarding their claim's approval or denial within a few weeks of filing.
In some cases, insurance adjusters may wrongfuly deny a claim by accusing the injured employee of willful misconduct. In incidents involving willful misconduct, insurers may argue that a certain intentional act contributed to work-related injuries. Employees in these instances would have a good understanding of the rules in place and choose to violate them, leading to their injury.
Some of the different types of willful misconduct include incarceration, intoxication, violating rules pertaining to work safety, and violating certain statutory rules such as speeding.
Although willful misconduct could lead to the denial of a claim, some insurers may attempt to stretch the evidence present to suggest willful misconduct. This risk could make some employees unwilling to pursue workers' compensation entirely out of fear of wrongful accusations of misconduct.
Even if a claim is denied, injured employees may still be able to seek compensation, especially if they sustained serious injuries that prevent them from returning to work in the same capacity. In the event of a denial, claimants may be able to submit their case to the Workers' Comp Appeal Board, which could review the case and determine if the claimant still qualifies for workers' comp.
For help with the appeals process, a reliable workers' comp attorney may be able to provide representation and work to support a claim. An experienced attorney can help gather evidence supporting the claimant's arguments and injuries and navigate the appeals process.
If employees are injured on the job and wish to begin the workers' comp claims process, they should be careful when awaiting a decision from insurance adjusters and employers. By avoiding certain critical mistakes along the way and gathering sufficient evidence to support their claims, injury victims will have a better chance of recovering the compensation they deserve.
Seeking treatment, adhering to doctors' advice, reporting the injury on time, being honest about injuries and the accidents behind them, and taking other precautions will help claimants successfully navigate the process and maximize the chance of approval.