Common Workers’ Compensation Mistakes That Can Hurt Your Claim

Workers’ compensation has been in place since 1908, when the federal government established a program to provide coverage for federal workers injured on the job.

Soon after that, states expanded the program to include workers in the private sector.

Workers’ compensation insurance has evolved into a no-fault system. That means a worker can have their medical expenses and a portion of their salary reimbursed if they are injured on the job, regardless of how the injury occurred. Even though this program has helped millions of workers over the years, it’s not a guarantee of success.

Your claim can be denied or undervalued, and that can happen due to common mistakes you might make that can hurt your claim.

It’s vital to understand that even if your claim is denied, you’re entitled to an appeal.

Before that happens, it helps to understand which mistakes might hurt your chances of approval.

Failing to Report Your Injury Immediately

How many workers have been injured on the job? According to the most recent data collected by the Bureau of Labor Statistics (BLS), 2.5 million workers were injured in a single year, and another 5,070 lost their lives. That is why the workers’ compensation program is so important. It is also why you want to ensure you receive the maximum compensation allowed, and that begins with reporting the injury.

Whether you have just a minor cut or a more severe injury, there needs to be a report because you don’t know how it will develop. This is what happens if you fail to report your injury immediately:

Denial of Benefits

Suppose you’re on the job and hurt your back by lifting a heavy object. You might go home and sit with a heating pad until the pain goes away. What if it doesn’t go away, and further work compounds the injury?

Or maybe the pain fades but comes roaring back the next time you lift something.

Keep in mind that reporting the injury is separate from filing a claim. For instance, in California, you have 30 days to report the injury to your employer, but up to a year to file the claim. In Florida, you have to report within 30 days, but you have two years to file a claim. If you didn’t report that initial incident in the required timeframe, you could be legally barred from receiving any benefits.

Undermined Credibility

If you go back to work after an injury, maybe because you don’t want to lose money, it’s understandable. However, it can undermine your credibility in a future claim. The insurer might use the fact that you returned to work as proof that your injuries aren’t as severe as you’re making them out to be.

Delayed Medical Treatment

When you delay reporting your injury, you also delay getting medical care. Once you start treatment, you want to be compensated, but that can become complicated if you have to wait for approval due to delays.

Weak Evidence

Failure to report a workplace injury immediately can compromise evidence. The longer you wait, the more likely it is that surveillance footage will be deleted or that a witness will forget what they saw.

The sooner you report the accident, the better off it will be for your eventual claim.

Inaccurate or Incomplete Medical Documentation

Your medical records are going to be the foundation of your claim. If those records are inaccurate or incomplete, it can call into question the severity of your injuries.

There could also be an issue raised with causation. If there’s not a strong medical opinion that links your injury to a specific workplace injury, insurers could dispute the claim outright or attempt to link it to a preexisting condition.

When there are discrepancies between your initial statement and the supporting medical documentation, it might make you look dishonest.

You also have to follow through with making all of your scheduled follow-up appointments or physical therapy sessions. For example, if you’re prescribed eight weeks of PT but stop going after five because you feel better, it can diminish your claim about your pain and suffering or limited mobility.

Posting Work Activities on Social Media

We are becoming a sharing society where everything that happens in our lives earns a post on social media. Under normal circumstances, there’s nothing wrong with sharing updates with your friends and family.

However, if you’ve been injured on the job and are going through the workers’ compensation claims process, you need to know that everything you post online will be scrutinized by the insurer. How can that impact your claim?

Consider the following:

• Contradiction of Injuries: Photos or videos showing you engaged in physical activity can contradict claims of you experiencing limited mobility or chronic pain. Even something as simple as working in your garden can be proof that you’re “fine.”
• Evidence of Fraud: A single photo, video, or tag that might suggest you’re active or enjoying life can be used as an accusation of you exaggerating or fabricating injuries.
• Location Tags and Check-ins: You can also be tagged in a location by a friend, which can be a problem for your claim. You might spend a day at the beach just sitting, but it can still look like you’re out engaging in activities they claimed to be unable to do.
• Negative Posts About Employers: You might have issues with how your employer is handling your injury claim. Venting about your problems online can make it look like you’re acting out of malice towards your company.

The best approach is to stay off social media until the issue is completely resolved. It’ll also help to remind your friends not to tag you in any photos throughout the process.

Returning to Work Without Medical Clearance

Before you return to work after an injury, your doctor needs to certify that you’ve reached maximum medical improvement (MMI).

That means any further treatment won’t affect your recovery. It doesn’t automatically mean that you’re completely healed and can return to work. It just means there is nothing else that can be done to change your health status. That will support a claim that involves permanent disability.

However, if you return to work before you’re cleared and reinjure yourself, that can complicate your claim. Insurers might argue that the second injury is a separate event and would make it difficult to be covered for medical treatment based on the original injury.

Additionally, returning to work early might indicate that your injuries are not causing lasting damage. That could lower your final settlement.

Failing to Appeal a Denied Claim Promptly

When a workers’ compensation claim is denied, it is not the end of the road, but how and when you respond will determine the final outcome. Every state enforces strict workers’ compensation appellate deadlines. Missing even one filing requirement can permanently bar you from recovering benefits.

The denial letter you receive will outline the reason for the decision. This is the perfect time to talk with an attorney who is experienced with workers’ compensation claims.

Whether you’ve been denied due to insufficient medical evidence, disputes over causation, or procedural errors, it is vital that you act to preserve your right to appeal that decision.

The appeals process typically involves requesting a hearing where you can submit additional medical documentation. You might also undergo further evaluation. A seasoned attorney understands the common reasons workers’ comp claims are denied and how to respond strategically.

They can help gather medical opinions, ensure deadlines are met, and navigate workers’ comp insurance adjusters’ tactics, which are often used to limit payouts. More importantly, they can help you avoid repeating the mistakes that led to the initial denial.

Taking swift action after a denial can significantly improve your chances of securing the disability benefits and medical coverage you deserve.

If your claim has been rejected, seek out a knowledgeable attorney who can provide you with a path towards the appeal.