Filing for workers’ comp should be easy…But it’s not.
Thousands of workers make avoidable mistakes every year that cost them the benefits they deserve. In fact, fewer than 40% of eligible workers even file a workers’ comp claim.
Workers’ compensation law is on your side after a job injury. But one misstep during the claims process can cause a denial – and leave you without medical or wage loss benefits.
The good news: Most mistakes can be avoided. When you know the ins and outs of workers’ comp law and follow this workers compensation guide, you will get approved. But if you don’t, you are in for a fight.
Let’s cover:
- Why timing is critical in a workers’ comp case
- Documentation errors that kill most claims
- Pre-existing conditions and what to do about them
- Claim denial and how to appeal
Waiting Too Long to Report Your Injury
This is the #1 mistake that sinks workers’ comp claims.
Workers have a limited amount of time to report a workplace injury. In most states, you have 30 to 90 days to report an injury – and missing this deadline can automatically disqualify your claim.
Workers fail to report an injury because they think it is not serious enough to tell their employer. But by the time they realize the injury is serious, the deadline has passed.
Insurance companies LOVE late injury reports. It makes it easier to deny the claim because they can argue you failed to give timely notice that the injury happened at work.
What you should do instead: Report any workplace injury to your employer as soon as possible – even if you think it is minor. Get it in writing and make a copy for your records.
Incomplete or Inaccurate Paperwork
Workers’ comp claims require lots of paperwork.
Fill out the forms incorrectly or leave sections blank, and your claim will likely get denied. Insurance companies search the paperwork for ways to turn down claims.
Some common mistakes people make on their workers comp claim forms:
- Providing inconsistent details about how the injury happened
- Neglecting to provide witness statements
- Missing signatures or dates
- Failing to submit all of the required forms
Insurance companies will pick apart your claim if you provide different details about how the accident happened in your paperwork versus your doctor’s records.
What you should do instead: Take the time to fill out all paperwork completely. Double check every detail so your story is consistent. Have an attorney review your paperwork before you send it.
Failure to Seek Immediate Medical Attention
Too many workers “tough it out” after an injury. They avoid the doctor because they don’t want to leave work or assume the injury is not that bad.
A common workers’ comp mistake: Waiting too long to get medical treatment for an injury.
Insurance companies can use a delay in medical treatment as evidence your injury is not serious or did not occur at work. You also risk your employer forcing you to see a doctor in their network. Seeing your own doctor first can get the insurance company to refuse to cover your treatment.
What you should do instead: Get medical attention immediately after a workplace injury. Tell the doctor the injury was work-related and have them document it.
Ignoring Pre-Existing Conditions
Pre-existing conditions: one of the most common reasons insurance companies deny a workers’ comp claim.
But there is good news – you can still qualify for benefits even if you have a pre-existing condition. Workers’ compensation law covers you if your work injury made a pre-existing condition worse.
The mistake workers make is trying to hide their pre-existing conditions. The insurance company will find out about the condition eventually (and they always do) and use it as an excuse to deny your entire claim.
What you should do instead: Disclose any pre-existing conditions right away. Document exactly how your work injury made your pre-existing condition worse. This is why you need your doctor to clearly state your work injury aggravated your existing condition.
Giving Recorded Statements Without Legal Advice
Insurance adjusters often call and ask you to provide a recorded statement about your injury.
Recorded statements are insurance company traps designed to catch you in a statement that can be used against your claim. The insurance adjuster will often ask leading questions or trick you into downplaying your injuries.
Researchers found that as many as 69% of work-related injuries may go uncounted. Why? Workers misunderstand the claims process or are intimidated by insurance companies.
What you should do instead: Refuse to give a recorded statement until you have spoken with an experienced workers’ comp attorney. You have the right to legal representation.
Not Following Your Doctor’s Orders
Medical evidence is critical to your workers’ comp claim.
If your doctor prescribes physical therapy, medication, or orders you to stay off work – you must follow these instructions to the letter. Insurance companies monitor your treatment, and any deviations are grounds for denial.
Missing appointments, refusing recommended treatment, or returning to work against medical advice all raise red flags for insurance companies. They will use this evidence to argue you must not be seriously injured if you are not following your doctor’s orders.
What you should do instead: Follow every single recommendation from your workers’ comp doctor. If you have to reschedule an appointment, do it ASAP.
Missing Critical Deadlines
Workers’ compensation claims have many deadlines – and missing any one of them can sink your case.
Beyond the initial deadline to report an injury, there are deadlines for filing your formal claim, submitting medical evidence, appealing a denial, and requesting hearings.
States have different timelines for each of these steps and the deadlines are strict. Courts generally do not grant extensions.
What you should do instead: Write down every deadline related to your claim and set reminders. An experienced workers’ comp attorney will ensure you never miss a critical deadline.
Wrapping Things Up
Workers’ comp claims don’t have to be difficult – but small mistakes can have big consequences.
The most common mistakes claimants make include:
- Waiting too long to report an injury
- Filing incomplete or inaccurate paperwork
- Skimping on medical treatment
- Hiding pre-existing conditions
- Missing important deadlines
Every one of these mistakes gives the insurance company an excuse to deny your claim.
You can avoid these pitfalls by understanding how workers’ comp law works and following the proper process from day one.
If you have already made a mistake or your claim has been denied, don’t give up. You still have options to appeal and fight for the benefits you deserve.
Workers’ comp is there to protect you after a job injury. Don’t let small mistakes rob you of the coverage you have earned.
