Wondering how to maximize your workers’ comp settlement? These 12 tips will help you build a strong work injury claim and get fair compensation.
It pays to know how to make the most of your workers’ compensation case and ensure you’re getting all the benefits you deserve.
With workers’ comp, you don’t have to prove your employer was at fault, and except for unusual circumstances, your work injury should be covered. Workers’ compensation medical benefits kick in the moment you’re hurt to cover emergency treatment.
Problems can come from your employer’s workers’ comp insurance carrier. These insurance companies are for-profit businesses that have a vested interest in avoiding large payments to claimants like you.
These 12 tips are designed to help you beat the insurance company at their own game, from the moment you’re hurt on the job until you cash your final settlement check.
Here are the 12 tips to maximize your workers’ comp settlement:
- Seek Immediate Medical Care
- Notify Your Employer of the Injury
- File Your Workers’ Comp Claim Fast
- Select or Change Your Doctor
- Be Specific and Consistent
- Give Limited Medical Authorizations
- Remember You’re Being Watched
- Be Prepared for an IME
- Beware of Recorded Statements
- Understand Your Disability Rating
- Keep Track of Everything
- Get the Compensation You Deserve
If you’re hurt on-the-job or while conducting business for your employer, seek immediate medical attention. Don’t wait to see if you’ll feel better in a few days.
If your supervisor wants to call an ambulance or take you to the company nurse, let them.
Any delay in getting medical care for your work-related injury gives the insurance company a reason to deny your claim. The insurance company could argue your injury didn’t happen at work, or that you couldn’t have been hurt too badly if you waited to see a doctor.
There is no good reason to put off telling your employer you were hurt on the job. The longer you wait, the harder it will be for your employer or the workers’ comp insurance company to believe you have a legitimate workers’ compensation claim.
Most employers will have their own Report of Injury form. If not, you can use OSHA’s Standard Employee’s Report of Injury form.
You must report your work-related injury to your employer, even if you’re afraid you’ll get in trouble or might lose your job. It’s illegal for an employer to harass or fire an injured employee for reporting a work-related injury or filing a workers’ comp claim.
Immediately contact a workers’ comp lawyer if you face retribution over a workplace injury.
Telling your employer that you’ve been hurt is not the same thing as filing a worker’s comp claim. You must do both to qualify for workers’ compensation benefits. You’re entitled to coverage for your medical expenses and lost wages.
Every state has its own deadline for filing workers’ compensation claims. Missing the filing deadline can cause you to lose any rights to worker’s comp for your injury.
After you’ve notified your employer of your injury, you should be given a workers’ comp claim form. Fill out the claim form completely and accurately. If you are in too much pain or groggy from medication, ask a trusted friend or family member for help.
Remember, this form is the official notification you are giving to the insurance company. An incomplete or messy form can slow down the compensation process. Be sure you send the completed form on time to the correct person.
Contact your State Workers’ Compensation Office for more information about your state’s claim filing forms and deadlines.
Although each state has its own rules and regulations regarding the choice of physicians for workers’ compensation injuries, you most likely must choose a physician authorized by your employer’s insurance company.
Many states only require you to stay with the insurance company’s doctor for a limited time. If you’re not comfortable with the care and treatment you’re receiving, you can change doctors. Just be sure to notify the worker’s comp insurance adjuster before you start treating with a new doctor.
Keep in mind that insurance company doctors may have a conflict of interest. In other words, the doctor’s desire to keep getting regular paychecks from the insurer may impact the way your injury is diagnosed and treated. For example, the doctor may deny an expensive test like an MRI or clear you for work before you’re fully healed.
Most importantly, you need a doctor that will give an honest evaluation and disability rating for your injuries, even if it will cost the insurance company more money.
Be ready to describe in detail how your accident happened. Tell every medical provider you interact with exactly how you were injured on the job.
Be honest, be specific, and don’t make excuses for your injuries or symptoms. The insurance company has experts who will carefully go over every single report and medical record to try and find a reason to deny your claim or limit your compensation.
The insurance company will also be on the lookout for any pre-existing condition as an excuse to deny your claim.
Don’t try to hide a prior injury or condition, but make it clear you did not have disabling symptoms before the work event that caused your current injury.
Try not to speak loosely when describing your injury, for example:
“I was cleaning out the supplies closet, and now my poor old back is killing me.”
Instead, be specific:
“Just after I returned from lunch at 1:30, I was lifting a full box of copy paper when something popped in the middle of my back. I immediately felt severe pain and I couldn’t straighten up. It hurt so bad I felt sick to my stomach. I’ve never hurt like that before, and the pain hasn’t let up since I lifted that box.”
Never give the insurance company a general release for your medical records. Your medical and mental health history is none of their business.
Be careful about signing any authorizations from anyone hired by the insurance company. They may try to sneak one in on you through a vocational counselor or the workers’ comp doctor.
Any authorization you sign should specifically state it is only for your work injury-related records dated after the accident date.
Don’t let the insurance adjuster get away with saying you have to sign their version of a medical authorization or lose your benefits. You can make changes in ink to the version they send you, type up your own, or contact a workers’ comp attorney to advocate on your behalf.
The insurance company is watching your every move, which can include hiring private detectives to follow you around and stake out your house.
With today’s technology, it’s not hard to catch video of you unloading groceries from your car, walking to the mailbox, or picking up your crying toddler. The insurance company will happily use those videos to end your workers’ compensation benefits, on the basis that you’re not as injured as you claim.
Even if you don’t end up on film, the insurance company is watching you in other ways:
- Social media: Any comments by or about you, or images of you are fair game, even posts made by others. We’ve all seen photos from parties and sporting events of someone acting foolish. Don’t be that guy.
- Medical records: Your medical and therapy records will be scrutinized. The medical staff and physical therapist will note in your records when you don’t follow instructions, take medications incorrectly, or miss therapy sessions.
- Appointments: The insurance company may end your benefits if you miss an appointment to meet with a vocational counselor, insurance company doctor, or fail to show up at a workers’ comp hearing.
Your employer’s workers’ compensation insurance company can ask you to undergo an Independent Medical Examination (IME) conducted by one of the insurance company’s doctors at any time.
Most IME’s are requested after the injured worker has reached Maximum Medical Improvement (MMI), meaning the person won’t get any better with further treatment.
After reaching MMI, your doctor may give you an impairment rating that qualifies you for permanent partial disability benefits. Before they will pay, the worker’s comp insurance company will send you to an IME doctor for a second opinion.
Make no mistake, the IME doctor is working for the insurance company, not for you. You won’t get any medical treatment or advice from an IME doctor. The sole purpose of the exam is to give the insurance company an “expert” opinion on your ability to get back to work and stop collecting benefits.
Consider getting legal advice from a workers’ compensation lawyer if you’ve been asked to submit to an IME.
Refusing to go to an IME can result in immediate termination of benefits. Some states limit the number of IMEs the insurance company can require. The reality is, it only takes one negative IME report to give the insurance company an excuse to end your benefits or reduce a disability settlement.
When you’ve been injured on the job, it’s only fair that the workers’ comp insurance company wants to hear your side of the story. What’s not fair is asking trick questions, then using what you said against you to deny your claim or reduce your benefits.
Early in the claim process, the insurance company representative may ask you to give a recorded statement. Don’t be surprised when the rep gets you on the phone and says your statement will be recorded.
You can say “No,” or tell the rep you aren’t well enough to answer questions yet. Until you’re ready and willing, you don’t have to let the claim representative pepper you with questions while being recorded.
Ideally, you would not submit to that kind of questioning without an attorney. In any case, never agree to a recorded statement when you are tired, upset, in pain, or taking pain medications.
More than half of all workers’ compensation claims are made by workers who suffer injuries that leave them with a permanent partial disability.
Definition of Workers’ Comp Disability Categories
- Temporary Total Disability completely prevents you from working for a limited amount of time.
- Temporary Partial Disability prevents you from doing some, but not all, of your job duties for a limited amount of time.
- Permanent Total Disability prevents you from ever returning to work, whether for your current employer or another employer.
- Permanent Partial Disability is a permanent injury that partially impairs your ability to work.
If you fall into a category of permanent disability, your doctor will add a score to show the severity of the disability. Disability impairment scores can range from 5 percent to 100 percent.
Depending on the state, permanently injured workers may be eligible for lifetime wage loss benefits, either in a lump-sum settlement or scheduled payments.
Future medical care expenses may be calculated into the settlement amount, making you responsible for ongoing medical bills. Sometimes a disability settlement provides lifetime medical benefits, meaning medical costs continue to be paid by the insurance company as they occur.
With your financial future at stake, it’s important to understand your workers’ comp disability rating and how your doctor came to that rating.
You can challenge the rating and disability score with a second opinion from a qualified physician, although you may have to pay out-of-pocket for the exam.
Your successful worker’s compensation claim begins with good recordkeeping. Make copies of everything, including every form you’ve filled out.
Your out-of-pocket expenses are generally reimbursable. Keep receipts for parking lot fees, bandages, over-the-counter medications, and the gasoline used while doing all that driving.
Keep a log of your mileage, and the gasoline purchased to drive to the various medical facilities, pharmacies, and the like. The log should include the dates, destinations, and mileage.
If you’re required to meet regularly with a vocational counselor, you can track that mileage, too.
On a regular basis, send a letter to the insurance company with a request for reimbursement along with copies of receipts and copies of your mileage and gasoline logs.
Some workers’ compensation claims are easy to handle on your own. You’re lucky when a workplace injury only keeps you out of work for a limited period of time and you can expect a full recovery. The insurance company will pay your worker’s comp claim and be done with it.
Severe work-related injuries or illnesses are another story. Workers who suffer permanent injuries can be entitled to high-dollar workers’ compensation settlements.
Workers’ comp insurance companies have an army of specialists trained to avoid paying out large sums of money to injured workers like you. Don’t be bullied into accepting a low settlement offer from the insurance company.
Workers who have been seriously injured, especially those who may be older or have a pre-existing condition, will almost always need the skills of an experienced workers’ compensation attorney to get the financial compensation they deserve.
There’s too much to lose by battling the insurance company alone. Most personal injury attorneys offer a free consultation. It costs you nothing to get a worker’s comp case evaluation from a professional.
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