Three Huge Mistakes That Could Essentially Destroy a Workers' Compensation Claim

Sarasota, FL (WorkersCompensation.com) - Nobody ever expects an employee to be injured at the work-place, but with a blink of an eye a worker can be involved in an incident and has to deal with medical bills, lost wages, and the task of filing for workers’ compensation benefits. Filing a compensation claim can be somewhat difficult.

However, these benefits can cover medical bills, lost income, and much more; so it’s important that this process goes as smoothly as possible with no errors. If an employee has a work injury or illness and is trying to receive compensation, it’s imperative to avoid doing anything that could mess up the claim. Employers/payers should ensure that their workers understand some basic facts about the workers’ compensation system, to protect themselves as well as their organizations. Read on to learn about the most common mistakes that could potentially ruin a worker’s compensation claim.

• Failing to report the injury

One of the most significant mistakes that a person can make with a workers’ compensation claim is failing to report the accident to the manager. Workers need to know that as soon after suffering an injury or illness, he needs to let the proper person know. The sooner, the better, because the more time that passes after, the more details could be forgotten, which could be crucial to the outcome of the claim. 

It’s important to have documentation of everything of importance; such as who was present at the time of the accident, when it happened, what and where it happened, as well as any other details.

“Notify your supervisor of your injury as soon as possible,” advises Peter Melton, a spokesperson for the California State Department of Industrial Relations. Workers should understand that  if the “injury or illness developed gradually, the employee should  report it as soon as he learns or believes it was caused by the job. Reporting promptly helps avoid problems and delays in receiving benefits, including medical care.” Workers who don’t report their injuries within 30 days risk losing their right to receive workers’ compensation benefits.

• Waiting to be Treated

It's imperative that after a workplace accident the employees seeks a full medical evaluation. The employee should also make sure to tell the physician everything, including the pain levels and any other details surrounding the work-related accident. It’s crucial that the injured worker provide as much detail and precision as possible with his medical provider when it comes to injuries and complaints. Even the most seemingly minor symptoms can contribute considerably to the employee’s whole health picture; so providing any and all information will also help the provider decide the best way to move forward when it comes to both the care as well as the worker’s compensation claim.

“It is important [for an injured worker] to get a medical checkup right away after an on-the-job injury,” said Steve Hardy, a certified physician in Emergency Medicine, American Board of Emergency Medicine. “Many companies utilize on-site occupational health nurses or medics for this purpose. [The injured worker should] check with his supervisor and fill out an incident report of the accident.”

Dr. Hardy also feels that if employers believe they are having a medical emergency, they should go to the nearest emergency department. Injured workers should also tell the physician or health care provider whether they feel comfortable returning to work or not. There are many instances where the person can still return to work with light-duty accommodations. “There are also new innovative methods for on the job injury assessment by telehealth practices and third-party group,” he said.

• Filling Out An Incomplete Or Inaccurate Application

Once the worker has informed his employer of the work-related incident, he should be given the proper reporting forms for the worker’s compensation insurance provider, and, depending on state law, additional forms for the state worker’s compensation board. It’s imperative that the employee fill out all paperwork accurately and promptly; a late form may end up preventing the worker from receiving benefits. Also, paperwork that is inaccurate or incomplete can delay benefits.

“The report of the injury is very important because the adjusters will use it for an employees’ claim,” said Michael Stack, CEO of Amaxx, a workers’ compensation training center. “This paperwork will set the tone of the claim path with the adjuster. It’s important to have someone from the employer side to help the worker fill out the paperwork appropriately. In some instances, people will delegate the responsibility of that form to someone else, and it may be very brief and limited in content, or the information could be incorrect.”

Stack also advises employers to “make sure to fill out as much as information as possible. Get statements from any witnesses as well as making sure to get a supervisor’s report of what happened in addition to the state form. Writing down every single thing you can remember in detail right out of the gate will help in setting up your team for success. Accuracy will aid in getting the clam going in the right direction.”

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