If you’ve been injured on the job, you deserve compensation. Unfortunately, it’s in the interest of your employer’s insurance company to deny you that compensation if they can. Their goal is to keep money in their pocket and out of yours. Some insurance companies are easier to work with than others, but they all have the same business model: to pay out as little as possible.
During your recovery, you’ll be building up lots of medical bills that you might be unable to pay. If your accident was severe, you might be forced to take months off from work. Even if your employer will hold your job for you, you need to be able to pay the bills during the time you’re not working. That’s why companies in Massachusetts are required to carry workers’ compensation insurance.
Getting workers’ comp benefits approved, especially if you are requesting a large payout, will usually involve an investigation. Insurance companies want proof that your injury occurred on the job. They won’t write you a check until they’ve looked at the case from every possible angle. That’s why it’s so important to understand as much as you can about how the process works so you can protect yourself and collect compensation for your medical bills and lost time or ability to work.
The Role of Doctors in Your Workers’ Comp Claim
It’s important to seek medical treatment as soon as possible after your work injury. You need to take care of yourself and make your health a priority. But you also need to get documentation of your injuries right away. That will set a benchmark for your progress throughout your recovery.
A doctor may fill several roles in the process of resolving your workers’ comp claim. Your own doctors will help you to recover and get back to work. But a doctor’s opinion (or several doctors’ opinions) will also make a difference in how much compensation you’re awarded. They are important to the claim investigation in addition to your recovery.
You may be required to undergo an Independent Medical Exam (IME) if the insurance company doesn’t accept your doctor’s findings or your physician has declared that you are partially or totally disabled as a result of the accident or injury. These payouts are larger and the insurance company will investigate these claims more carefully.
Your meeting with a workers’ comp doctor could make a huge difference in your final compensation. It’s important to go into this appointment with your eyes wide open. The insurance company will try their best to get you to accept less, sometimes using what you say against you.
Here’s what you need to know about meeting with a worker’s compensation doctor—plus mistakes to avoid during your appointment.
How Does a Workers’ Comp Claim Work?
To understand the mistakes to avoid when meeting with a workers’ comp doctor, it’s important to get familiar with the insurance claim process itself. In Massachusetts, you have four years to file your worker’s compensation claim after you notice your injury.
If there was an accident and you were injured on the job site, it’s easy to identify exactly when the incident occurred. It’s even easier to prove your case if witnesses saw what happened. But if you developed a repetitive stress injury or an illness from ongoing exposure to toxic substances, it can be harder to determine and prove exactly how or when the problem started to develop. Regardless, it’s a good idea to start the claim process as soon as possible.
Your first step is to get medical treatment and to notify your employer of the injury or illness. You will need to provide the date and time of the incident, as well as information about the injury itself and how it occurred. Be sure to identify any witnesses, if there were any.
Once you’ve reported your injury, your employer will need to file a claim with their workers’ compensation insurance. In the Commonwealth of Massachusetts, employers are required to carry this insurance. If you are out of work for five days or more, they will also have to report the incident to the Department of Industrial Accidents (DIA) within seven days of the injury report.
During the claim investigation process, it’s very important to keep all of your documents organized. Take notes and keep all of your medical bills in one place. Write down the details of the incident while they’re fresh in your mind. Documenting everything will help you prove your claim as the insurance company conducts its investigation.
Some workers’ comp claims are very straightforward and are settled quickly. Others are more complex and require more investigation from the employer or insurance company. Some cases end up going to court if the company is unable or unwilling to settle the claim with the injured party.
Does Your Injury Qualify for Compensation?
Before you even file a claim, it’s important to be realistic about your injury. If it’s a minor injury that doesn’t affect your ability to work and heals quickly, it’s probably not worth filing a workers’ comp claim. Even if the injury is more severe, it needs to be an injury you sustained while on the clock.
You also will not qualify for workers’ compensation if you were found to be violating company policies, fighting, acting in an unsafe manner, or under the influence when the injury or accident occurred. Insurance companies will look for any reason not to pay and you need to be realistic about whether or not your claim will result in a payout.
Things get a little trickier when it comes to repetitive injuries. You can be awarded workers’ compensation for cumulative injuries or illness caused by exposure to toxins in the workplace. However, these cases are sometimes harder to prove and you will almost certainly need to submit to an IME to get the compensation you’re due. You will also need the help of an experienced workers’ comp attorney in Massachusetts.
Keep a Log During the Investigation
You’ll have to attend a number of medical appointments throughout the course of your workers’ comp case. These cases usually take about a year to resolve, although some take longer and some more quickly. That’s a long time. It’s not realistic to expect yourself to remember everything that happened during each step in the process.
One way to ensure that you’ll have an accurate record of your recovery process is to keep a log or journal throughout the claim investigation. Write down everything that relates to your case as you go. If you feel up to it, keep an ongoing record of how you’re feeling at different points during your recovery.
Memory is unreliable. The more you write down, the better. You don’t have to show the log to anyone, but it’s important to have for your own protection as you work with the insurance company, investigators, and workers’ comp doctors.
Workers’ Comp Doctors and Independent Medical Exams
Depending on your injuries, you might see several different medical professionals throughout your recovery. You might need to consult with one or more specialists, your primary care physicians, and/or a physical therapist. These doctors will provide information about your condition, but their primary goal is to provide you will the best medical care possible.
A worker’s compensation doctor, on the other hand, is hired by the insurance company to conduct an Independent Medical Exam. This is a medical evaluation that is only for gathering information and getting a second opinion for the workers’ comp investigation.
You already know that the goal of any insurance company is to keep payouts as low as possible. Therefore, you should go into your IME understanding that what you say could be used against you in settling your claim.
You should also know that if you don’t agree to an IME request, your claim will almost certainly be denied. This appointment is part of the insurance company’s investigation and they will gladly use your refusal to close the case without paying.
About the IME Process
During your IME, the workers’ comp doctor will examine you. If necessary, they may conduct some tests as part of the exam. Their job is to provide the insurance company with a second opinion and although they are supposed to be objective in their examination, always remember that they will be reporting back to the company.
The doctor will also go over your medical history and records to see your initial diagnosis and understand any prior injuries. You’ll be asked questions about the injury listed on the claim, any pre-existing conditions or old injuries, your current treatment plan, and the level of pain or limitation the injury has caused. You might also be asked about the incident itself, or when symptoms started for a long-term illness you developed as a result of your job.
Be prepared for the doctor to ask you lots of questions. They need to put your injury in context. They also want to make a fair evaluation of your condition. Be polite and answer all their questions. With that said, there are also a few things you should avoid during an IME with a workers’ comp doctor.
What NOT to Do During Your IME Appointment
If you’ve been ordered to undergo an Independent Medical Exam by the insurance company, then you might be feeling a little nervous. It’s one thing to go to your own doctors and explain what happened to cause your injury, but it can feel very different to discuss your health with a stranger who has been hired by the insurance company. Still, if you refuse the IME, your claim will almost certainly be denied, so it’s an important step in the process.
Before the appointment, prepare yourself. You might think that if you tell the doctor what they want to hear, your claim will be approved. But there’s a lot that can go wrong in these appointments. You have to be ready for anything that might happen.
Here are some “don’ts” for your workers’ comp evaluation appointment:
1. Don’t Exaggerate
It can be very tempting to say that your injury is worse than it is, especially if you’re worried that you won’t get enough for your claim to cover your medical bills and missed work. Unfortunately, this is one of the most common mistakes people make, and it could definitely hurt your case.
A doctor is an expert in evaluating injuries and illnesses. They might not know exactly how much pain you’ve been in, but it’s usually pretty easy for a doctor to tell if you’ve been exaggerating about how bad your injury is. Don’t downplay your injury and limitations, but don’t be tempted to embellish.
You also shouldn’t make up symptoms. The doctor will be taking notes and you don’t want to start spinning a story that could come back to bite you during the claim resolution process.
2. Don’t Lie
Insurance companies are always on the lookout for inconsistencies between injury reports, claims, and other testimony. If the facts of the case aren’t the same across all reports, the company might use that inconsistency to deny or reduce the claim.
Be sure that you are telling the workers’ comp doctor the same story you told on the day of the accident. It is very important to be truthful and to avoid stretching the truth. Our memory can be inconsistent, which is why you should take notes and document the facts of the case along the way.
You should also be truthful about your medical history. Your credibility is important to your case. The insurance company is going to find out about any prior injuries, whether you volunteer the information or not. It’s better to be upfront and honest with the workers’ compensation doctor to avoid any attacks on your character, credibility, and honesty.
3. Don’t Make Friends
If you’re a friendly person, you might have the tendency to get to know someone quickly. Or, you might get very chatty when you’re nervous and volunteer too much information about yourself. That can get you into trouble during an IME.
Remember, the workers’ comp doctor has been hired by the insurance company. You should be polite and willing to answer the doctor’s questions, but it’s important to avoid volunteering too much extra information. The more the doctor can report back to the insurance company, the less likely it is that you’ll get the full payout you deserve.
An idle conversation might seem insignificant to you, but it can hurt your case. If you reveal details about your habits, lifestyle, and family, the doctor might conclude that your injuries were not that serious, even if they’ve affected your daily activities. Cooperate with the doctor, but don’t overshare and make friends.
4. Don’t Add Unnecessary Details
This ties into the last point—don’t say more than you need to and don’t add unnecessary details. Answer any questions honestly and directly, but just stick to the basic facts. Don’t volunteer any information that the doctor hasn’t requested. Don’t go beyond the information you reported to your employer.
Sticking to basic facts accomplishes a few things. It reduces the opportunity for innocent inconsistencies to come up and it reduces the amount of information the insurance company can use in their case. Don’t withhold information, but don’t volunteer it. If the doctor needs to know something, they will ask you a specific question.
Other Mistakes That Hurt Your Claim
There’s a lot to keep track of during a workers’ comp claim and it’s easy to hurt your case without even realizing it. It’s also important to know your rights and to ensure that the insurance company isn’t taking advantage of you during the process. Do your research and remember that the insurance company is NOT on your side.
Here are some additional mistakes that could hurt your claim:
Not Going to Doctors’ Appointments or Running Late
It’s important to keep your appointments, even if you’re feeling better. An insurance company might see it as a sign that you no longer need medical treatment or that your injuries weren’t that bad. Plus, running late to your IME or any other appointment just reflects badly on you and will irritate your doctors.
Making Recorded Statements
You are not required to make a recorded statement to any insurance company representative or doctor. Even if it seems harmless, you should never agree to do so. What you say could easily be used against you later.
Asking for Too Much—Or Settling For Too Little
Every situation is different. In addition to paying for your medical bills, you may be able to get temporary weekly disability benefits or a lump sum from the insurance company.
Asking for too much and being unwilling to negotiate could hurt your claim and end with you being given a lower amount in court. On the other hand, you don’t want to settle for too little and regret the outcome.
A worker’s compensation lawyer can fight for what you deserve and advise you on what’s realistic in your situation.
What if Your Claim is Denied?
There are several reasons a claim can be denied. If you have been honest with the workers’ comp doctor, the insurance company, and your employer, then you shouldn’t have much to worry about. However, an insurance company can deny a claim if they can show that the injuries:
- Occurred on your way to and from work, not while you were on the clock
- Self-inflicted and not caused by dangers in the workplace
- Inflicted during fighting or horseplay
- Occurred while you were using alcohol or drugs, committing a crime, or breaking company rules
After seeing a workers’ comp doctor, your employer’s insurance company might choose to approve your claim, but they might also reduce their compensation offer or deny it altogether, based on the doctor’s testimony. If that happens, you have the right to appeal.
Working With a Massachusetts Workers’ Comp Attorney
If you have a simple workers’ comp claim that’s unlikely to be disputed, you might not need to hire a lawyer. It might be okay to handle your own case if your injury was minor, like a sprained ankle or a deep cut, especially if your employer doesn’t dispute that the injury occurred on the job site.
With that said, most workers’ comp claims are much more complicated than that. People who are more seriously injured and miss a lot of work are eligible for more money and will be placed under more scrutiny. After all, more is at stake. You might have ongoing doctors’ bills and other factors that will affect your claim.
If you have a pre-existing or old injury in the same part of the body, you might also have more trouble getting an insurance company to pay out on your own. The insurance company could easily argue that the old injury is causing your problems, not the work-related recent injury. You might need the help of an attorney and your doctors to prove that the injury is causing you pain and creating limitations.
Whenever a case becomes more complex, it’s a good idea to speak with a workers’ comp attorney as soon as possible. They will represent you and guide you through the entire process, advising you on what you should and shouldn’t do. You’ll feel more comfortable knowing that someone knowledgeable is on your side. The insurance company has lots of resources and will have the upper hand if you don’t have someone helping you.
If you’re hesitant about hiring a lawyer due to financial concerns, know that workers’ comp lawyers in Massachusetts don’t take any money up front. They only get paid when your case is settled and you receive a payout. Plus, you’re likely to walk away with more compensation when you work with a lawyer than if you go it alone, so working with an attorney will pay for itself.
The Law Office of John J. Sheehan can help if you’re worried about paying the bills after an injury at work. Attorney Sheehan is a personal injury attorney specializing in work injuries and accidents. He has many years of experience in these cases in the Boston area and can help you get the money you deserve. Call Us 24/7 at 617-336-8441 to learn more!