Do’s & Don’ts Of Workers’ Comp Claims

July 8, 2021


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worker hurt his back lifting a heavy box in a warehouse

There’s a lot at stake when injured employees file workers’ comp claims.

You may be working reduced hours or unable to work at all as medical bills pile up and your condition doesn’t seem to be getting any better. Although wage replacement, medical coverage, and other workers’ comp benefits are available through the Washington Department of Labor and Industries (L&I) or your self-insured employers, securing these benefits is not always straightforward, and they are certainly not guaranteed.

Many workers make the mistake of following the advice of L&I or their employer without asking the right questions or considering the consequences. Mistakes made early on in the claim can derail the claim down the road. If you’ve been injured, don’t make these costly mistakes.

Read below to learn about the Do’s and Don’ts of workers’ comp claims!

Workers’ Comp Claims: Act Fast

First things first, if you want to maximize your chances of getting workers’ comp, you need to report the injury and start the L&I claim process as soon as possible. Any delay opens the door for your self-insured employer or L&I claim manager to question whether you were hurt at work and start building a case against you.

Keep in mind that technically you have one year from the date of your injury to file a claim for workers’ comp benefits, and two years if the injury is an occupational disease. However, if you miss these deadlines, it’s highly unlikely your claim will ever see the light of day.

Learn more about starting the L&I claim process here

Choose Your Own Doctor

Self-insured employers are notorious for recommending health care providers that are biased in favor of the company and its interests. Seeing the company doctor could result in a medical opinion that doesn’t accurately reflect your injuries. And once an unsupportive medical opinion is on the record, it’s difficult to overcome.

If L&I is handling your claim, your first medical visit for a work-related injury or illness will be covered automatically. For all subsequent visits, you must choose a doctor within the L&I network of medical providers.

Be sure to choose a supportive doctor because they will make key decisions throughout your L&I claim process, including:

  • Certifying whether your injury is work-related
  • Helping you file the claim
  • Determining when and how you can return to work
  • Recommending all necessary treatment you may need

Simply put, see your own doctor, and make sure they’re supportive!

Don’t Play Tough

When you first see a doctor after an injury or suspected occupational illness, the worst thing you can do is to downplay your pain or suffering in front of the doctor. The doctor’s records can only reflect the injuries and pain they observe, so be sure to detail the pain and other symptoms they can’t see.

Keep in mind that L&I or your self-insured employer may use these records down the road to downplay your injuries and pain, claim that you weren’t really injured at all, or that your injuries were caused by something outside of the workplace.

In short, be completely honest about your injuries. Tell the doctor how you were injured, where you are in pain, and the level and nature of pain you are experiencing.

Beware Of Independent Medical Exams

Once the claim process is underway, L&I or self-insured employers may order an Independent Medical Exam (IME), which is conducted by a doctor hired by the state agency or your company. An IME request signals that your claim manager either needs more information to decide whether or not to accept or deny your claim, or they are preparing to fight your claim.

While the IME doesn’t guarantee an immediate claim denial, the information gathered during the exam can be used to support a permanent denial in the future.

L&I and self-insured employers have close relationships with independent medical examiners throughout Washington state. These doctors work for L&I and their opinions tend to favor L&I and employer decisions.

How To Prepare For An IME

The following tips can help you minimize the potential damage of an IME to your workers’ comp claim:

  • Have someone you trust accompany you to the examination. If possible, have them detailed notes or make an audio recording of the exam.
  • Assume that you are under observation at all times, from the moment you enter the facility’s parking lot until you leave the premises. The IME doctor will be on the lookout for any suspicious behavior or evidence that contradicts your injury claim.
  • Do not sign any paperwork other than to check-in to the appointment.
  • Be polite and cooperative with the IME doctor, but do not answer any questions regarding who may be at fault for your injury, or any other questions that don’t relate to the specifics of your case, such as other medical conditions you may have.
  • Provide all symptoms, injuries, and medical care related to your case.
  • Do not conceal any pain or discomfort during your IME. Let the doctor know.
  • Do not submit to invasive tests or agree to procedures that your regular doctor has already performed. Do not submit to any painful procedures, for that matter.

Although it is unlikely that the independent medical examination report will be thorough and fair, you can minimize damage to your workers’ compensation claim with the right preparation.

If you’d like confidential advice and professional consultation before your IME, an Emery Reddy attorney can provide you with essential tips.

Mental Health Issues Are Valid Workers’ Comp Claims

Many injured workers suffer from depression and other mental health issues as a result of their workplace injury or illness. In some cases, the mental health issue is the basis for the workers’ comp claim.

Mental health illnesses are treated like physical injuries when they occur in the workplace. But conditions like depression often make it difficult for the worker to muster the energy to find the right doctor and negotiate the workers’ comp claim process.

If you find yourself in this situation, reach out to an attorney and explain your situation. An experienced L&I attorney can explain your rights and options and lay out a plan to fight for your case.

Get in touch now for a free consultation. Our team will analyze your case and see how to get workers’ comp for your injury.

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