You’ve just been injured on the job. What’s next? Most injured workers report the injury to their employer and go to the hospital. Then, they start working with the Human Resources Department to navigate the process of getting their wages and medical bills paid while they recover. Many workers make the mistake of following the instructions of their employer or L&I without asking the right questions or considering the consequences. Any mistakes made early on in the claim can spell disaster for the claim down the road. Here are the
Top 10 mistakes that can ruin your L&I claim
Not reporting a claim right away
It’s common for a worker who is hurt on the job to delay reporting or filing an L&I claim, especially if the injury doesn’t initially seem that severe. A lot of injured workers want to wait to see how badly they’re hurt before they report the injury or file their L&I claim. They worry about what their supervisor and coworkers will think, and whether filing will affect their job, future raises and or promotions. A lot of workers use vacation and sick time instead of using the workers’ comp system. Some do not report any injury at all to their supervisor, and might even downplay the injury to their doctors. Sometimes the boss persuades an injured worker not to file, knowing that an L&I claim could increase the employer’s workers’ comp costs.
Not reporting an injury right away or delaying filing the L&I claim is a big mistake. Any delay in reporting or filing opens the door for your employer to question whether you were hurt at work. Employers are much more likely to support your claim if the injury is reported in real time. The Claim Manager assigned to your case is also incrementally more likely to accept your claim if you timely file it, rather than delaying. If you want the best chance of your employer and L&I accepting your claim, you need to report the injury and file right after it occurs.
Longer delays can be fatal to your case. You have one year from the date of your injury to file a claim for L&I benefits, or two years if the injury is an occupational disease. If you miss these deadlines, it’s very likely your claim will be permanently barred by these statutes of limitation.
Seeing the doctor your employer chooses
Your employer will nearly always recommend the health care provider that tends to serve the company and its interests. Seeing this medical professional can result in an adverse medical opinion that doesn’t reflect the true nature or extent of your injuries. And once an unsupportive medical opinion is on the record, it’s difficult to overcome it in order to prevail on your claim. Simply put, see your own doctor, no matter what your employer says.
This is equally true with regard to independent medical examiners (IMEs). IMEs work for L&I or your employer (if your employer is self-insured). IMEs will rarely support an injured worker’s claim. Seeing one is often the death knell for the injured workers’ L&I claim.
Playing the tough guy (or girl)
When you first see a doctor after the injury, you need to be completely honest about the nature and extent of your injuries and the pain you are experiencing. Tell the doctor how you were hurt, how badly you are hurt, where you are hurt, and the level of pain you are experiencing. This is the exact wrong time to downplay the pain or to be “brave” in front of your doctor or the loved one you bring to the doctor’s appointment. If you don’t tell the doctor exactly what you are experiencing, the doctor’s records won’t reflect your injuries and pain, and L&I or your employer could use these records to later prove that your injuries and pain are less severe, that you weren’t really injured at all, or that your injuries are the result of something that happened outside of the workplace.
Forgetting that everything you say can be used against you
From the moment you are injured at work, you should expect to be monitored. L&I defense firms regularly use surveillance companies to try to catch an injured worker doing physical activity that contradicts the L&I claim. IME staff and physicians also look for any sign that an injured worker could be overplaying his or her injury. Defense counsel has been known to hire investigators to research and record social media posts and online activity. Employers are incentivized to use resources to fight an L&I claim because accepted claims affect the amount they pay for workers’ comp insurance.
Refusing work offered by your employer
Being offered light duty work can put you in a very tricky situation. If your employer offers you light duty, it forces you to make a big decision, often in very little time. You may get offered a light duty position despite the fact that your injury prevents you from working that position. Worse, your employer could force you to respond to the offer within a very tight timeline. And if you don’t respond, your employer might use your denial to argue that L&I should deny your claim. It is true that your employer is required to get approval from your doctor for the offer, but the approval can be as simple as a verbal okay.
If you find yourself in this situation, the first thing you should do is to contact an attorney immediately. The second thing you should do is contact your doctor. If the doctor disagrees with the light duty job in writing, you will have a good argument to L&I that you remain unable to work. In most circumstances, you should not outright refuse an offer for light duty work. Unless you can accept it without issue, you (or your attorney) needs to build your case and the record as to why light duty work is not an option for you.
Waiting to appeal an order
Every L&I decision can be protested or appealed. You have 60 days to appeal or protest an L&I decision. If you miss this important deadline, the decision will likely become final. In short, if you miss an appeal, you’re stuck with the outcome. And a lot of decisions are based on very important issues within an L&I case. Entire cases have been lost because a claimant simply forgot to appeal or protest an adverse decision within the 60-day window.
Returning to work too soon
The best employees want to get back to work as quickly as possible. They want to start producing again and continue moving their careers forward. However, going back to work before you are fully healed can negatively impact your L&I claim. An employer who wants to fight an L&I claim may use the employee’s return to work as evidence that the worker is in fact able to work full time and has healed from the industrial injury. Unscrupulous employers sometimes use the period after the injured worker returns to work to PIP the worker until the employee is fired or quits. Simply put, make certain you are fully healed before you return to work.
Accepting the wrong disability rating
Who issued the rating? Which doctors support it? Did the IME provide the rating? Are you done treating? Have you truly reached MMI? Do you agree with the rating? Are you ready to go back to work? Are you concerned that you might need another procedure? Do you just need more time to see if you’re healing? These are all important questions that must be answered before you agree to a disability rating. You get one shot at maximizing the amount you receive for your workplace injury, so it’s important that you have the right medical opinion and support to ensure that you receive the highest rating available.
Not getting good advice soon enough
You can do a lot of damage to your claim without knowing it. A percentage of L&I claims go perfectly smoothly. You see a doctor and file an L&I claim. The doctor’s report is favorable and L&I accepts the claim. When you are done treating it your doctor supports the highest category rating possible. You get back to your work right-as-rain and L&I cuts you a large check. This happens, just not very often. If you are concerned that things might not go well with your L&I claims, the chances are that a disaster is looming. Some people wait until they get a string of adverse orders before they call an attorney. The key is to get help before the adverse orders pile up. A talented attorney can fix a lot of problems with an L&I case that has been mismanaged, but they can’t fix every problem. And sometimes attorneys won’t accept cases where adverse orders have been issued and not timely protested. Most attorneys will give a free consultation and tell you if they can help. Good attorneys won’t take cases if they can’t provide you value beyond what you can receive for yourself. If you suspect you might have an issue with your case, call a good L&I attorney.
Not realizing that mental health issues are valid L&I claims
Some people who are injured at work eventually suffer from depression and other mental health issues. For some, the mental health issue is the industrial injury and the basis for the L&I claim. Mental health issues are treated similarly to physical injuries when they occur in the workplace. On the other hand, it can be difficult to find a mental health professional capable of supporting a mental health L&I claim. And complicating this matter is that conditions like depression make it hard to find the energy to fight L&I and take the steps necessary to keep a claim open. If you find yourself in this situation, reach out to an attorney and explain your situation. An experienced L&I attorney, or team of L&I attorneys can explain your rights and options, and will seek to represent you if they feel they can fight for your case.