Arizona’s workers’ compensation system is designed to cover your medical expenses and lost wages if you are injured at work.
However, there are some situations in which something you do or don’t do can complicate or jeopardize your payments.
Most of these complications are easy to avoid if you know what not to do while on workers’ comp, such as:
- Delaying in reporting your injury
- Skipping or delaying medical treatment
- Downplaying your symptoms or misleading a doctor
- Behaving inconsistently with your injury
- Returning to work too soon
If you want to make sure you don’t put your workers’ compensation benefits at risk, please call Matt Fendon Law Group at (800) 229-3880.
Not Reporting Your Injury or Illness to Your Employer
To be eligible to receive workers’ comp benefits, you need to follow the rules to qualify for them.
One of these rules is that you need to notify your employer as soon as possible that you have received a work-related injury or that your work conditions have caused you to suffer from a medical condition.
You should notify your employer in writing when you become aware of injury or illness symptoms. A formal report would be ideal, but any “paper trail” like a text message or email to your employer works as well.
Do not wait, thinking that things will improve on their own or worrying that your employer might think you are trying to make up a workers’ comp claim.
You could lose the right to a workers’ compensation claim if you miss the window to report your injury or illness.
Failing to Seek Immediate Medical Treatment
Waiting to receive medical care after an injury at work does you no favors and can cause your employer or insurer to doubt your claim’s sincerity or severity.
Receiving immediate medical attention bolsters the strength of your claim.
When you see a doctor for the first time, mention that your injury or illness happened at work.
Minimizing Your Symptoms to Your Doctor
In addition to not seeking medical treatment, another mistake some employees will make is thinking that if they downplay their symptoms, this will strengthen their claim by making it look like they are not trying to take advantage of their employer or workers’ compensation.
Being honest and complete in discussing your symptoms with your doctor is important for two reasons:
- It helps to ensure that you receive the medical treatment you really need; and
- It reduces the risk that, especially if you need more or more intensive medical attention later, this will not be taken as you being inconsistent or trying to game the system.
Trying to “tough it out” does not help you when it comes to your workers’ compensation claim, and can make matters worse for you physically and in the way your employer’s insurance company sees your claim.
Be honest about your symptoms.
Not Giving Complete and Accurate Details of Your Injury to the Workers’ Comp Doctor
Your employer’s insurance company has the right to have you see a doctor of its choosing to do an independent medical examination (IME) of you. You should expect it to exercise this right.
This IME doctor will have access to the medical records related to your injury and will be sending a medical report of the independent medical exam to the workers’ comp insurer, so it is essential that you be honest during your examination.
- Do not understate or overstate your injury, medical condition, or the symptoms you are experiencing.
- Give honest, direct, and succinct answers to questions. Do not volunteer additional information.
Basically, it is a good idea to think of your IME doctor like a police officer performing an investigation. Being evasive or not fully candid during questioning is never a good idea and will only make the examiner suspicious.
Not Reporting Changes in Your Medical Condition
Once your doctor’s treatment plan is underway, you must let your treating physician and the workers’ compensation insurer know if your symptoms improve or worsen.
This helps ensure that if your workers’ comp benefits need to be adjusted, this can happen in a timely way.
Not Keeping Records of Your Treatment
You should keep all records of the treatment you receive for your workplace injuries.
If any dispute arises between you and the workers’ compensation insurance company, these can be valuable in helping your workers’ comp attorney resolve the matter favorably for you.
Staying with the IME Doctor as Your Treating Doctor
Although not all doctors chosen by the insurance carrier will be hostile to your claim, it is usually best to have a doctor of your choice to manage your treatment plan to avoid any possible conflict of interest between you and your doctor.
Behaving Inconsistently With the Claimed Nature and Extent of Your Injury or Illness
Insurance fraud is not unheard of in workers’ compensation claims, and insurance companies are vigilant to look for signs of it. You should expect your employer’s insurance company to pay attention to your behavior to ensure that you act appropriately, given your injury or medical condition.
For example, it is now common for insurance companies to hire people to find and monitor the social media accounts of workers’ compensation beneficiaries. Anyone whose social media postings suggest that an individual is not as seriously affected by his or her claimed symptoms as claimed to the insurer is likely to come under increased scrutiny, including possible surveillance by a private investigator.
Your safest bet to avoid falling into a “surveillance trap” is to avoid using social media during your treatment. If you must post on social media platforms, avoid discussing your injury or medical condition, your recovery progress, your activities, or your work status. Also, avoid posting photos or videos of yourself engaging in physical activities.
Even if you believe such postings are honest and that you are not trying to trick the insurance company, all it takes is a screen capture from your social media that looks slightly inconsistent to allow the insurance carrier to challenge your veracity or accuse you of insurance fraud. Do not give it that opportunity.
Missing Medical Appointments
Once your medical treatment plan is underway, the workers’ compensation insurance company will expect you to comply with it, including making all your scheduled medical appointments.
If you start missing these, the insurer can claim that you are not in compliance with your plan and use that as justification to suspend your workers’ compensation benefits.
If you have good reason not to make a medical appointment, do your best to reschedule it as soon as possible.
Not Returning to Work When You are Cleared for Light-Duty
When you recover sufficiently from your injury or medical condition, your treating physician may clear you to return to work on a light-duty basis. If your employer has a light-duty job available for you, then as long as the work offered is consistent with any restrictions your treating physician specifies, you should return to work.
If you refuse to go back to suitable employment, your employer and the insurance carrier are both likely to see this as bad faith on your part. This can lead to efforts to reduce or cut off your benefits.
Going Back to Work Too Soon or Ignoring Work Restrictions
Resist the temptation to go back to work before your treating medical provider clears you to do so.
Employers will sometimes offer to have you return to work on a light-duty basis before your doctor’s advice recommends it, but if you do so and it worsens your condition, this can set back your recovery.
Similarly, if your light-duty work duties are such that they require you to perform activities that go past your doctor’s orders, this can also lead to re-injury. Worse, if this happens, the insurance company may consider you acting inconsistently with your claim and challenge your right to continued benefits.
Never let yourself be rushed into going back to work if you believe you are not ready for it, or to be pressured into doing work that takes you past your doctor’s restrictions.
Talk with your workers’ compensation attorney if you believe this is happening.
Accepting the First Settlement Offer You Receive
Eventually, your recovery will reach the point where your treating doctor will conclude that further treatment for your work injury will not result in any more improvement. This is known as reaching your level of maximum medical improvement.
Once this occurs, if you have not fully recovered, the insurance company will likely offer you a settlement before closing your case. This settlement can be either scheduled over time or a one-time lump sum payment.
Workers’ compensation insurance carriers are like any other insurers: they are interested in keeping payouts as low as possible. Thus, it is not uncommon for the first settlement offer you receive to be on the low end of the compensation you can reasonably expect if you continue to negotiate.
This is where it can be especially advantageous to you to have an experienced Arizona workers’ compensation attorney to represent you. Such an attorney will know how to deal with insurers to make sure that you are not short-changed by a lowball initial offer.
Quitting Your Employment
An important part of workers’ compensation benefits is a wage replacement benefit and temporary partial disability benefits. As long as you remain with your employer, these benefits can continue.
If, however, you decide to leave work (especially before you reach the point of maximum medical improvement), your employer can use this against you:
- Your employer can use your resignation from work as you voluntarily choosing to limit your income. This can adversely affect any lost wage benefits you are receiving.
- If you leave work while you are cleared for light duty, this can negatively affect your ability to receive temporary disability benefits.
- Leaving work early can also impact your ability to collect unemployment benefits.
If you are considering leaving your employment while you are still collecting workers’ compensation benefits, consult with your workers’ compensation attorney to help you assess the potential effects this will have on your continued benefits eligibility.
Not Hiring an Experienced Workers’ Compensation Lawyer
Do you need an attorney to represent you in making a workers’ compensation claim in Arizona? You don’t, but it’s a much better idea to have one.
There are multiple points along the workers’ compensation journey that can turn into traps for the unwary injured worker.
For example, consider the common insurance company practice of asking you to participate in a recorded telephone interview concerning your claim. What you may not know is that the questions being asked of you are often of a nature to get you to make a statement against your own interest as a way of reducing or even denying you benefits.
Having an experienced workers’ comp attorney with you during such a call reduces the risk that you will unknowingly give the insurer ammunition to use against you in a recorded statement.
And, as we have already mentioned above, negotiating with an insurance company adjuster on your own to work out the terms of any final settlement is another potential trap. These adjusters are savvy negotiators whose duty of loyalty is to the insurance carrier, not to you. If they can persuade you to settle for less than you are entitled to, they will not hesitate.
Having an experienced workers’ compensation attorney on your side during these negotiations will keep the insurance adjuster honest, because your attorney will also be a savvy negotiator and will not let you be taken advantage of. This could mean the difference between getting the settlement you deserve and being shortchanged.
Do You Have Questions About Your Arizona Workers’ Compensation Claim?
The Matt Fendon Law Group exclusively handles workers’ compensation claims and appeals in Arizona.
Our founding attorney, Matt Fendon, is an Arizona board-certified specialist in workers’ compensation law. His comprehensive knowledge of Arizona workers’ compensation laws, coupled with our intense focus on customer satisfaction, allows us to deliver an unparalleled experience for our clients who have workplace injuries or occupational diseases.
With five offices across the state, we can help you receive workers’ compensation benefits no matter where you are in Arizona. Contact our law firm toll-free at (800) 229-3880 or complete our online contact form. We offer free consultations for workers’ comp cases.
