Workers' compensation claims can be maddening and complex. It can be a long and difficult process and the last thing you want to do is make a mistake that can cause your claim to be denied, to delay your receipt of benefits, or enable the insurance company to stop paying you benefits. The following is a list of 5 mistakes that can cause you to lose your workers' compensation case.
1) Failing to report your injury to your employer
Under the Pennsylvania Workers' Compensation Act, you have 120 days to report your work injury to your employer. We strongly recommend that you report any work injury to your boss or direct supervisor immediately (even if you think it is not a serious injury) to avoid any dispute regarding proper notice. Keep in mind that providing proper notice, while required under the Act, will not toll the Statute of Limitation, which is 3 years. If there is any possibility that an on-the-job injury could affect your ability to do your job, or make you miss work, file an accident report immediately. (And be as specific as possible — mention time, location, and body part injured, don’t just report “I hurt my back.”) You have three years to file your workers compensation claim, but if you wait too long, the details of the event could be harder to prove. Even if you think your injury will get better overnight with some rest and Advil, let your employer know you were hurt on the job.
2) Failing to follow doctor's orders
A strong workers’ compensation claim requires medical evidence. Workers’ compensation insurance is designed to assist injured workers until they can return to work. It is important to follow doctors’ recommendations for treatment, medication, rehabilitation, etc., including keeping appointments. If your employer or the insurer believes that you are not working to recover, your benefits could be suspended or terminated. If you disagree with your doctors’ orders, you should seek a second opinion from another doctor of similar specialty. Also do not miss any follow-up doctor's appointments or physical therapy sessions (unless you have a legitimate excuse and contact the provider ahead of time), or the insurance company may think your injury is not severe, or that you are being non-compliant with your doctor's treatment plans.
3) Thinking you do not have a claim because of a pre-existing condition
You may have a valid workers’ compensation case if you were hurt on the job and you are currently unable to work because the aggravation of your pre-existing condition makes you unable to work. In fact, the definition of an injury for Pennsylvania Workers’ Compensation purposes includes an aggravation of a pre-existing condition. Employers and insurance companies may try to argue that you are unable to work because of your underlying condition and not because of the aggravation of that injury caused by your workplace accident. Therefore, you will need evidence that your pre-existing condition was aggravated by your on-the-job accident in order to recover workers’ compensation.
4) Returning to work too quickly
To save money and try to end your claim quickly, your employer’s insurer may ask your employer to find some work you can do as you recover, or claim that you are fine to return to your pre-injury position. Any job offer must pass legal and medical scrutiny. This means that the job offer must contain certain specifics about what the job is, what duties you will be asked to perform, the rate of pay, and other specifics; the job must also be within the restrictions of YOUR doctor (very often the employer will use the IME doctor's restrictions, which will be less restrictive than your doctor's restrictions)You should request a description of proposed job duties and have your doctors review it to ensure that you can do the work. You should not do any work without doctors’ approval, for the sake of your health as well as receipt of full benefits.
5) Not hiring an experienced attorney to protect your rights
Thinking that you can handle your case by yourself can sometimes be the biggest mistake an injured worker makes. Perhaps your report with the adjuster has been a good one, and you think that they may have your best interest at hand; but frankly the only people that will look out for YOUR interests will be you, your family and your attorney. There may be things that you have never even considered, like a Medicare set aside, the language of documents you need to file, and the overall value of your claim to name a few. These are things that an experienced attorney needs to discuss with you so you are completely informed when making decisions about your case.
These are only 5 of the mistakes that can cause you to lose your workers' compensation claim. Of course there are others. Most attorneys will discuss your case, free of charge, on the telephone. You should always consider talking to several attorneys so you know you are hiring the right one for you and your case.