Knowing what not to do while on workers’ comp helps prevent injured workers from losing their right to benefits. Failing to timely notify his or her employer of the workplace injury or to attend all required workers’ comp hearings can have a detrimental impact on the worker’s receipt of or claim for benefits. Opaque or dishonest communications with the treating physician or workers’ compensation doctor can also create obstacles for the worker. Acting in ways that are contrary to the reported symptoms or restrictions imposed by the worker’s doctor should likewise be avoided.
Failing to Timely Notify the Employer of the Injury
Workers must notify their employer “as soon as practicable” or, at the latest, within 45 days following a workplace injury. If the worker fails to provide his or her employer with this timely notice, payment of workers’ compensation may be delayed.
Failing to Inform the Treating Doctor that Injury is Work-Related
Workers should inform any treating physicians (emergency doctors, primary doctor, etc.) that the injury occurred at work. Workers should also truthfully and in a straightforward manner explain what happened and what they are experiencing as a result.
Providing this information to the treating physician creates a paper trail that the worker can use to support his or her claim. Failing to follow this step may result in gaps in the record that can create unnecessary obstacles to successfully resolving a workers’ compensation claim and maintaining the workers’ compensation benefits.
Failing to Attend Workers’ Compensation Hearings
If the worker has filed a formal claim for benefits with the Illinois Workers’ Compensation Commission, then it is critical for the worker to follow the proper procedures. By regularly attending required workers’ comp hearings, the worker helps to smooth the path to resolution of the claim and continued receipt of benefits.
Omitting, Fabricating, or Exaggerating Information
Workers should be transparent in communicating with their treating physician(s) and the workers’ compensation doctor. Omitting or exaggerating symptoms or parts of the accident that caused the injury may jeopardize the workers’ claim for benefits. Fabricating symptoms is not just unwise or potentially detrimental to the workers’ claim, it is also illegal. Workers are encouraged to stick to the facts when talking about symptoms or the cause of the accident.
It is common for insurance companies to hire private investigators to watch the injured worker for inconsistent behavior given the reported symptoms. These private investigators may watch the injured worker while the worker is on and off duty. If the private investigator sees and reports that the worker who is supposedly unable to walk without crutches, for example, is climbing up on a ladder to clean the gutters, this information will be noted and forwarded to the insurance company and, possibly, the employer. The insurance company can – and, most likely, will – use this information to rebut the worker’s claim for benefits and/or his or her inability to return to work.
Deviating from the Doctor’s Orders or Treatment Plan
Workers who deviate from the doctor’s treatment plan or do not follow the doctor’s orders risk undermining the credibility of their workers’ compensation claim or having workers’ compensation benefits terminated. It is common for workers to feel better during treatment, and thus, comfortable going beyond, for example, the restrictions on heavy-lifting or activity imposed by the doctor. Workers should resist this temptation.
If the insurance company hires a private investigator who sees an injured employee doing things like lifting heavy objects or otherwise exerting themselves, the investigator will report this back to the insurance company. The employer may also be informed of this as well. This type of information can be detrimental to the injured worker’s claim.
Signing Paperwork Presented to Injured by Third Parties
Workers are advised against making official medical statements or signing paperwork – such as a medical authorization – presented to them by third parties such as the insurance company or their employer without first consulting with their attorney, if represented. Under Illinois law, workers are not required to sign medical authorizations for insurance companies; however, insurance companies may attempt to persuade workers to sign these forms.
Workers are encouraged to speak with a workers’ compensation attorney prior to signing any official documents (such as proposed settlement agreements) or making official statements. Lawyers for work related injuries can review the paperwork for the workers’ compensation claim and advise the worker as to what he or she can, must, and should not sign.
Failing to Return to Work When Cleared to Do So
It is the worker’s responsibility to return to work on a light-duty or unrestricted basis when cleared to do so. If the worker does not return to work when given clearance, this will raise eyebrows and may cause the insurance company or employer to question the validity of the workers’ compensation claim.
If the worker has been given clearance to return for light-duty work and is still experiencing adverse symptoms, the worker is advised to inform his or her treating physician and to keep a log of the symptoms experienced and when. Regardless, however, the worker is encouraged to return to work on a light-duty or modified basis after he or she has received permission from his or her doctor. The worker can also notify the employer if he or she is experiencing adverse symptoms while on light-duty work so that the employer can make accommodations.
Failing to Attend Doctor’s Appointments
The worker should regularly attend all doctor’s appointments when able to do so, and to reschedule those that he or she is unable to make. The insurance company and the Illinois Workers’ Compensation Commission will be viewing the worker’s medical records, including the log of all appointments and whether the worker attended those appointments. If the worker misses multiple appointments, especially in the absence of an emergency, this may raise red flags. Likewise, the worker should attend all physical therapy or other medical management and therapeutic appointments to show the commission and the insurance company that the worker is complying.