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What Not to Say to a Workers’ Comp Doctor

Written by Ankin Law Office

Knowing what not to say to a workers’ comp doctor can help ensure injured workers protect their right to compensation. When speaking with a workers’ compensation doctor, injured workers should avoid exaggerating or lying about their injuries and hiding details about prior injuries or how the current injury occurred. Also important is for the injured worker to refrain from speaking negatively or disparagingly about his or her employer, even if the worker feels that the employer’s negligence contributed to the cause of the injury. Additionally, the worker should ensure that the statements he or she gives to the workers’ compensation doctor match up with the statements he or she gave to his or her treating or primary physician.

Difference Between the Workers’ Compensation Doctor and the Worker’s Treating Physician

The worker sees a treating or primary physician to perform the ordinary medical services and provide treatment for the injuries. Treating physicians, for example, conduct the initial examination, take diagnostic tests, and provide or recommend ongoing medical care. In contrast, the workers’ compensation doctor is hired by the insurance company or employer for the sole or primary purpose of evaluating the injury in the context of the injured worker’s underlying workers’ compensation claim. The workers’ compensation doctor may perform this evaluation at the beginning of the claim process, or after a claim has been successfully approved. The workers’ compensation doctor may also assign a disability rating to the worker’s injury and provide a second opinion regarding the worker’s condition.

Purpose of the Evaluation by the Workers’ Compensation Doctor

The purpose of the evaluation by the workers’ compensation doctor is to determine the extent of the injury, the impact of the injury on the worker’s ability to perform tasks, and to verify information in the claim. For example, if the worker claims that the injury has caused him or her to lose the use of his or her legs, then the workers’ compensation doctor will perform an evaluation to verify that the worker is in fact unable to use his or her legs.

The workers’ compensation doctor communicates his or her findings to the insurance company, which in turn communicates with the injured worker’s employer. As such, it is vital that the injured worker communicate accurately and effectively with the workers’ compensation doctor to avoid undermining the validity of his or her claim, which could result in a denial of the victim’s benefits.

Exaggerating or Lying About the Worker’s Injuries

Workers should be transparent and honest about the nature and extent of their injury. Rather than bolstering a workers’ compensation claim, exaggerations can undermine the credibility of the worker and thus the worker’s claim.

If the worker is untruthful as to the nature and extent of the injury, the workers’ compensation doctor will often pick up on this. Workers’ compensation doctors will be able to use diagnostic imaging and other tests to determine the extent of the injury. Exaggerations or lies about the nature and extent of the worker’s injury may result in the claim getting denied because the insurance company might use this to discredit an otherwise valid claim.

Acting In Ways That Do Not Match Up with Injury or Reported Symptoms

The worker should act naturally when interacting with the workers’ compensation doctor and staff. If the worker has an injured leg or back, the worker should refrain from exaggerating or faking a limp, as talked about previously. The worker should inform the workers’ compensation doctor if he or she is unable to, for example, bend over completely, and wear or bring back braces that the worker has been using to help with the injury.

The worker should keep in mind, though, that the staff may notice, for example, if the worker drops his or her keys on the ground and is able to bend over and pick up his or her keys without issue, yet stresses to the doctor that he or she is unable to bend over. This type of behavior may cause the workers’ compensation doctor to question the validity of the underlying claims of injury, which will be communicated to the insurance company. Workers should instead act naturally and communicate honestly with the workers’ compensation doctor about the nature and extent of the injuries, including how and when the injury impacts their daily lives.

Omissions or Lies About Prior Injuries

If workers have suffered from a previous injury, whether on or off duty, workers are encouraged to be transparent in speaking with the workers’ compensation doctor about this. Workers may be tempted to conceal or downplay a prior injury under the misguided belief that, if the insurance company or the doctor knows about it, then the workers’ claims may be denied. However, the workers’ compensation doctor will review diagnostic tests and medical records, thus informing them that the worker has suffered a past injury. The effect of this opaque communication with the workers’ compensation doctor may be that the current claim is denied.

If a worker has suffered a prior injury, such as a back injury, and a current incident has caused a new back injury or exacerbated the old injury, the workers’ compensation doctor should be informed of this. A prior injury on top of the new one does not necessarily mean that the worker’s current claim will be denied. If the worker tries to hide the previous injury, and the workers’ compensation doctor makes note of the prior injury, the doctor or the insurance company may assume that the worker is experiencing pain or discomfort because of the prior injury, rather than the current injury. Transparency from the outset of the communications with the workers’ compensation can limit the potential for the claim becoming weakened or denied in this respect.

Omissions or Lies About Accident that Caused the Injury

Workers are encouraged to be transparent and truthful when talking with the workers’ compensation attorney regarding the accident that caused the injury. Workers may be tempted to omit or fabricate certain details about the accident out of fear that their claim may be denied if it looks like the workers contributed to the accident. Workers should resist this temptation and instead be honest and straightforward about the accident.

Most workers’ compensation doctors interact with numerous injured workers each year. If the story these physicians are told does not match up with the injury, or if there are gaps in the story surrounding the accident, then the workers’ compensation doctor will likely become suspicious. With these red flags raised, the entirety of the claim may be called into question, increasing the chances of a denial.

Talking Negatively or Disparagingly About the Worker’s Employer

When speaking with the workers’ compensation doctor, workers are discouraged from talking negatively about their employer. Even if the worker feels that the employer contributed to or caused the worker’s injury, the worker should refrain from communicating this to the workers’ compensation doctor. This is particularly important because the workers’ compensation doctor reports his or her findings to the insurance company, and the employer may read these remarks. The result can be that the worker’s credibility is undermined, or work conditions are uncomfortable and awkward if the worker returns to work.

Contradictory Statements from Those Reported to Treating Physician

An injured worker will go to a physician – typically, of his or her choosing – for medical evaluation and treatment of the injury. During these visits, the treating physician will take detailed notes about the worker’s injury and statements made by the worker regarding the accident that caused the injury. The treating physician(s) may be asked to forward the worker’s medical records to the workers’ compensation insurance company and/or the worker’s employer.

When the workers’ compensation doctor meets with the worker, the doctor may have reviewed the medical records from the injured worker’s treating physician or will review the records after the visit. Inconsistencies about the nature, extent, or cause of the worker’s injury will be brought to light by the medical records. The workers’ compensation doctor will make note of these inconsistencies and pass this information on to the insurance company, which may result in a denial of the claim.

Misrepresenting or Downplaying Severity of Injury

Workers should not misrepresent symptoms, such as by downplaying the severity of the injury, or the pain or immobility caused by the injury. Workers may be inclined to downplay the symptoms if, for example, they feel that they do not have a valid claim or will not successfully win a workers’ compensation claim. Downplaying the severity of the injury, however, can have an unfortunate impact on the victim’s claim. It can, for example, lead to a denial of the claim, make it difficult to achieve a favorable result, or cause the injured worker to believe that he or she should simply accept a settlement offer from the insurance company.

Discussions About Fault or Statements about Interest in Settling Claim

Workers are discouraged from talking about fault or their interest in settling workers’ compensation claims. Workers should be transparent in talking with the workers’ compensation doctor about what happened, but refrain from assigning fault for the cause of the accident or injury. Likewise, workers should avoid making statements about settlement. While oral agreements or statements about settlements are not binding, the insurance company may use any statements made by the victim to attempt to persuade the worker to settle.

Workers are encouraged to speak with an Illinois’ workers’ compensation lawyer if they are wondering what not to say to a workers’ comp doctor. A workers’ compensation lawyer can assist the worker in effectively communicating with the workers’ compensation doctor. If the worker speaks with the attorney prior to the appointment with the workers’ compensation doctor, then the lawyer may be able to help the worker prepare for the evaluation, including explaining the purpose of the evaluation. Before accepting a workers’ compensation settlement in Illinois for payment of, for example, a worker’s medical bills, the worker is encouraged to ask his or her workers’ compensation lawyer to advise whether the proposed settlement is in the worker’s best interest.