What Not to Do While on Workers’ Comp to Keep Your Benefits

The Importance of Following Workers’ Compensation Rules

Workers’ compensation insurance is a no-fault insurance system that provides a safety net for people who suffer on-the-job injuries. Forty-nine states require most employers to buy workers’ comp insurance unless a workers’ comp exemption applies. Texas does not require any employer to buy workers’ comp insurance.

But what are you allowed to do while on workers' comp exactly? Here’s what you need to know.

Understanding the Basics of Workers’ Comp

The insurer does not need to determine fault to pay your claim. However, it does examine several other issues that it can use to deny your claim, including:

• Did your injury happen at work or on personal time?

• Was your injury a pre-existing condition?

• Have you fully and accurately described your injury?

Once the insurer accepts your claim, you are entitled to keep receiving benefits until you are healthy enough to return to work. State laws do not require workers’ comp insurers to pay benefits after you have recovered or reached maximum medical improvement.

Maximum medical improvement means you will not recover any further, regardless of the treatment and therapy you receive. When you reach this point, you have a permanent injury and can seek permanent disability benefits. Many insurers will try to negotiate a workers’ comp settlement to fully and finally resolve your case in exchange for a lump sum payment.

What Not to Do While on Workers’ Comp: 5 Actions to Avoid

With all of these rules in place, a misstep can jeopardize your workers’ comp benefits. The following five mistakes can call your entitlement to benefits into question:

1. Missing or Refusing Medical Appointments

You must seek treatment and follow your doctor’s instructions while you receive benefits. If you plan on refusing care, skipping doctor’s appointments, or missing physical therapy appointments, workers' comp insurers may terminate your benefits. If you are not happy with your doctor, most states give you the option to change doctors.

However, you must be careful to select an approved doctor. In Pennsylvania, for example, your employer and its insurer provide a physicians list, and you will have to choose a doctor on the list for your first 90 days of treatment. If you go off the list before that time, the insurer can refuse to pay.

Similarly, if you experience an emergency and cannot reach an approved doctor, you can often seek treatment without getting charged. For example, California workers’ comp insurers must provide up to $10,000 in emergency treatment before you file a claim. Just make sure you notify the medical provider that they must seek payment from a workers’ comp insurer.

2. Failing to Fully and Honestly Describe Your Injuries

The insurer needs a full and accurate description of your injuries. Exaggerating or fabricating injuries could result in a claim denial and even accusations of fraud.

Does workers' comp follow you around closely enough to find these inaccuracies? Yes, they do. Insurers have nearly unlimited resources to track down potential fraud. Many use investigators to watch claimants and monitor their social media for anything inconsistent with their alleged injuries.

For example, suppose that you suffered a neck injury but exaggerated your symptoms. If the insurer sees a video of you on social media riding a horse, the insurer will know your neck is fine and does not need benefits or a neck injury settlement. Avoiding workers' comp surveillance may be impossible, so the safer option is to describe your injuries honestly.

At the same time, withholding information from your doctor and the insurer may create problems as well. For instance, workers’ comp also covers mental health problems resulting from your work. Thus, workers’ comp in Wyoming usually pays for counseling if you experience post-traumatic stress disorder symptoms. If you conceal these symptoms, the insurer will not pay for treatment and therapy.

3. Refusing to Return to Work

Your benefits last until you heal. But the insurer expects you to return to work when the doctor reports your fitness for your job duties. If you refuse to work, including refusing light duty, the insurer can end your benefits early.

Instead of refusing to work, ask for a second opinion. Most states have a procedure to request a review of your case by a different doctor.

4. Secretly Working

Another common mistake is to work secretly. Keep in mind that you can work while receiving workers’ comp benefits. Moreover, the insurer expects you to work within the scope of any limits imposed by your doctor; if you return to full-time construction work after sustaining a construction injury, for example, your benefits might be impacted.

However, you must inform the insurer that you are working. Moreover, once you return to full-time, full-duty work, the insurer will end your wage replacement benefits.

Can workers' comp find out if you're working, though? Because the same investigators who follow you around and read your social media posts, workers’ comp can in fact try to determine whether you are working.

5. Talking to the Insurer Without a Lawyer

One of the biggest mistakes you can make for your claim is to speak to the worker’s comp insurer without a workers’ compensation lawyer. Insurers know the law and will look for anything that suggests you have done something wrong. A lawyer can tell you what not to say to a workers’ comp adjuster.

Learn What Not to Do While on Workers’ Comp From ConsumerShield

The goal of workers’ comp is to keep you financially afloat while you receive treatment and therapy for your on-the-job injury. ConsumerShield can connect you with a lawyer to help you determine what not to do while on workers' comp. Contact us for a free case evaluation.