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Nine Dos & Don’ts of Workers’ Compensation Claims

September 27, 2017 | 7 min read

For the last two years, Colorado has seen lower “loss costs,” primarily as a result of fewer, and less severe, worksite accidents. The Colorado Division of Insurance defines” loss costs” as medical payments and lost wages paid to injured employees.

“Employers in Colorado continue to do a good job of preventing workplace incidents in the first place, which helps everyone in keeping workers’ compensation costs down,” said Colorado Insurance Commissioner Marguerite Salazar.

While I agree that this is part of the reason costs are down, I know that the main reason costs are down in our state is that the insurance carriers are denying more claims, and denying more treatment or requests for surgery than ever before. They have also kept costs down by using physicians or clinics that might not make referrals for diagnostic testing or specialist help as quickly as a doctor outside the workers’ compensation system might. This may save a few bucks on the front side, but the injured worker may suffer if they do not get the treatment that they need timely.

If you have been hurt while on the job, you need to contact a Colorado work comp attorney for help through the process of your workers’ compensation claim. If the insurance company has denied any treatment or made your doctor jump through a bunch of hoops to get you treated an attorney can help both you and the doctor.

What to Do, What Not to Do

Employees in Colorado have to be careful and deliberate after a workplace accident. There are some clear dos and don’ts when it comes to navigating Colorado’s Workers’ Compensation Law during your claim:

Don’t try to move: If you’ve been hurt on the job, don’t try to move if you have any doubts at all about your ability to do so. You could make your injury worse. Signal or call for help and then seek immediate medical attention.

Do see your employer’s doctor: Your employer has a designated medical provider. You have to see this doctor for your injury unless it is an emergency that requires you to go to the ER for immediate treatment.  Once the need for immediate treatment is over you are required to see the company authorized clinic or doctor for follow up. If you see any other doctor and it’s not an emergency, you could be on the hook for whatever medical fees they charge.  In most of Colorado, the employer is required to provide you with the names of at least 4 different clinics or treatment facilities, and 2 have to have different ownership. If they fail to do this at the time of injury an argument can be made that the injured worker gets to choose his own physician but this can be difficult so in that situation talk to an experienced workers compensation attorney before making that choice.

Don’t wait to report your injury: In Colorado, you must report your injury to your employer within four business days. The claim cannot be denied if you report it after 4 days but it does cause problems and it is far more likely that the insurance company will contest the claim if it is not reported right away. This is even more important if there are no witnesses to the incident that creates the injury. Many times an incident will happen and the worker will not say anything because they think it is minor and time will make it better. If it later turns out to be worse than expected there is a high likelihood the claim will be denied, so report even minor incidents and get it checked out even if you do not think it is anything serious.

Do tell your doctor everything: During your visit, it is important to tell the designated medical provider everything about your injury. It is critical not to leave anything out. Do not downplay anything. They will frequently ask you to fill out a pain diagram. This is important for the first visit because things not noted on the pain diagram are often contested later. For example, if a fall caused a broken arm and some back or neck pain, it would be natural to get the arm fixed because it is the portion of the injury that is the most immediate. Unfortunately, failure to talk to the doctor, or note the other areas on the pain diagram will cause the insurance company to treat only the broken arm and deny everything else.

Don’t forget about witnesses: When notifying your employer about your accident, make sure to include information about any witnesses who might have been present at the time of the incident. This makes the investigation go much smoother and makes it less likely the insurance company will deny the claim.

Do get a second opinion: If you have any concerns about your doctor’s initial diagnosis, do not hesitate to seek out a second opinion about your injury. You have every right to do so.  However, the workers’ compensation insurance company will probably not pay for the second opinion so be aware that if you do this it is likely at your expense. Usually, they will only pay for treatment from an authorized physician or their referrals so you can ask your doctor to refer you and see if it is authorized. Of course, have concerns about how truly independent that second opinion is if it is another doctor that the insurance company is willing to let you see.

Do talk to an attorney: Workers’ compensation is complicated. There are pages of rules and regulations, and injured employees can get confused easily, putting their benefits at risk. The biggest mistake you can make is to try to handle your claim on your own even if the insurance company has admitted liability and is paying benefits. You should also realize that most insurance companies will pay for medical benefits with the authorized treating doctor initially. This does not mean that they have admitted liability or agree that you have a work-related accident.  This is especially true if you have not missed at least three days or three shifts from work. We have seen many cases where a surgery gets postponed  6 months after the injury only to have the insurance company deny it and say that they are questioning whether this injury happened at work.

Don’t sign anything: While you are recovering there will be any number of people who try to get you to release forms, insurance documents, or settlement proposals. Don’t sign anything, especially if you have not met with a Colorado workers’ compensation attorney. You are required to provide them with medical releases but an attorney knows how to limit these and how to avoid them sending blank releases all over town or to providers that treated you 20 years ago.

Don’t ignore any work restrictions: If your injury is serious but not necessarily critical, your doctor will notify you of your ability to return to work, but it could include restrictions on the tasks you are allowed to perform. Do not ignore these restrictions. Doing so could jeopardize your ability to receive compensation for your injuries. It is not unusual for employers or supervisors to want someone to go back to doing exactly the same job even with the restrictions but don’t get forced into going along with this, the doctor needs to be notified that they are not complying with the restrictions the doctor gave you.

While You are Recovering from your Injury

So, you have been hurt on the job. Your doctor has declared you temporarily disabled, you have been sent home for six months and you are collecting workers’ compensation benefits. What do you do now? Do you have any restrictions?

Your best bet is to follow your medical provider’s advice and remember that if your doctor has sent you home because you are not physically able to do your job, then you are probably not well enough to run a marathon, go skiing, work on your car, or take a second job. It is critical that you avoid doing anything outside those restrictions.

For example, a bus driver in New York got hurt on the job in 2009 and needed surgery to repair a torn rotator cuff. A little more than a year later, the bus driver needed surgery again. As it turned out, his employer had surveillance video of the bus driver renovating his new house while he was out on workers’ comp leave, which led to the aggravation of the bus driver’s original injury. It is not uncommon for an insurance company to do surveillance if they feel that someone is working, or doing things that are inconsistent with what they tell the doctor they can do.

Usually, this information comes from coworkers that see you in the neighborhood or at the store, or from Facebook or Instagram posts that show pictures of, or talk about things you are doing that are contrary to how you present yourself at the doctor’s office. Stay off social media, or at a minimum, do NOT post anything about recreational or social activities.

If you have been hurt at work, it is absolutely critical that you seek out professional legal counsel before you do anything. Do not do anything that may make your injury worse, risking losing your workers’ compensation benefits. Contact one of our Colorado work comp lawyers as soon as possible at 303-792-5595 or fill out our free case evaluation form by clicking here.