What Are the Most Common Mistakes When Filing a Workers’ Compensation Claim?

Common Workers’ Comp Claim Mistakes – Key Takeaways

Before diving into the specifics, here are the essential points every injured worker needs to understand:

• Timing matters more than most people realize: Missing deadlines can eliminate your eligibility for benefits, and waiting to file a claim (or hire a lawyer) is one of the most common mistakes injured workers make.
• Documentation requirements exceed basic paperwork: Do not think you can turn over a couple of medical bills and secure fair compensation—insurers demand serious documentation before they agree to pay claimants.
• The insurer’s number-one goal is to underpay (or avoid paying) the claimant: Rather than “acting ethically” or “honoring policyholders,” many insurers are most concerned with their financial bottom line.
• Handling claim-related communications yourself can be a catastrophic miscalculation: Insurance companies utilize every opportunity to trip claimants up and reduce their compensation, so let your workers’ comp lawyer handle claim-related communications for you.
• The sooner legal counsel gets involved, the better: Injured workers deserve to rest without worrying about an insurance claim, so don’t wait to hire your attorney.

The Most Devastating Filing Mistakes for Injured Workers to Avoid

If we have to guess, you are facing unfamiliar circumstances. Workplace injuries often strike without warning, and most individuals who have suffered an injury have little experience filing workers’ compensation claims. While we can forgive you for making a mistake during this foreign process, insurance companies won’t—in fact, insurers will use your mistakes against you.

Some of the errors that other filers have made, and you can now avoid, are:

Missing Critical Deadlines

Workers’ compensation claims operate under strict time constraints that vary significantly between states. These deadlines aren’t suggestions, but absolute requirements—missing them can instantly disqualify even the most legitimate claims.

Some deadlines that it would be a mistake to ignore are:

• Injury reporting deadlines, which typically range from 30 to 90 days after the injury happens or an illness is discovered
• Formal claim filing periods, which generally extend several months to years beyond the initial reporting requirement
• Appeal deadlines, which may loom shortly after the claimant receives a denial or other unfavorable decision 

Beyond initial reporting, injured workers face cascading deadlines that can eliminate entire categories of benefits. When you hire a workers’ compensation attorney from our firm, ensuring your claim abides by all deadlines will be one of our foremost priorities.

Inadequate Medical Documentation

Medical records form the foundation of every workers’ compensation claim. Yet most workers don’t understand what documentation matters, how much detail insurance companies require, or how to acquire and hand over that documentation as part of their claims.

Our attorneys and support staff know exactly how to document injuries and collaborate with medical professionals, who often provide us:

• X-rays, MRIs, and physical examination findings that support subjective complaints
• Records showing how a worker’s injuries respond to various treatment approaches
• Detailed descriptions of how injuries affect daily activities and work capabilities
• Medical bills
• Other medical documentation that can be integral to a claim’s success

Workers do not always know what care they need for their injuries, let alone how to document those injuries or that care. Let our firm take the lead in proving your medical needs and healthcare expenses.

Incomplete Reporting of the Incident(s) That Caused Injury (or Illness)

While workers’ compensation insurance should cover a broad range of injuries and incidents (regardless of fault), insurance companies might deny a claim based on allegations of impairment or horseplay.

The possibility of counterarguments against your claim is one reason why we must document the cause of your injury, which may include:

• Detailed descriptions of exactly how injuries occurred, not vague statements like “hurt my back lifting”
• Proof of lighting conditions, weather, equipment malfunctions, and safety protocol violations that may have contributed to the accident
• Names and contact information for all coworkers who observed the injury
• Specific details about machinery, tools, or materials involved in the incident

Some particular forms of documentation that may directly benefit your workers’ compensation claim are:

• Photographs of injury scenes from multiple angles
• Written witness statements collected immediately after incidents
• Equipment inspection reports showing mechanical failures or safety violations
• Written acknowledgment of hazardous conditions from a supervisor
• Documentation of any safety training deficiencies

Workers who fail to collect this evidence immediately after injuries occur miss opportunities to build compelling cases.

Allowing Underqualified Medical Providers to Dictate Your Evaluation and Treatment

To some degree, insurance companies may dictate which medical providers can be involved in the claims process. Yet, your workers’ comp lawyer from our team will do everything in our power to ensure you get all the necessary evaluation and treatment from qualified medical providers.

Insurance companies’ handpicked medical providers may minimize your injury severity, rush your return-to-work date, and fail to document symptoms adequately—intentional tactics to benefit the insurer. Allowing insurers’ providers to have the only say in your evaluation and treatment would be a mistake.

Communicating Carelessly

Casual conversations with supervisors, coworkers, and insurance adjusters can directly harm your workers’ comp claim. Some types of careless communication you want to avoid are:

• Minimizing injury severity: Comments like “I’m fine” or “it’s not that bad” can be documented and used against workers during the insurance claims process.
• Premature return-to-work commitments: Informal agreements made while medicated or stressed can backfire during claim evaluations.
• Social media oversharing: Photos showing physical activities or positive status updates can prompt claim challenges.
• Conversations with adjusters: Recorded statements often occur when workers are uninformed about their rights and legal protections, so let an attorney from our team handle these discussions.

Insurance adjusters use leading questions and sympathetic tones to elicit damaging statements from injured workers. Your attorney will handle negotiations with insurance companies, allowing them to protect you and resolve your claim as efficiently as possible.

How Insurance Companies Try to Take Advantage of Workers’ Inexperience, Trust, and Impairment

We understand that insurance companies have businesses to run. Even so, that is no justification to treat injured workers with bad faith, depriving them of the compensation they deserve just so insurance companies can save some money.

Our attorneys are always prepared for insurance companies to:

Deny Legitimate Workers’ Comp Claims

Workers’ compensation insurance is a profit-driven industry where every dollar paid in benefits reduces company profits. This fundamental conflict creates systematic pressure to deny and minimize claims.

Manipulate the Injured Worker

It seems far-fetched, but insurance adjusters receive extensive training in psychological manipulation techniques designed to elicit damaging statements from injured workers. Common manipulation strategies include:

• Using concerned tones and expressing worry for workers’ families while secretly documenting everything for potential claim challenges
• The adjuster positioning themselves as a helpful advocate while actually working to minimize company liability and benefit payments
• Creating artificial urgency for the worker to make a settlement decision
• Discouraging workers from seeking legal advice

These tactics can be subtle, and countless workers have succumbed to these bad-faith tactics. As soon as you hire your workers’ compensation attorney from our team, you no longer have to worry about (or even face) these bad-faith strategies.

Delay Your Claim

Insurance companies deliberately create administrative obstacles that delay claim processing and frustrate injured workers into caving to the insurer’s agenda. Complex paperwork requirements, repeated document requests, and lengthy review processes may all be intended to wear you down—the insurance company hopes you will accept a lowball settlement because you’re tired of dealing with a tedious claims process.

Our attorneys are persistent, demanding that insurance companies get straight to negotiations. We don’t tolerate delays.

Injured workers may not be familiar with insurance companies’ tactics and strategies, but we are. Attorney Jerry Sisk and his team are proud to take on the insurance companies on behalf of our state’s injured workers, and we won’t let you down.

Your Covered Losses After a Work Injury or Illness 

Workers’ compensation policies provide a few critical forms of support that can keep the worker afloat while they heal, and those benefits include:

Medical Expense Coverage

Workers’ compensation insurance typically covers comprehensive medical coverage for all treatment related to workplace injuries, including:

• Emergency medical care
• Ongoing physician services
• Diagnostic procedures
• Surgical interventions 
• Rehabilitation services 
• Prescription medications
• Medical equipment

We have seen workers suffer seemingly every injury in the diagnostic manual, from severe traumatic brain injuries to broken bones, internal bleeding, spinal cord injuries, burns, and beyond. Our firm ensures that clients get the diagnoses and treatments they need and the compensation they deserve for medical care.

If you suffer from any mental health conditions as a result of a work injury (or from work-related circumstances), we will seek any compensation you are entitled to for diagnosis and treatment of those conditions. State law is specific when it comes to workers’ comp coverage and conditions like post-traumatic stress disorder (PTSD).

Wage Replacement 

Workers’ compensation provides several types of wage replacement designed to support injured workers during recovery and beyond. Wage calculation factors that can affect benefit amounts include:

• Average weekly wage computations based on earnings history before injury occurrence
• Maximum and minimum benefit limits that vary significantly between different state jurisdictions
• Cost-of-living adjustments that may increase benefits over time in some states
• Concurrent benefit limitations when workers receive disability payments from multiple sources

Vocational rehabilitation benefits assist injured workers in transitioning to new employment when their previous jobs become impossible due to injury-related limitations. We will evaluate the cost of immediate and long-term professional harm and demand compensation according to those losses.

Additional Compensation Categories

Death benefits provide financial support for families when workplace injuries result in fatalities. These benefits typically include funeral expense reimbursement, ongoing income replacement for surviving spouses and children, and lump-sum payments designed to compensate for lost future earnings.

Disfigurement awards compensate workers for permanent scarring, amputations, or other physical changes that result from workplace injuries. Mileage reimbursement covers transportation costs for medical appointments, physical therapy sessions, and other injury-related travel expenses.

These are categories of losses we are always aware of when crafting our settlement demands for injured workers.