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First off, in my experience, when an Illinois work comp insurance company denies a claim, it’s quite often not for legitimate reasons. They try to deny you because you had a similar injury years ago or they make up some other reason.
And while I know that insurance companies are sneaky and often straight up lie to injured workers, that doesn’t mean that every time they fight a case they are in the wrong. In fact, the most common reason they fight a case has to do with something an injured worker says. And for whatever reason we’ve been seeing this mistake a lot lately.
When you go to a doctor/hospital for treatment, the forms they have you fill out asks if your injuries are work related. They don’t tell you this, but they are asking it because it could change who they have to send the bill to. Too many workers, for whatever reason, say that they weren’t hurt at work when they were. This also happens when people fill out forms for short or long term disability.
Sometimes it happens because the worker doesn’t realize that the injury is work related. That’s understandable. But when you are given the chance on these forms to state how you hurt yourself and the things you mention have nothing to do with your work activities, that kills your case.
What I don’t want anyone to do is lie. That includes not guessing at an answer. If you don’t know if an injury is work related or not, you don’t have to check yes or no, but instead can say, “Not sure. I want to talk to the doctor about that.” On a recent call, a package handler at a major company told us he had a flare up of back pain a month prior. But he told the doctor he had been dealing with that pain for six months. When your stories are inconsistent, it gives the insurance company good cause for not approving your benefits.
In some cases, workers know they were hurt at work, but tell a different story to the doctor anyway. Usually it’s because a boss makes them feel bad or promises to take care of them. Doing so will immediately cause your work comp case to be denied if you file one. The only way to overcome that is if some witness will come forward and corroborate your story or there’s video evidence of how you got hurt. And even with that, it will cause an unnecessary delay to your case. I can tell you that we see this happen all of the time and almost never does the employer do right by the employee. And if they wanted to do right by them, they should know that this is why they have work comp insurance.
I can tell you as someone whose career started off by defending insurance companies – it was a great learning experience, but yuck – the first thing a defense attorney does when they get a file assigned to them is review your medical records. If at any point we see an inconsistent story as to how you were hurt, it will immediately cause a recommendation that the case be fought.
Bottom line is that you should always tell the truth. And if you don’t know the answer to a question, don’t give one.
