If you have read our Illinois work injury blog, you know that we talk a lot about how insurance companies deny or delay benefits all of the time for no reason. It is part of a general business strategy and how they make billions. Not paying out on claims is the goal.

Sometimes though insurance companies can refuse payment on your case and they are doing so in a justifiable way. I am sure that thought just makes them salivate. Unfortunately, their best defense and the number one way they deny claims has to do with something that injured workers do to themselves. It’s not even a dirty trick.

Illinois workers comp cases have a lot to do with credibility. The more credible you are, the more likely you are to win. Same goes true for your doctor. If they are credible it can help your case or harm it if they are not.

It is assumed that when you see a doctor, you will tell them the truth. As a result, the first thing an insurance adjuster or their lawyer does when they review your case is see what you tell a doctor on your first visit. And while the original doctor is the most important one, they will check what you say to all medical providers.

When you see a doctor, you are often asked to fill out a questionnaire about why you are there. They will also take an oral history from you. What you say there is incredibly important.

Some people lie to their doctor about how they got hurt because their boss tells them to and they feel pressure. Other people do not pay attention to what the form says and check no on a box that asks if your injuries are work related. That isn’t always a problem for a repetitive injury, but is a huge problem if you claim a one time incident hurt you. In other words, if you felt a pop in your back lifting a box at work, but on the form say it didn’t happen at work, that will hurt your case.

What you say verbally and what the doctor writes down is even more important. If you swear you told them you were hurt at work, but they write down that you got injured at home, that will likely destroy your case. I am not saying that you look over their shoulder while they write stuff down. I do suggest that you make it clear you were hurt at work when giving your history. Don’t just say “I was lifting a box and hurt my back.” Do say, “I was at work. I lift boxes every day and at 10 a.m. I picked one up like I always do and felt a pop in my back. I reported it right away to my supervisor who told me to see a doctor so here I am.”

If you do knowingly lie, it kills your credibility. Unless we can call a witness that says they heard your boss tell you to lie and that they have done that before, your lie will be hard to overcome. And either way, the insurance company will deny benefits and be in the right to do so. The only way you will win is if you can convince an attorney to take your case to trial and survive for many months while that process plays out.

The only close second that insurance companies love is when you have a delay in your medical care. In other words, if you get hurt in December, but do not see a doctor until March or April, that gap implies that you were really injured doing something else. Timely treatment which includes follow up care is really important in these cases too.

All of these points are about proving what the truth is. If you do not have accurate information in your medical records, it can really cause you harm.

If you have any questions about this or want to discuss a case, please call us for a free case review at 312-346-5578.