Common Mistakes in Workers Compensation Claims and How to Avoid Them

• William Gall

Being injured on the job is bad enough without having to stress over your workers compensation claim getting denied.

But did you know…

47% of workers who eventually received settlements had their initial claims denied.

The good news?

Most of these denials were preventable. By being aware of the most common mistakes in workers compensation claims and knowing how to avoid them, you can dramatically increase your odds of getting the benefits you deserve.

What you need to discover:

• The Biggest Workers Compensation Filing Blunders
• How Poor Documentation Kills Claims
• Timing Mistakes That Cost You Benefits
• Medical Evidence Errors That Lead to Denials
• When You Need Legal Help

The Stark Reality of Workers Compensation Denials

Ready for a little reality check?

Only 40% of eligible workers bother to even apply for workers compensation benefits.

The latest stats show that the denial rates for workers compensation benefits vary widely by state, anywhere from 7% to 13% for initial claims. But here’s what’s really important…

Claim denials are NOT necessarily the end of the road.

The data indicates that 67% of denied claims get converted to paid claims within one year. But the catch? Claims that get denied and then won on appeal take on average 55% longer and cost 55% more than those that are paid without an appeal.

This is exactly why it’s so critical to do your workers compensation claim correctly the first time. And in cases where you’re dealing with a complex injury or an insurance company giving you a hard time, it can be a total lifesaver to consult with an experienced workers compensation lawyer in Chicago to make sure you’re on the right track.

Mistake #1: Not Reporting Your Injury Immediately

This is probably the most common mistake workers make.

You’re working and you get injured. It happens. A lot.

The issue is you start thinking, “Well it’s not that bad,” or “I can tough it out.”

So you decide to take a pain killer and hope it goes away.

BIG mistake.

States have strict reporting deadlines for workers compensation injuries. The requirements range from 30 days in some states to up to two years in others.

But here’s the thing…

The longer you wait, the more likely it is to become an issue with proving that your injury is work-related.

Why Immediate Reporting is Key

Insurance companies and employers are happy to dispute a workers compensation claim that wasn’t reported right away.

They can argue that you were injured outside of work, or that you made your injury worse by not seeking treatment early on.

When you file immediately:

• It creates a specific timeline directly linking your injury to your work duties
• Your medical records show you sought treatment immediately
• Witnesses still remember what happened
• Your employer can’t say they didn’t know about the injury

The solution is easy: Report any injury to your supervisor or human resources department as soon as it happens. Even if you think it’s nothing. You can always withdraw your claim if it turns out to be a non-issue.

Mistake #2: Lack of Documentation

Remember the old saying, “If it isn’t documented, it didn’t happen?”

That’s especially true for workers compensation claims.

Failure to document your injury is one of the quickest ways to have your claim denied.

And it’s 100% preventable if you know what to do.

What You Need to Document

Make sure you have these documents from day one:

• The incident report: date, time, location, what you were doing, how the injury occurred
• Witness information: names and contact information for anyone who witnessed the accident
• Medical records: all doctor visits, treatment, prescriptions, and medical bills
• Work restrictions: any limitations your doctor puts on your activities
• Communication: all emails, letters, and phone calls with your employer and their insurance company

Don’t forget to take photos of the accident scene if possible. The more documentation you have, the stronger your case.

Mistake #3: Choosing the Wrong Doctor

Here’s one of the most overlooked mistakes workers make.

Your employer’s insurance company gets to choose your initial treating doctor in most states. But just because they assign you a doctor, that doesn’t mean you have to stay with them if you don’t like them.

Know Your Medical Rights

Most states allow you to get a second opinion if you disagree with the diagnosis. And you can always request a different doctor from their list of approved physicians.

The key is knowing your state’s specific rules around medical treatment.

But here’s the most important thing…

NEVER miss medical appointments or ignore your doctor’s orders. Insurance companies will use that against you to argue your injury isn’t serious or that you’re not following proper treatment protocols.

Mistake #4: Returning to Work Too Soon

Does the thought of getting back to work make you anxious?

It should.

Wanting to get back to work is totally normal. You need the paycheck. You don’t want to feel like you’re milking the system.

But going back to work before you’re medically cleared can seriously hurt your claim.

Don’t Fall For the Insurance Company’s Pressure Tactics

When you return to work too soon you could re-injure yourself and make the original injury worse. Insurance companies will also use this against you to argue you weren’t really hurt that badly. And they can deny your claim for future medical treatment as a result.

Never go back to work until your doctor releases you. If your employer is pressuring you, document those conversations.

Mistake #5: Misunderstanding Pre-Existing Conditions

Here’s something that confuses a lot of people…

Having a pre-existing medical condition does not automatically make you ineligible for workers compensation benefits. But insurance companies will absolutely try to use it against you if they can.

The most common reason claims get denied? 28% of denied claims are rejected because the insurer alleges the injury was caused by a pre-existing condition.

How Pre-Existing Conditions Really Work

Pre-existing conditions are all about causation and most states follow what’s called the “aggravation rule.” This means you can still be eligible for benefits if your work somehow made your pre-existing condition worse or triggered new symptoms to appear.

The key is getting medical evidence to back up your claim that your work duties made your condition worse or caused new symptoms.

Mistake #6: Trying to Do Everything Yourself

Look. I get it.

You don’t want to pay attorney fees if you don’t have to.

But here’s the thing you need to know…

Workers who hire a lawyer after their claim is denied end up receiving 47% more in benefits on average than those who represent themselves. The average settlement nearly doubles from $12,400 without an attorney to $18,200 with legal representation.

When You Definitely Need Legal Help

If your claim gets denied, you’re being pushed to go back to work too early, or you have a serious injury that could lead to permanent disability, seriously consider hiring an attorney.

Most workers compensation lawyers work on contingency, which means you don’t pay them unless they win your case.

The Numbers Don’t Lie

Navigating the workers compensation system is often frustrating and confusing.

70.6% of denied claims end up in litigation compared to only 27.5% of claims that were never denied.

These statistics prove that getting your workers compensation claim correct from the start is more important than ever.

How to Steer Clear of These Costly Mistakes

Here’s your quick action plan for avoiding the most common mistakes in workers compensation claims:

• Immediately after an injury: Report it to your supervisor ASAP, Seek medical attention (even if the injury seems minor), Take photos of the accident scene
• During the claims process: Keep detailed records of everything, Follow all medical advice, Don’t rush back to work
• If issues arise: Don’t accept a denial without exploring your options, Consult with a qualified attorney, Appeal denials within required timeframes

The Bottom Line

Workers compensation claims don’t have to be complicated.

But failing to avoid these common mistakes can have serious consequences.

The data is clear: nearly half of all successful workers compensation claims face an initial denial from the insurance company.

But with proer preparation and attention to detail, most of these mistakes are completely avoidable.

Don’t let a single preventable mistake cost you the benefits you’re entitled to.