Statistics show that 4,600,000 workplace injuries happen every year.
If you’re part of those statistics, you can expect your share of doctor’s visits in the upcoming days and weeks.
Exams are an important part of getting your workplace injury treated properly. They’re also a part of the workers’ comp claim process.
Workers’ comp is coverage provided for all employees and pays 100% of your medical costs if the injury is work-related. It also reimburses you for lost work time after the waiting period.
What you say to the doctor can affect the outcome of your claim, so knowing what not to say to workers’ comp doctor staff is important.
If you’re thinking you should hold back details or falsify the information to bolster your workers’ comp claim, you’re setting yourself up for a denial. The insurance company will look for any reason possible to deny your claim, so getting caught in a lie is the worst-case scenario for your claim.
Understanding what the doctor looks for during the exam helps you understand why it’s important to be truthful and answer questions fully.
Keep reading to discover what things you should avoid saying to your workers’ comp doctor.
What Is an Independent Medical Exam?
Workers’ compensation payouts totaled an estimated $62 billion in 2017. Insurance companies want to keep those payouts as low as possible, so they may ask for additional exams or information before approving your claim.
When you have a worker’s compensation claim, you may need to undergo an independent medical exam (IME). This exam is separate from the treatment you receive from your own doctor for the injuries.
The doctor who conducts your IME is an expert on worker’s compensation cases and injuries. Your employer’s insurance company may request the exam to make sure the injuries qualify for worker’s compensation. The insurance company may choose the doctor you see for the IME.
The exam may be used to decide if the medical treatment your doctor recommends is necessary. It may also be a way to check on your work status and when you’re able to go back to work.
Since the exam can have a major impact on your worker’s compensation claim, it’s important to handle it carefully. Saying or doing the wrong thing in front of the workers’ comp doctor could cause your claim to be denied.
Honesty is the most important part of all interactions with your worker’s compensation doctor. Hiding details or lying about the injuries may seem like it’ll help your case, but it usually hurts you.
Physicians who complete the exams and insurance companies are trained to spot the inconsistencies in your stories. Even one exaggeration or fib could damage your credibility.
Once that happens, the insurance company will question all of your answers. They’ll use that small moment of dishonesty as a way to discredit you and possibly deny your claim.
What Happens at an IME?
The doctor will likely already have your medical record related to the injury if you’ve already seen a treating physician. The insurance company may have additional questions based on those records that they send to the physician. If the insurance company questions whether or not you need surgery or if you need extended time off of work, those questions may be included.
The doctor conducts a full medical exam. This includes questions and physical exams and testing.
Some of the questions are likely things you’ve answered already to other physicians or to the insurance company. Being consistent with your answers is important since the doctor is looking for discrepancies.
The questions might relate to:
- Pre-existing conditions or past injuries
- When symptoms started
- The severity of the injuries and symptoms
- Limitations caused by the injuries, both at work and in daily life
- The diagnosis you received from your treating physician
- Current treatment plan and continuing treatments you’re receiving
- Circumstances surrounding the workplace accident
Review your answers to those questions to ensure you’re able to respond clearly to the doctor. Review your medical exam notes if you have access to them from your treating physician.
Exaggerating Your Symptoms
You want to make sure your injuries are covered by workers’ comp, so it makes sense to make them sound as bad as possible. But that exaggeration could hurt you in the end.
As a trained medical professional, a worker’s compensation doctor can often spot exaggerated claims. The physician will perform various tests and exams to diagnose and verify your complaints.
The doctor may check for your reactions to pain and may be able to tell if you’re faking a painful reaction. They may also spot if you respond to pain when you shouldn’t or don’t respond when you should be based on the supposed injuries and the tests they’re doing.
Diagnostic imaging can also reveal that you’re exaggerating your symptoms. It’s tough to deny that you’re exaggerating when the injury doesn’t appear severe on the imaging test results.
Always give the doctor an actual assessment of your pain level and injuries. It may not be the worst pain you’ve ever felt, but that doesn’t mean your claim will get denied.
If the doctor determines you’re exaggerating your symptoms, the insurance company may use that as a reason to deny the claim completely.
Lying About Symptoms You Don’t Have
A similar scenario you should also avoid is making up symptoms or injuries that you don’t have at all. Just like exaggerating the severity of an injury you do have, making up extra pains or injuries is something the doctor will likely figure out quickly. Doctors often have years of experience in the area and know what to look for when it comes to made-up symptoms.
It’s also important not to lie about limitations caused by the injury. Don’t say you can’t bend over, drive, or walk without crutches if you can do those things.
If you lie about your injury, you lose credibility. The doctor may question if any of your symptoms or injuries are real.
Doctors make notes about everything from the exam, so the insurance company will see that you lied about symptoms if you get caught. This can hurt your chances of having your claim paid.
Your best option is to describe the actual injuries and symptoms you feel as accurately as possible. Don’t exaggerate or make up symptoms.
But you also don’t want to downplay any actual symptoms you feel. You may think it makes your claims more believable by downplaying it, but you want to be completely honest when describing your situation.
Leaving Out Past Injuries
As part of any medical exam, the doctor takes your medical history. It’s tempting to leave out information about past injuries or pre-existing conditions. You may think the insurance company will deny your claim because of those injuries.
Say you hurt your back a few years ago. Your recent work injury caused a new injury to your back. You may worry that workers’ comp won’t cover this new injury because your back was already hurt.
It’s important that you’re honest about any past injuries or pre-existing conditions. Even if you don’t tell the doctors about them, they may find out about them during the exam.
If you previously had knee surgery and reinjured your knee at work, the doctor may see your surgical scar. Previous injuries may show up on diagnostic imaging. The doctor may see notes in your medical records about past treatment for an injury or medical condition.
If you don’t bring up the past injury, the doctor may assume this injury isn’t new at all. They may feel your old injury is causing problems again and you’re trying to blame a work accident for it to get the bills paid. That may not be the case, but it looks suspicious when you’re not honest about it.
Explain what happened in the previous injury. Be prepared to talk about the treatment you received for it.
The insurance company may try to say the pain is coming from the old injury. Don’t use that as a reason to hide the old injury.
Know how to describe how this pain is different. Let the doctor know you haven’t had pain in years from the old injury. Describe how this pain is new and more severe than any pain you’ve felt since your old injury.
Omitting Details About the Accident
You want the worker’s comp claim to go in your favor, but don’t like about how the accident happened to achieve that.
The doctor will ask you want happened leading up to the injury. Explain the situation completely without leaving out any details.
You might be tempted to leave out details that make you look bad. There’s a good chance the doctor or insurance company will figure out that you’re not being completely honest and forthcoming.
They’re trained to spot inconsistencies in your story. If you leave out part of the story, the doctor may start to question what really happened. If something you told the doctor doesn’t match up to what your employer says happened, it might send up a red flag.
Saying Negative Things About Your Employer
Sometimes after a workplace injury, you feel resentment toward your employer. That’s especially true if the working conditions were unsafe or if the company failed to give you the proper safety gear.
Avoid the temptation to speak badly about your employer. This casts a negative light on you, and those details may end up in the doctor’s medical report.
That information could eventually get back to your employer. That puts you in a tough spot at work.
Assume anything you say will be reported back to the insurance company and your employer. Despite how you feel about your company, avoid expressing those negative feelings to the doctor.
It’s always in your best interest to be polite to doctors, whether it’s the treating physician of your choice or a workers’ comp doctor hired by the insurance company.
You may feel defensive while undergoing the exam. It may feel like the doctor is trying to find holes in your story.
While the doctors are trained to look for inconsistencies, they’re not out to sabotage you. If you treat them like the enemy, they’re less likely to help you out.
Try to keep your emotions controlled during the exam, even if your worried, upset, or angry. Hostile behavior puts the doctor on the defensive and may make you seem like you’re hiding something.
Acting in Contrast to Your Injuries
It’s not just what you say to the worker’s comp doctor that can hurt you. Acting in a way that contradicts your injuries can get your claim denied.
If you walk just fine in the parking lot by start limping and acting like you’re in pain when you get inside, the staff at the doctor’s office may notice this. They’ll take note of the difference in how you act.
Your footwear is another consideration. If you wear high heels while trying to tell the doctor you have an ankle injury, you’re showing that you’re exaggerating your pain.
If you need a brace, crutches, or other devices to deal with the pain, wear those to the appointment. This shows that you’re using those devices to help you feel better.
If you’re being honest about your injuries, your actions should follow, so this really comes down to being honest about your injuries. If your ankle hurts as bad as you say, you won’t be able to walk in heels. If you can’t put any weight on your leg, you’ll have to walk with crutches.
Arriving Late or No-Showing
Another red flag is showing up late or not showing up at all for your IME. This makes you look like you’re trying to avoid the exam or that you don’t think it’s important.
If you show up late or skip completely, the doctor reports this to the insurance company. Even if you have a valid reason for skipping, it reflects poorly on you and can hurt your case.
Verify the date and time to ensure you don’t forget about the appointment. Get there early, especially if traffic is heavy or you’re not sure where you’re going. This gives you a buffer in case something keeps you from getting there quickly.
What Not to Say to Workers’ Comp Doctor
It’s important that you know what not to say to workers’ comp doctor staff to protect your claim. Lying and negativity are two of the major mistakes that you can make when interacting with the doctor. Make sure you have your facts straight and share them honestly for the best chance of having your workers’ comp claim approved.
How to Find the Right Doctor Near You
Once you know what to say and not say to a workers’ comp doctor, it is time to find one.
You May Not Get to Choose
Depending on the circumstances, you may not get the option to choose your workers’ compensation doctor. Each state has its own laws, with some letting the employer choose. Some states have “preferred provider plans,” which include workers’ compensation doctors that you will have to choose from. In other cases, you may have to select from a state-approved list.
You may also be able to choose a different workers’ comp doctor if you can show that you need specialist care or the treatment from the original doctor is not improving your condition.
Where to Look
You may be able to use your primary physician as your workers’ comp doctor, but this is not always the case. In some states, this is only allowed if there is already a form on file stating that this would happen in case of a work-related injury, and that form is dated from before the injury. Family doctors represent the largest portion of workers’ compensation providers, at 20.3%, followed by orthopedic surgeons at 17%.
Even if you do not use your primary physician, they are still a good starting point, as they can typically recommend workers’ comp doctors in your area. You can also ask the lawyer you are working with for suggestions or check online
What to Look for in a Workers’ Comp Physician
No matter how you find the doctor you will use for your workers’ comp injury, you want to confirm a few things to ensure that they will be able to provide you the necessary treatment and documentation.
Accept Workers’ Compensation Insurance
Start by confirming that your chosen doctor accepts workers’ compensation for payment. Because there are sometimes variations in payment schedules or paperwork required for workers’ comp compared with typical patients, not all doctors accept workers’ comp.
Experience With Documentation
Ideally, your chosen doctor should not only accept injured workers but have experience with the worker’s compensation system. This will help ensure that they fill out the necessary documentation properly. Essentially, it will mean they have the experience to help the entire claim and insurance process go smoothly.
Experience with Your Type of Injury
Don’t forget to make sure the doctor in question has experience dealing with your type of injuries. After all, you would not want to work with a doctor who specializes in leg injuries if you have a back problem. Specialists are more likely to have recent experience and be familiar with the latest techniques and research, helping you heal more quickly.
A final consideration is whether appointments are available. You want to start healing as soon as possible, so you don’t want to have to wait months to start treatment. Delaying treatment would not only delay your healing but also could lead to your condition worsening. It could also potentially delay when you receive financial compensation for your workplace injury. Given that in 2015 alone, employers paid workers’ compensation benefits totaling $61.9 billion, you could be eligible for a significant sum and likely do not want to delay receiving it.
If you’ve been injured on the job, visit our website to find a workers’ comp doctor or call (888) 590-4030 today!