Once you file a workers' compensation claim in Oregon, the workers' compensation rules give insurers many tools to investigate the claim. Insurers can obtain your medical records. The insurers often have investigators that speak with the employer, co-workers and check your background. An insurer can require that you attend a medical examination with a doctor of its choice. Insurers will often take your taped statement, and under the workers' compensation, you must agree to provide a statement. This article gives you some important tips to help you avoid the fatal mistakes that can kill your claim.
You Can Have Attorney Help You, and The Insurance Company Has to Pay For It.
A recent change in the law gives you a big advantage when providing a recorded statement to an insurer. In the past, most injured workers were left on their own when faced an adjuster for a recorded statement. That is because the workers' compensation law did not provide that an attorney could be paid for helping injured workers with claim interviews. Recent changes in the law provide that an attorney sit with you through the statement, and the insurance company must pay your attorneys' fee. Even though the insurer is paying the attorney's fee, the attorney is your advocate, and you are the attorney's client.
The Insurance Company Already Knows the Answer to Many of the Questions It's Asking.
When you sign a claims form, you are authorizing the insurance company to obtain your medical records, and not just those records related to your on the job injury. This authorization also allows the insurance company to speak to your doctors. Insurance companies also maintain a "claims index" database. The insurance company can use the index to determine if you have ever filed any other insurance claims involving an injury. When we meet with a client to prepare for a recorded statement, we half jokingly tell our client that the insurance company knows more about them than they do! In a lot of ways, that is true.
So, here are some rules to keep in mind when preparing for your statement:
Tell The Truth
Every time I meet with a client to prepare for a recorded statement, I am reminded that most people are honest. Still, I always begin with a caution that the client needs to tell the truth. Giving false information is guaranteed to kill your claim more than anything else. Insurers will compare what you tell them in a statement against what you told the employer, the ER doctor, and your physical therapist. You will get caught if you are trying to overstate or understate any part of your claim. Don't do it.
Also consider this. Insurance companies will not hesitate to hire a private investigator to follow you around, and video record your every movement. So if you say something to a claims adjuster, and there is video footage contradicting your statement, your claim will probably be denied, and there will not be a whole lot you can do about it.
Honesty is usually not the issue, but these other issues are.
Listen To The Whole Question
This sounds basic, but it is sometimes hard to do. Some clients are nervous going into a statement, and will cut off the questioner and blurt out the answer before listening to the whole question. The problem is that you may be answering one question, and the investigator may be asking a completely different question. Also, the statements are often put into writing, and the written interview, called a "transcript," may end up in front of an Administrative Law Judge at a hearing. A transcript of two people talking over each other is confusing, and confusion only helps the insurance company.
Make Sure You Understand The Question
Again, giving a recorded statement can be stressful, and at the risk of embarrassment, people sometimes answer questions they really do not understand. The interviewer is going to assume that you understood a question if you answered it, so if you do not understand the question, it is your responsibility to ask the interviewer to re-phrase the question. It's no big deal, and most investigators are willing to rephrase the question for you.
This is probably the most frequent mistake clients make when giving statements and sworn testimony. Thinking that they are being tested, some people will give an answer just for the sake of giving an answer. The problem is that if you guess incorrectly, an insurance company will try to make it look like you are being dishonest.
The recorded statement is not a test, and you are only responsible for what you actually know and remember. Do not be forced to speculate on an answer. "I don't know" and "I do not remember" are perfect answers if they are honest answers.
Another way to avoid guessing is to make it clear in your answer if you are not quite sure about your response. Some people will state that they are giving the answer “to the best of their memory,” or will simply add that they are “not exactly sure” about their answer. This is a good way to show the adjuster that you are giving as much information as possible, even if you are not 100% sure about your answer. Estimates also work well too. If you can provide your best estimate in response to any question, you are showing the questioner that you are giving your best effort to give an honest and accurate answer to the question.
Be careful about responding to questions that include terms like "ever," and "never." For example, "Have you ever injured your low back before?" "Ever" means "ever." There may be that one time you hurt yourself, and it was not a big deal. That counts. So, if you are not sure, you can say something like, "As far as I know . . . . . "
What Questions Can You Avoid?
The insurer is allowed to ask about your background and off work activities to find out if your work injury is really a work injury, but there are limits. The insurance adjuster must limit questions that are "relevant to the claim." If you feel that the question has absolutely nothing to do with the claim, you can ask the adjuster why he or she is asking a particular question, and if you really are uncomfortable, you can politely decline to answer the question, and ask the adjuster to move on to the next question. When I am with a client during a statement, and I think the questioner is wandering too far from the point, I will ask them to explain how a certain question in relevant. They will either move on, or change the question.
If you have a pending claim, and have questions about the process, give us a call, or fill out the contact form.