Answers to Medical Malpractice, Workers Comp, Long Term Disability Insurance, and Car Accident Questions
Here are some of the questions people have when they first contact us about D.C., Maryland and Virginia medical malpractice, serious car accidents, long term disability insurance claims, or workers compensation.
We try to provide as much information as we can based on our experience as medical malpractice lawyers in D.C., Maryland and Virginia and based on representing many hundreds of people who have been injured in accidents or at work in D.C., Maryland and Virginia.
Here are the basics:
Patients permanently injured by medical malpractice, or the families of patients killed because of medical negligence, when a hospital, HMO or healthcare corporation doesn't follow basic patient safety rules deserve justice - resources to help with the harms and losses due to the injuries or death of their loved one.
Drivers who don't follow the rules of the road, driving recklessly, driving drunk, speeding, and texting should be accountable for the harm they cause when their actions cause a serious car accident or car wreck.
Workers hurt on the job deserve workers compensation benefits for lost wages, medical treatment and permanent injuries. If a worker is killed on the job, his family deserves workers compensation death benefits - to at least help with the financial loss of a loved one.
If you're on a long term disability insurance claim and your claim has been denied, you probably need an attorney to do the appeal. Insurance companies will use every trick in their aresenal to deny or limit your benefits. Don't try to handle an appeal on your own.
Since every person is unique, if you have questions or need information about an injury or death in your family, please contact us to talk it through. We'll talk to you, schedule a free initial meeting and give you all the information we can.
Call us today at 202-393-3320.
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How Can I Get My Insurance Adjuster To Cooperate?
If you're on workers compensation, you have probably already figured out it's not a fair fight.
Your workers comp adjuster has handled hundreds, if not thousands, of workers compensation claims in D.C., Maryland and Virginia. Her job is to limit the amount the insurance company pays - for medical treatment, testing, medications, therapy, benefits - you name it, she will try to reduce it.
Remember, the adjuster works for the insurance company - not you and your family. In fact, your employer may have very little say in the matter of how you're treated, and often can't help you (other times they're upset because you got hurt on their job and may not even care).
Plus, these insurance adjusters handle hundreds of cases at a time - they don't have time for you. They don't want to be bothered and you may notice that days and weeks have gone by while you are waiting to hear back from them on important issues like your paycheck and medical treatment authorizations. You might even be waiting to hear back on authorization for surgery - and your condition is getting worse while you wait for them.
And unless you have the experience and knowledge to deal with them, plus the time to devote to calling, writing, and faxing everything to get things done, it's never going to be fair.
With a minor injury that may not matter, but if you need significant medical treatment and will be out of work for an extended period of time because of your injury, you don't want to rely on the adjuster to do right by you. You will definitely need an attorney to advocate for your and your family.
Call us today at (202) 393 - 3320 to discuss your options and we'll send you one of our free books, guides and reports that will give you the information you need now to take care of yourself and your family.
What if My Company Doesn't Have Light Duty Work for Me?
What is light duty when you're on workers' comp in DC, Maryland or Virginia?
Before going back to work, the doctor can put you on light duty. Basically, he gives you restrictions that say you can do some activities, but not everything your job requires. Usually your doctor will say you can't lift over 20 pounds after a back injury, or no overhead work after a torn rotator cuff surgery, or no climbing ladders after a knee surgery. If you have any type of restriction from your work injury that prevents you from doing your regular job, and your company offers you work within those restrictions, that's light duty.
Did you know that sometimes light duty can actually help you recover more quickly, and get you back to work in shorter time? See how light duty can help you here.
But, what if your employer doesn't have light duty?
What should you do? Remember, light duty means that you're at work performing some duties (not the full duties of your job) and you are being paid accordingly. Also, remember, if you are earning less money than you were at the time you got hurt (and that's per week, not just your hourly rate) you should be getting workers comp checks to make up the difference while you're on light duty.
The simple way to calculate it is this: If you are getting paid the same per week (with overtime and bonuses calculated for your weekly wage) you will get a paycheck from your company again and you won't get any further workers' comp benefit.
Here's how it works: if you're making less money on light duty because you are working less hours or can't do overtime like you used to, your workers comp benefits would be 2/3 of the difference between your wages at the time you got hurt and the new light duty job. These benefits are called Temporary Partial Disability benefits.
Light duty doesn't stop you from getting your disability benefits, but if you're offered light work duty work within your restrictions and you turn it down, the workers comp insurance company can stop or reduce your benefits. (And you should bet they will).
Here's the best part - where a lot of people get mixed up: IF your company doesn't offer light duty work, they have to continue to pay your full workers compensation rate.
Many construction companies do not have light duty in the trade. So, even though a doctor may say you can return to some work with restrictions, until you are cleared to return to full duty, your workers' comp benefits should continue at the full rate. So it is really important to get a note or disability slip from your doctor indicating any restrictions or limitations you have because of the work injury.
Workers' comp check coming late?
Click here to see what to do. We know that just because the workers' compensation check is late, it doesn't mean that you can pay your bills late, so here's the answer to another common question involving workers comp benefits and light duty.
You're probably under a lot of stress due to the uncertainty - most people are - because how can you know what or how much you should be getting, or how to get the best medical care for your injuries, or what type of benefits you can get in the future?
Don't worry - we help you with all that.
Still not sure? It's a complicated and confusing system that favors insurance companies. Remember, the insurance company has a team of specialized adjusters, lawyers, doctors, nurses, case managers - all working against you (that's their job, and they're good at it) from the moment you get hurt.
So just call us at 202-393-3320 and you will speak with a real person who wants to hear your story. We make time to answer questions about work injuries in D.C., Maryland and Virginia every week and we'd love to hear from you.
Do you need a DC Lawyer for Your ERISA Long Term Disability Insurance ?
HAS YOUR ERISA LONG TERM DISABILITY INSURANCE CLAIM BEEN DENIED?
Here's the thing about ERISA governed long term disability insurance plans: they are usually going to be interpreted exactly as they are read. So you need to watch out for certain phrases that will make it very difficult to collect benefits should you ever actually need to use the policy.
Most people - yes, even lawyers, doctors and consultants - working in DC don't read through the long term disability policies they get as part of their employment benefits, and they make assumptions about what's in the policy. It's actually common sense, right? If your policy is called "long term disability," you wouldn't be crazy to assume that you are going to be covered in case you should ever have a disability that keeps you out of work long term.
I wish that it was that simple and reliable. But the reality is, many of the terms and conditions in the policy are actively working to exclude you from coverage, and the federal law that governs most of these policies (ERISA) makes it easy for the insurance companies to deny claims because they have "discretion." And though they should be looking out for your best interest (the premiums have been paid, after all) what they are most concerned about is their bottom line and reporting to their shareholders, who are also looking out for their bottom line.
It's not right. That's why, if your long term disability insurance claim has been denied, you should contact an attorney who understands ERISA who will know exactly what to do to give you your best chance at receiving benefits after an appeal. You should not try to handle an appeal on your own.
At this point you may be asking yourself: is having an ERISA long term disability insurance policy even worth it? The answer is, maybe, it depends on what's in your policy and the severity of the medical condition or injury you have. We like to advise people to buy supplemental insurance, just to cover all of their bases, with a non employee sponsored, non ERISA governed policy. But, if you already have a claim and need help getting benefits, you will want an attorney.
Here's what's great about having an attorney handle your ERISA claim:
1. An Attorney knows how to put together what's called an Administrative Record (this is your appeal of the denial of benefits - and should contain everything you need to convince the insurance company to put you back on claim) - it is also what the federal judge will rely on when deciding whether or not to award your benefits;
2. An Attorney will be able to help you navigate the medical community in order to get the proper documentation for your disability or illness. They will do this by working with your doctors or consulting physicians to review your case and making sure your medical records and reports give all of the proper information about your condition and how it affects your ability to work; and
3. An Attorney will know how to argue your case before a federal judge (there are rules of the courtroom, a level of proficiency that comes with experience, and a knowledge of what the judge needs to hear in order to rule on your case).
You need a lawyer in DC who will listen to you and work with you to put you in the best position to receive benefits from your claim. Long term disability appeals are a lot more than filling out a form and sending it in to the insurance company.
Give us a call today at 202-393-3320 and we will review your denial letter for free and give you our analysis on what to do next. Don't wait - if you received a denial letter, you only have 180 days to appeal under ERISA. That's not a lot of time given the amount of work you have in front of you.
What if my claim is not governed by ERISA?
If your disability claim is not covered by ERISA
In a Non-ERISA covered disability claim, the person who is disabled and can't work due to an illness or injury (usually called the claimant) basically has no rights. What does that mean? Well, the insurance policy specifies everything involved in the claim, all of the rules, definitions, terms - everything.
That usually means:
You usually have 45 to 90 days to appeal;
There are no standard review timelines;
Your appeal has no rules governing how it is reviewed -
the insurance company can pretty much do this how they want to;
If you lose your appeal, you have to file a lawsuit in state court
and can get a jury trial;
In state court, the case is analyzed under standard contract law rules, it's really a breach of contract case. If you have a problem with getting claims paid out in a non-ERISA policy, you should contact an attorney who deals with contracts.
Is workers compensation keeping you up at night?
It's a lot to learn and deal with when you get hurt at work. Let's face it, the workers compensation system is complicated and stacked against injured workers in favor of insurance companies and large corporations. There are rules for everything - how and when you file a claim (despite what you've heard, the insurance company doesn't file it for you), when you can see a doctor, whether you have to sign insurance company forms, how much you will get paid...
There is no way to know it all - at least not well enough to protect yourself and your family from financial and medical ruin if you end up making a mistake.
That's why we've written the second edition of Protect Your Rights: The Ultimate Guide to D.C. Workers Compensation - so you don't have to worry.
Get a good night sleep tonight and every night by calling us at (202) 393-3320.
A union worker asks: what if my doctor has me on light duty but my job doesn't have light duty?
First, get The Union Worker's Guide to Workers Comp to learn how to avoid costing your family hundreds of dollars per week.
Most union contractors don't have light duty jobs. Its heavy duty work like you were doing before the injury or its nothing. But many doctors tell their patients they can go back to light duty, even if there is no light duty work available.
In that case, the insurance company has to pay your full benefits because you cannot return to the job you were doing before you got hurt and the contractor is not offering light duty. Sometimes a contractor will make up a job, like sitting in the trailer or at the job site entrance making sure everyone who comes in has a hard hat and safety goggles - if that's the case, they will pay your hourly rate instead of workers comp benefits.
But if you are making less per week on the light duty job (because you're not doing overtime, for example) you should get workers comp benefits based on the difference.
I Hurt My Shoulder at Work and My Doctor Thinks It's a Torn Rotator Cuff. What Do I Do?
A torn rotator cuff (tears of the the tendons in one or more of the major muscles of the shoulder) is a painful, often disabling injury. Many times it requires surgery, especially if an MRI confirms a tear and physical therapy or injections haven't helped.
How do you protect yourself if this serious injury happens at work?
First, tell your employer it happened on the job. We call this giving notice, and it should be done as soon as possible after the injury.
Next, get to a specialist. This is not an injury that can be managed or treated by a family physician and maybe not even by a general orthopedic surgeon.
Third, be wary of doctors referred by the insurance company. The insurance company will be watching their bottom line, not advocating for your care. If the insurance company referred you a doctor ask yourself: is he going to order expensive tests, like an MRI, that the insurance company will have to pay for? Is he going to believe you when you say how much it hurts? Is he thorough and does he seem objective? You should not let the insurance companies' doctor manage your treatment.
Finally, file your workers' compensation claim in the right jurisdiction.
These are the things you should do, but remember, there is a lot more to it. Making a mistake can cost you a lot of money in lost wages and a lot of time and treatment when it comes to your injury. In most cases, you should not go it alone. You may need an advocate to fight for your rights.
Before you make any serious and difficult decisions, read the free book offered by our offices and written just for workers hurt on the job in the D.C. area: Protect Your Rights: The Ultimate Guide to D.C. Workers Compensation.
It's free to injured workers and their families in D.C., Maryland and Virginia. So order your free copy today - call us at 202-393-3320.
What if your company does not have light duty and cannot create light duty work?
The answer is simple. They have to pay your full workers compensation benefits, also called temporary total disability, or TTD. It's just as if your doctor said you could not do any work because of the injury. Unless and until they provide light duty work, you should be on full workers compensation benefits. If your employer does happen to have light duty, but the normal pay rate for the position you're doing on light duty is less than what you make on full duty, then the workers compensation insurance company still need to make up 2/3 of the difference. The point is that while you are unable to do your regular job, you should still be making 2/3 of your salary/hourly rate (tax free) for as long as you can't do your regular job.
At some point, you may be asked to start vocational rehabilitation or work hardening, or both. But that doesn't usually happen until you are down the line long enough to gauge whether or not you have a permanent injury e.g. whether or not you'll be able to go back to work regular duty.
There are lots of questions that come up in the workers compensation process - don't try to go it alone. Give us a call - we are happy to help you and give you lots of free materials that will equip you for the road ahead.
Give us a call today at 202-393-3320 and order one of our free consumer guides today.
Why Do I Need An Experienced ERISA Attorney for my Denied Claim?
If your insurance policy comes through your employer, and your claim has been denied, your case falls under the federal ERISA code (The Employee Retirement Income Security Act of 1974). Ironically, this act was passed to protect the cash in your pension fund, but over time it has been used to protect insurance companies more than employees. And for some reason it covers employer-sponsored disability insurance plans in addition to dealing with pensions.
Ninety-nine percent of all disability insurance plans offered to employees are governed by ERISA. Under ERISA, you have the right to file suit in federal court if your claim for benefits is denied.
But, unlike almost any other legal proceeding, one side goes into court with all of the “good cards.” That side is the insurance company.
The most important card held by the insurance companies is something called a “reservation of discretion.” The reservation of discretion is something that the courts have given to the insurance companies – free! Here is what this “special card” means:
If your claim for benefits is denied, you will lose your lawsuit against the insurance company, even if you are right and it is wrong, if there is any evidence that supports the insurance company’s decision.
In any other legal proceeding, you can win if you have more than 50 percent of the evidence in your favor. Under ERISA, however, the claimant can have 85 percent of the evidence, and the insurance company can have 15 percent of the evidence, and if the insurance policy contains a “reservation of discretion,” they win!
If your claim has been denied, you'll need an experienced attorney to review your denial letter. We will review your denial letter for free. Contact my legal team at 202-393-3320 to take advantage of this incredible offer.
How Do I Know If a Work Hardening Program is the Next Right Step for My Case?
Work hardening is a little like physical therapy. The idea is to simulate work activity to see if you can do it and transition back to work.
That sounds great but in practice, some work hardening facilities don't know your real job duties (they just get a job classification from a generic list), and some think they are assessing psychological factors like "pain or illness behavior" or "symptom magnification".
These are insurance buzz words for "you are faking or malingering" - and the people making these "findings" are only physical therapists - they can help you stretch, use proper body mechanics and give tips on overcoming soreness but they're not doctors.
The key is to always be on guard - these facilities get almost all of their patients from workers comp insurance companies and sometimes "evidence" that someone is somehow not giving full effort (according to a physical therapist) is more valuable to them than getting you back to work.
We do have a fantastic physical and occupational therapy group that we work with that gets referrals from attorneys, insurance companies, family members - everywhere! So you don't have worry that they are biased, or that they won't do a great job with you. Give us a call today and we would be happy to share that information with you. 202-393-3320.