5 Ways to Kill your Workers Compensation Case
You don’t expect it. Never think about it. But it happens.
You get hurt on the job. And you can’t work.
It’s stressful. Who will pay for the time off? How will you find a doctor? Will your job still be there when you return?
But while you’re laid up – sometimes before you even leave the job site - insurance companies and their lawyers are already on the job – trying to kill your comp case. Don’t pull the trigger yourself.
WHAT IS WORKERS COMPENSATION?
Workers compensation laws were designed to help injured workers get through these difficult times. Basic protections originated in Germany in the 1800s. After a long, hard fight, workers in this country began getting basic protections in the early 1900s. Unions, of course, were instrumental in promoting workers rights.
Recently, though, workers compensation laws have become complex. In some cases, they protect insurance companies and big business - not injured workers. I tell all my clients workers compensation is about protecting your future rights.
Businesses are required by law to have workers compensation insurance. These insurance companies will pay the medical expenses and benefits for the injured workers of the businesses they insure. If the injured worker doesn't follow the law - doesn't tell a supervisor about the injury, doesn't file the proper forms in time, etc., or if the insurance company thinks the injury did not happen at work, or the injury is not related to work, it will deny the claim.
YOU GOT HURT. WHAT DO YOU DO?
If you’re hurt at work, go see a doctor. If it’s a bad injury – go to the hospital.
Sometimes insurance companies or employers will tell you you have to go to their doctor or clinic, or they have a doctor for you, or everyone who gets hurt goes to the same doctor. Don't believe it. If you get hurt in the District or Maryland, you can choose your own doctor. Get referrals from co-workers, clergy, friends and family.
You are entitled to the best medical care for your injury. Find a doctor who specializes in treating your type of injury. If you have carpal tunnel syndrome from using your hands, wrists or arms over and over, you may need a hand specialist. If you hurt your back lifting something at work, you may need an orthopaedist (sometimes called a "bone doctor") or spine specialist.
If you work in Virginia, the insurance company will give you a panel of physicians to choose from - usually 3 doctors in your area. Of course, if you are seriously injured, you are entitled to emergency medical care and treatment without approval from your employer or its insurance company.
WHAT ARE THE 5 MISTAKES THAT WILL KILL MY CASE?
1. Don’t report the injury.
Insurance companies love this defense. It let’s them question whether the injury even happened, whether it happened at work. And let’s them delay your benefits and medical treatment while they investigate the claim.
If you get hurt at work, tell a supervisor. If there is an accident or incident form, fill it out and give it to a supervisor or foreman. It is not enough to tell a co- worker or someone with the same job as you. It has to be a supervisor or foreman. If you fill out an accident or incident form, be sure to date it and get a copy.
2. Rely on your employer to “take care of you.”
Workers compensation is about protecting your future rights – your ability to earn a living for your family and get the medical treatment you need for your injuries. That is your responsibility.
Even well meaning employers don’t know the ins and outs of workers compensation laws – and can kill your case (if you let them) by not filing the proper forms or giving you well meant, but wrong, advice. And most companies have a large workers compensation insurance company the case is turned over to – that insurance company has no duty to you.
3. Don’t tell the doctor that you got hurt on the job.
Many people go to the emergency room and will tell the doctor “I hurt my back” or “I fell and hurt my knee” – and that helps the doctor diagnose the injury. But if it happened at work, say so. Tell the doctor, nurse and anyone taking a history that you hurt your back lifting a generator at work or slipped on grease changing a bus tire at work.
Be specific. It will save time and expense. When insurance companies get medical reports that don’t indicate you told the doctor you got hurt at work, they delay (or in some cases) deny claims.
4. Go to the employer’s “work injury clinic.”
You get hurt on the job and report it to a supervisor – so far so good. But the foreman says “we have a company doctor (or a workers comp doctor, or a workers’ clinic) you have to go to our doctor. Everyone who gets hurt on the job goes to this clinic. Its convenient. Its free. Forget it.
You are entitled to proper medical care from an appropriate specialist if you’re hurt at work. In D.C, and Maryland, you can choose your own physician. In Virginia, you can choose one of a panel of 3 qualified physicians.
Workers compensation insurance companies try to get you to go to a clinic – one they probably fund or subsidize. Who do you think the clinic doctor looks out for – you or the insurance company and employers that send him 50 patients per week?
Choose a physician who will have his or her patient’s best interests at heart – not one who relies on insurance companies to send him patients. a statement from the injured worker, which they record. They may tell you it is required to receive benefits, but it is not. Some insurance companies will use a statement to deny benefits on a technicality. The insurance adjuster and lawyers will try to manipulate your words and use them against you. Remember, they do this for a living and have been doing it for a long time. Never give a statement in any legal proceeding without your lawyer present. What you say can be used against you.
5. Don’t file claim forms with the proper Agency.
Maybe the insurance company is paying your benefits and medical treatment. You haven’t had any problems. Or your employer said they’d take care of it – maybe even gave you some forms to sign.
Not good enough.
Every local jurisdiction - DC, VA and MD - has a government department or commission for workers compensation and the laws of all 3 require an injured worker to file a claim with the state or city within a certain period of time after the injury. For example, Virginia requires a claim form to be filed within 2 years of the injury.
D.C. has two forms – a notice and a claim form that need to be filed with the D.C. Office of Workers Compensation. At least one large employer in the District routinely gives its injured workers one of the forms. Really looking out for you, huh?
Don’t kill your comp case before it gets started. Protect your family and your future.