How to Handle Workers' Compensation Questions

Workers' compensation is a form of insurance your employer purchases to provide medical and wage benefits to workers that are injured or become ill during the course of their job. Almost all states in the US have laws that mandate your employer's participation except Texas. Workers' compensation insurance is a safeguard for both the employee and the employer. The employee has guaranteed rights when injured as well as potential access to benefits like funds to pay medical bills, lost wages, and rehabilitation expenses. If the employee dies from their injury, the family has access to death benefits. The employer gains protection against a civil lawsuit from the employee in exchange for these protections. It's considered a social contract but has its limitations for either party.

One of the most important things to do after being hurt on the job is to report the injury to a supervisor right away. When reporting your injury, be sure to include the date and time and what and how it happened, including any witnesses. Every state has different deadlines to report an injury. But generally speaking, it should be done as soon as possible. 

After your injury has been reported, your employer should file a claim with their insurance company. Often, insurance companies will accept liability right away. Other times, they may delay until an investigation has been concluded. The scope of the investigation could include reviewing your medical records and a formal interview called a deposition. 

If you should be so unlucky to be experiencing the former, that doesn't mean you have to wait untreated. There are some doctors that will treat injured workers on a lien basis, meaning the doctor doesn't expect payment until you win your case. You can also seek financial help through government agencies after being injured on the job. Suppose an insurance company denies your claim because they suspect you didn't receive your injury at work. In that case, you can request a trial that is conducted under the supervision of a judge. 

Sometimes even if the insurance company accepts liability, there can be further disputes over the necessary treatment. Suppose your doctor requests certain tests or treatment the insurance company doesn't feel necessary. In that case, the claim is escalated to a process known as Utilization Review. If you win, then the insurance company has to abide by your doctor's recommendations. If not, you can appeal for a second review called an Independent Medical Review, which involves a 2nd, neutral doctor's evaluation. In most cases, this is the final review, and you will have no recourse should the court decide in the insurance company's favor. 

There can also be disagreements over temporary disability, such as disputing whether you're too injured to continue working. If they decide you can still work, there is no reason to pay for disability benefits. In these cases, your doctor will need to write a report to be reviewed. If no agreement can be made, a 2nd doctor, referred to as an Agreed Medical Examiner, is again the tiebreaker. If there is still a dispute, you can request a trial for temporary disability.

When there is a dispute between your doctor and the insurance company over treatment plans, diagnoses, or temporary and permanent disability, an Independent Medical Examination (IME) is how it can be resolved. This exam is a request from your employer's insurance company. However, if you don't comply, your claim will be denied. 

These exams are often the proof insurance companies are looking for to limit or deny your benefits. Regardless, it's critical to be honest during this exam. You may be asked questions like:

• How easily can you sit and stand?
• Do you feel discomfort when you move?
• Did you have a hard time getting in and out of your car today?
• What is your medical history?
• Do you have any preexisting conditions?
• What kind of medical treatments have you had in the past?

While it's important, to be honest, that doesn't mean you have to downplay your injuries. If your quality of life has changed, you should tell the doctor about that too. That being said, you should not exaggerate your injuries during an IME because these doctors are trained to recognize fraudulent acts of suffering. Furthermore, they may run you through a battery of tests and exams to assess your reaction to pain. If the doctor feels you're not being forthcoming, that's enough to deny your claim.

Don't say negative things about your employer either, even though you may feel resentful if your employer put you in a dangerous situation that resulted in your injury. These types of comments could potentially end up in the official report, which of course, could be seen by your employer. 

Don't lie about previous injuries. While you may feel an old injury may hurt your case, that's not categorically true. What will absolutely hurt your case is if you lie about previous injuries, and it's then discovered through medical records. Suppose you fell and sprained your knee while serving tables in college, then you slip and fall on the same knee at your current job, but this time, you tear a ligament. In that case, the new injury can be described as more severe, so it shouldn't be a reason to deny your claim.

And finally, don't neglect any details about the accident. Your initial statement will be compared to the statements you give the IME doctor, and discrepancies could be grounds to deny your claim.

If your case makes it to a hearing, it's probably because both parties could not agree upon the amount of compensation. Suppose you haven't retained a workers' comp lawyer yet. In that case, this is definitely the time to do it because an experienced lawyer will be well-versed in handling workers' compensation questions. There are generally six types of questions at a hearing. 

General background questions: You'll be asked things like your full legal name, address, date of birth, social security number, living arrangements, marital status, number of children and their ages, and tax filing status. Questions about your family are so that the judge can establish dependencies, which will figure into the weekly compensation rate to which you should be entitled.

Education and training questions: Your education and training background are routine at these hearings because the defense will use it to argue about your level of experience, even if your education and training have nothing to do with your current position.

Employment history: You'll be asked about your employment history, including hours worked and wages. It's critical to be very specific, and your worker's comp lawyer can help you prepare for this.

Job Duties: These questions are crucial to your case. You'll be asked when you were hired and if you had any required physical exams before you started the job. You will need to describe your duties in detail, the hours you worked, and your salary. 

About the accident: You'll need to provide the date of the accident and describe how it happened, who you reported it to, and the areas of the body that have been impacted. Additionally, you'll need to share how you were treated for your injuries and the job duty restrictions recommended by your doctor. 

Medical questions: When you're in a workers' comp hearing, all medical history is relevant. You will need to prepare yourself to answer in detail all previous existing conditions, doctors you've seen and for what, and any limitations you have because of old injuries.

Ability to return to work: You'll need to testify about all jobs you've applied for since your injury and if an employer is willing to hire you with your current disability or restrictions. You'll be asked about activities and hobbies you may be involved with, and it is crucial, to be honest here. It's not uncommon for insurance companies to hire private investigators. Discovering you've been bowling with an arm injury will completely destroy any chances of winning your claim.

Ideally, you and your employer's insurance company can handle a workers' compensation case without issue. However, there are times when an injury at work isn't so easy. Here are some reasons you may need to hire a workers’ comp lawyer to ensure your rights are protected, and you get the compensation you deserve.

You have a preexisting condition: If you have older injuries or underlying health issues, these could be used to deny you benefits. Insurance companies love to use preexisting conditions to deny workers' comp claims.

Your employer refuses to accept the injury was work-related: A workers' comp attorney can help connect the dots between your injury and the workplace.

The insurance company denies benefits: Just because you've been denied initially doesn't mean you have to give up. There are appeals processes that a lawyer can help you with.

Your injuries are severe, and you cannot return to work permanently or for an extended period: In circumstances like this, medical bills can skyrocket. Because of this, the insurance company will fight tooth and nail to reduce benefits. This is definitely the time to lawyer up.

You’re facing retaliation: If your employer is being malicious because you filed for workers' comp by cutting your hours, harassing you, or firing you, it is illegal. They can face heavy fines from the Department of Labor, and you should be able to be compensated with the help of a lawyer.

If you have any questions about how a Morgan & Morgan workers’ comp lawyer can help you with your claim, don't hesitate to reach out for a free and confidential case evaluation. Our attorneys have been fighting for everyday people just like yourself for over 30-years, and we have a stellar reputation for winning compensation for our clients.