Aug 7th, 2018
You’ve had a work-related injury. It is not unreasonable to want others to validate your pain, especially when your injury might be invisible. After all, it is your body.
You need someone who believes you, can advocate for you, and will go above and beyond to make sure you get the benefits you deserve and the proper care you need.
Here are four scenarios when you shouldn’t be your own personal advocate in your work comp case:
Your employer’s insurance company is in the business to save as much money as possible. Insurance companies assign attorneys to work comp cases to help them defend the claim.
You may receive a notice of conference setting, to appear before the judge. When you appear, there will be an attorney representing your employer and their insurance company. Would you ever want to appear at a proceeding where the other side is represented, and you are not? There is a built-in disadvantage here. Do not walk into a litigation situation without the upper hand.
Independent Medical Evaluations are objective assessments the insurance company might request you take if the company doesn’t agree with your physician’s plan for treatment, including costly procedures, and whether your injury is permanent.
All your medical records, not just those pertaining to your case, are sent to an IME physician. Then your employer’s insurance company might write a letter to this physician explaining the nature of your injury as well as pose questions to the IME doctor such as whether you have the condition you claim, if your symptoms are legitimately caused by a work-related injury, if surgery is recommended, if surgery is necessary and when can you return to work.
The insurance company is “doctor shopping,” hoping to get the opinion they want. They are hoping to get a doctor say, “she is fine, she needs no further treatment.” These appointments may be required at some point, but you need someone walking along side you in the process when this step occurs.
Your medical records are proof of your injury. They help decide the extent of your work-related injury and suggest a treatment plan. Medical records are crucial to your work comp case. The average person isn’t versed in analyzing medical documents and their case shouldn’t depend on this fact. The last thing you want to do when you’re recovering from your injury is to attempt to decode your records yourself.
Let’s say your physician requests an MRI. It’s approved, and the results conclude you have a spinal fracture, but the work comp physician fails to disclose this with you, you might not know this has happened, and then you can’t appeal the judgement to get the proper care and compensation you need.
I have spent countless hours reviewing medical records and have trained eyes to sort through medical jargon and terminology. I’m not a doctor, but I have learned the way records are written, can find what is left out, and can point out what may have been ignored.
Nurse Case Managers are registered nurses employed by the insurance companies. They accompany you to your doctors’ appointments and act as a friendly, comforting liaison between you and your physicians, lawyers and insurance companies. They’re hired to navigate you through your medical processes, explain procedures, and suggest treatment.
In reality, your NCM isn’t looking out for you. Insurance companies employ NCMs to attend your appointments on its behalf. There are cases where an NCM will go behind the patient’s back and request the physician sign off on the patient going back to work or suggest refusing to refill a pain medication, which can all hurt not only your work comp case, but your right to a speedy and less painful recovery.
In your time of pain amid an already confusing process, it might be hard to know what you should or shouldn’t say in your nurse case manager’s presence. Please note, everything you do or say will be reported back to the insurance company and potentially used to decrease benefits and contradict your claim. Kiefer Law suggests clients not speak to the NCM unless informing of new appointments’ dates and times.
You should consider not being your own personal advocate in your work comp case. No matter the scenario, it‘s best to have someone in your corner who believes in your pain and will advocate for you to get you the best care and compensation. I will take the time to deal with your employer’s insurance company attorney, sort through your medical records and handle any judgements regarding your case. This way you can focus on what’s most important: healing.
– Christine Kiefer, Lawyer, Kiefer Law Office LLC.