Category Archives: workers comp basics

Who Calls The Shots, Your Employer-Selected Doctor Or The Insurance Company?

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Insurance companies sometimes tell doctors that they will not pay for procedures that the doctor says are medically appropriate.

Today’s post comes from guest author Nathan Reckman from Paul McAndrew Law Firm in Iowa. I think this blog post is especially useful because it shows how workers’ compensation program details vary from state to state. It turns out that the nuances are very important. Todd Bennett and Roger Moore, partners in Rehm, Bennett & Moore, are admitted to the bar in Iowa.

In Iowa, employers have the right to control an injured worker’s medical care. This means that if you are injured at work, your employer gets to send you to a doctor of their choosing. The doctors chosen by the employer are called “authorized treating physicians.” In theory, after an employer chooses their authorized treating physician, they are required to pay for any care that doctor believes is necessary to treat the work injury. In practice, the employer and their workers’ compensation insurance company often try to interfere with the care the injured worker is entitled to by refusing to pay for procedures or tests recommended by their handpicked doctor.

Typically, when an authorized doctor suggests an expensive course of care (like surgery) the first thing the doctor will do is check with the insurance company to make sure the surgery is going to be paid for. Instead of immediately scheduling the needed surgery, the doctor will wait until the insurance carrier agrees to pay for the procedure. Doctors do this so they don’t have to worry about how they are going to be paid. Asking for this unneeded authorization from the insurance company means the insurance company now has a say in determining what individual procedures are proper for the care of the work injury.

We often see injured workers whose injury was initially accepted by the employer until the doctor requests authorization for an expensive surgery. When faced with the additional cost of surgery, the insurance carrier denies the work injury hoping the injured worker will either forego surgery or try to pay for the surgery through other means, such as their personal health insurance.

This situation may also arise when the authorized doctor recommends expensive diagnostic procedures, like CT scans, or refers the injured worker to a specialist, for example a psychiatrist for depression related to the work injury.

To make sure your rights are protected, it’s often helpful to have an experienced workers’ compensation attorney on your side if you’re facing a situation where your employer is trying to interfere with the decisions of their handpicked doctor. Injured workers should get the care that their doctor, not an insurance company, determines is medically appropriate.

Average Weekly Wage Decides Workers’ Comp Benefits

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Workers’ Compensation benefits are partially determined by your average weekly wage.

One of the factors that determines how much you receive in workers’ compensation benefits is the calculation of your average weekly wage. In Nebraska, in most cases, average weekly wage is calculated by:

  1. going back 26 weeks
  2. multiplying your hours times your straight time pay
  3. excluding abnormally low-hours weeks (generally those of 32 hours a week or less)
  4. taking the total amount of wages earned in non-abnormally low work weeks divided by the number of non-abnormal weeks.

Multiply your average weekly wage by two-thirds, and that is what you should receive for your weekly workers’ compensation benefit. That amount is exempt from federal and state taxes in Nebraska, so your work comp check should oftentimes be close to your actual take-home pay, unless you are working a lot of overtime.

There are all sorts of exceptions to the basic way to calculate average weekly wage. If you receive a fixed amount for room and board as part of your contract, then that amount is included in addition to your wages. If you just started at your employer, then a court might look at what other workers were making in the six months before your injury to determine your average weekly wage. An employer might also try to reduce your workers’ compensation benefits if they can deem you a “seasonal employee.” School-district employees will often be paid workers’ compensation benefits based off a weekly average of their annual pay.

There are two types of workers’ compensation benefits: temporary and permanent. Employees who work less than 40 hours a week will be paid permanent disability benefits based on a 40-hour week. But please keep in mind that all of these rules vary from state to state.

Suicide – Recognize the Signs Before It’s Too Late

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Today’s post comes from guest author Leonard Jernigan from The Jernigan Law Firm in North Carolina. Dealing with chronic illness or work injuries around the holidays can be very challenging and overwhelming. Unfortunately, sometimes people think that their best choice is suicide. This important blog post assists readers with recognizing the signs and directing folks who are struggling towards getting professional help. Because in this time of year where people are supposed to care for each other, sometimes it’s also important to listen and take care of each other.

Several years ago I had declined to represent an injured truck driver until his wife called me and said she found a suicide note and asked me to reconsider. I did and was able to help him. I believe there is a connection between suicide and workers’ compensation. Clearly the pain of an injury, coupled with the stress of not being able to return to work can cause tremendous psychological strain.

One Texas doctor actually testified at a legislative hearing that prolonged decisions on workers’ compensation coverage in the state had lead to an increase in work’ comp’ related suicides in recent years. “The incidence of those reports has been astonishingly high compared to five years ago,” he told the legislators, “when they were, to my knowledge, nonexistent.”

Below are some signs that you or somebody you know may be at risk. This list of warning signals comes from the website of the American Psychological Association. If you see any of these signs, seek help from a doctor or therapist, or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Continue reading

If I am Hurt on the Job, What Should I Tell My Doctor?

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One of the most important parts of any case is the history of your injury that you provide to your doctor when you first see him or her.

If you were hurt during a specific incident, make sure to tell your doctor how you were hurt, when you were hurt, where the injury took place, and who else was present. Tell him about the pain and symptoms that you have been experiencing. Also be sure to describe in detail all of the body parts that you have injured. Even if one injury hurts more than the others, make sure to tell your doctor about every single injury.

If you have been hurt by repetitive-work activities, be specific about the number of movements that you make. For instance, tell your doctor about the number of times you lift or grip things in an hour, day, or week.

If you have been hurt by exposure at work, whether it is to a hot, humid environment, chemicals, or any other environmental condition, be specific when you tell your doctor about the pain and symptoms that you have due to that exposure.

If you leave work and become better, and then return to work and experience an increase in your symptoms, be specific when you tell your doctor about any changes in your condition.

It is important to be accurate and honest the first time that you seek treatment with your doctor, for both your health and your workers’ compensation claim.

Well-documented Expense Records Increase Value of Your M&T Reimbursement

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Today’s post comes from guest author Michael Furdyna from New York. Mileage and travel expenses are usually part of the medical process in a workers’ compensation claim. It’s essential to keep detailed receipts and have a plan for submitting those expenses in a timely manner. Today’s article includes tips and suggestions on how to ensure you are reimbursed fairly for your expenses.

While receiving medical treatment related to a workers’ compensation case, claimants often have additional expenses such as mileage, fuel costs, transportation fares, and out-of-pocket prescriptions. Yet many claimants don’t realize they are entitled to reimbursement for expenses they incur in obtaining treatment.

Submitting information related to these expenses is an important part of the workers’ compensation process. Problems can arise, however, when incomplete or disorganized information is provided to an insurance carrier. This can result in delays and errors in receiving the proper amount to which they are entitled.

Claimants can avoid these sorts of problems with small acts of diligence and record keeping. Here are a few suggestions:

Save your receipts and keep a record of your doctor visits. Keeping a log and saving receipts incurred from specific doctor visits provides a “narrative” that makes it easier to tie together dates and expenses.

Make sure to use the correct form. The New York State WCB requires Continue reading