Some work injuries never really resolve. Often an injured worker works through pain in order to support themselves and their family. Many workers in this situation stop seeking medical treatment for their work injury – and that often causes major problems for the injured worker.
Besides the obvious health issues, there are two legal problems that arise when an injured worker gives up on medical care. The first is that it lowers their chances of getting future medical care awarded in court. Injured workers who stop seeking medical treatment for their injuries can also undermine their credibility with a judge. The assumption is that if an injured worker isn’t seeking medical treatment they really aren’t hurt and any testimony about pain or limitations lacks credibility.
But there are many good arguments to make about why injured workers’ stop seeking medical treatment.
1.Workers’ compensation stops paying medical benefits – When workers’ compensation stops paying for medical care, many injured workers can’t afford to pay for treatment.
1a. Injured workers are told their case is “closed” by an insurer or employer – Insurance adjusters and nurse case managers often tell injured workers that their case is closed when their doctor places them at maximum medical improvement or MMI. This often accompanies a check for permanent disability that many workers believe is a settlement that closes their case.
A workers’ compensation case stays open for at least two years from the last payment of benefits. A case is only closed if it goes to trial and gets dismissed or if the injured worker signs settlement paperwork that is filed with the Nebraska Workers’ Compensation Court.
But, it’s easy to understand why an injured worker may think their case is closed and not go to the doctor in this situation. After all they have been told by an authority figure that their case is closed and they received a check for permanent disability.
Many self-insured employers in Nebraska also discourage injured workers’ from seeking medical care after the employee is released from care by a doctor.
2. Non-existent or bad health insurance – An injured worker can continue seeking medical treatment in a denied workers’ compensation case by having their health insurance pay. Some employees do just that whether it’s under their insurance or under a spouse’s insurance. Taking that action can be helpful. But if you don’t have health insurance because it’s not offered or because you can’t afford it, that’s not an option.
High deductible and co-pay insurance can be almost as bad as no insurance. I’ve seen two employees with supposedly “good insurance” have medical bills in disputed workers’ compensation claims sent to collections. Nebraska has enacted legislation to protect injured workers from debt collectors, but an injured worker would likely need to get an attorney to enjoy the protections of that law. Often times injured worker don’t want to or are afraid to contact attorneys. Adjusters and other company health personnel will also discourage employees from calling lawyers.
3. Unable to take time off from work to go to doctor — Medical clinics tend to be open during business hours when injured workers are working. That time crunch can also be amplified by having to commute to a job.
Insurance and management side readers may say “What about FMLA?” FMLA could allow an injured employee to take time off for medical care. But some employees may not be aware of their rights under the FMLA. Employers usually also require paperwork for FMLA which requires the cooperation of a medical doctor which can create a hurdle for some employees — particularly those without a good relationship with a doctor.
Not all employees are eligible for FMLA. Maybe their employer has fewer than 50 employees. Maybe they haven’t been employed for more than a year. Maybe an injured worker has exhausted their FMLA leave during their work injury. Maybe the employee hasn’t worked enough hours because of the injury to be eligible for FMLA.
As added insult to a work injury, an employee taking time off work to see medical treatment would be taking intermittent FMLA. Employers hate intermittent FMLA and often employees who use intermittent FMLA are often suspected of fraud.
Urgent care clinics and emergency rooms are available for treatment after hours. But going to an ER complaining of pain is a good way to get tagged as a drug seeker by the insurance industry.
4. Worker is alienated from treating doctors — Some employees don’t go to the doctor if they are in pain because they don’t trust or like their doctor. I will be the first to admit that some injured workers are unreasonable people. But some doctors have a lousy bedside manner. Some doctors are overly cozy with nurse case managers who work for insurers or employers. When either of those two factors are present, even a reasonable and personable injured worker may feel that treating with that doctor is futile.
I mentioned suspicions of drug seeking behavior by injured workers earlier in this post. Concerns about drug abuse by injured workers have been heightened over concerns stemming from the opioid crisis. As a result, doctors are even more reluctant to prescribe pain medication. As I pointed out in April, concerns about opioid addiction are good pretext for insurers and claims administrators to wash their hands of medical care obligations under workers’ compensation.
But if opioids and benzos are off the table for long-term pain management, what are the alternatives? Currently, there isn’t much that is widely accepted. If injured workers hear from their doctors that they can’t do anything about their long-term pain, that message will discourage an injured worker from seeking medical treatment.
Some doctors are willing to perform novel pain management techniques like stem cell therapy or prolotherapy. But since these methods are relatively new, so they aren’t widely accepted. Since novel ways to treat pain aren’t widely accepted, it’s easy for insurers and claims administrators to deny those novel treatments.