Even if your doctor has formally recommended a surgery, getting authorization from L&I can be challenging for injured workers in…
A work-related injury can be devastating. There are many challenges when good health is lost to injury or occupational disease. Finances are depleted while the worker receives less than full pay, loss of employer-sponsored healthcare insurance, and misses out on overtime opportunities not to mention the chance to earn performance-based bonuses. There is a toll on the mental health of everyone involved as fear and anxiety become a byproduct of the injury. There is also the inevitable impact, sometimes catastrophic, on the injured worker’s family as relationships can be irreparably altered by the changes brought by a severe injury. That is where a workers’ compensation claim can help improve the situation… if you follow the rules.
With all of these concerns in play, how does the injured worker prevent their worker’s compensation claim from going south?
Principally, by ensuring that they follow simple rules:
- Know your file
- Be proactive, not reactive
- Be honest
- Understand the opposing party’s needs and position
Injured workers who constructively manage their claim or have an experienced and skilled attorney to do so for them will avoid the pitfalls that drive so many workers’ compensation claim(s) into the uncertainties that come with elevated conflict.
1. Know Your File
Doctors and healthcare workers can make transcription mistakes or forget to include relevant information in their treatment records. Requests for treatment authorization are sometimes misfiled or a healthcare worker may fail to attach all of the relevant treatment records. That results in a state agency, self-insured employer, or an insurance company not having the necessary information to complete a fair review. In some cases, a vocational expert may have completed analysis based upon jobs as they are typically performed but they inadvertently omitted unique duties in your job-of-injury description. If you fail to correct errors that arise in your claim as these are occurring, you run the risk of being asked to attend an unnecessary independent medical exam (IME) or having your workers’ compensation claim otherwise take a turn for the worse.
2. Be Proactive, Not Reactive
For example, if you’ve been recommended for surgery but opted to decline it in the past and then reconsidered it as an option due to no progressive medical improvement, speak up and make sure everyone knows that is what you want. If you wait until after everyone has concluded that you are at maximum medical improvement before you ask to reinitiate consideration of surgery, those defending your workers’ compensation claim may be more apt to believe that your request is being made merely to keep your claim file open and your wage replacement (time loss) benefits in place. Defense interests may suspect you are trying to milk your claim for more compensated time spent off from work. They may attempt to manage your claim in a fashion that promotes conflict rather than resolution. The key is to be proactive and make clear what your intentions are and to emphasize that you really are trying to get back to work.
In addition, if you are not proactive, claims managers may feel that they need to “manage” your file more aggressively because you aren’t making progress toward goals everyone can see. It’s their job. Do not wait for them to start “managing” your claim or it is likely you’ll experience greater hardship.
3. Be Honest with Your Workers’ Compensation Claim
When sent for testing, many injured workers will attempt to communicate the extent of their pain by embellishing descriptions of symptom severity, extent, or frequency. In doing so, the injured workers are trying to ask for help, but instead, they are unnecessarily complicating their claim. If an injured worker is sent to an IME physician, that doctor is already defense-minded in large part. IME physicians are not asked to weigh in on diagnosis, treatment, or vocational issues unless the claims manager requests it. When an already defense-oriented IME physician sees an injured worker expressing the extent of their symptoms in aggrandized ways, they write reports that assassinate the character of the injured worker. They may even claim the injured worker is cheating, being dishonest, malingering and even perhaps committing fraud. Injured workers should always give full effort and be 100% honest when attending an IME or functional capacity tests. While two different doctors may come to two different opinions regarding a workers’ compensation claim in contention, the injured worker’s position is made far more tenuous if the defense interests can also use a medical doctor to say the worker is failing to give full effort. Do not give the opposing side the means with which to compromise your integrity or place your claim contentions in doubt. That will only make your claim experience far worse.
4. Understand the Needs of the Opposing Party
If you give up easily, you will be pressed to give up immediately. That’s the first law of the workers’ compensation claim jungle! On the other hand, if you never offer a compromise, you will just as quickly be forced to litigate a question that could otherwise be worked out in a cooperative spirit through competent negotiation.
As a worker, if you don’t have the skills or confidence to manage your own claim competently, and few people do when they’ve suffered a complex or serious injury or occupational disease, you are best advised to enlist the help of an experienced workers’ compensation attorney to help you through the difficult circumstances caused by an industrial injury or occupational disease.
ABOUT THE AUTHOR:
Spencer Parr is a litigation and trial attorney at Washington Law Center focused primarily in the areas of Labor & Industries claims and injury pension benefits. Before co-founding Washington Law Center, Spencer served in the U.S. Army. He has litigated major issues in the law, represented clients from coast to coast, and dedicated his professional life to assisting the injured and disabled. Click here to learn more about Spencer. View More Labor & Industries and Work Injury Resources.