Having Trouble With Your Workers' Compensation Claim? You Are Not Alone!
While sitting in court on a recent workers' compensation case, I started to think about all the reasons someone calls an attorney after suffering a significant work-related injury. For me, former clients are often the best source of referrals. However, I'm not talking about why the caller chose a particular attorney. Set aside referrals and marketing for a moment.
I am talking about why the injured person even decided to consult an attorney at all. Sometimes, the injured person feels they need some general legal advice in light of their situation. That's often a good idea. A significant injury presents many issues that can be helped by competent advice. Most personal injury attorneys will provide a free consultation.
Aside from general advice, what are some of the most frequent problems encountered by injured workers that lead them to call an attorney? I can think of many common problems that lead to such a call. Here is a list of a few of the most frequent reasons I hear:
- The Preexisting Condition Denial -- The insurance carrier denied my workers' compensation claim because I have a preexisting condition.
- The No Settlement Unless You Close Medical Benefits Refusal -- The insurance carrier refuses to discuss my claim or negotiate any settlement with me unless I give up all rights to medical care for my injuries.
- The Company Doctor is a Bad Doctor Problem -- The insurance carrier has provided me with a doctor. However, he won't treat my injuries; won't listen to me, etc.. If the provided doctor wants to care for me, then the carrier won't approve his treatment; denied his request for specific treatment; tried to make me change doctors, etc..
- The My Case is Only Worth That Shock -- The insurance carrier has provided an offer. However, it is extremely small and the carrier has insisted it is all I am entitled to receive under Alabama law.
- The You Did Not Give Us Proper Notice So We Don't Accept Your Claim Excuse -- The insurance carrier claims I did not provide notice of my accident as Alabama law requires and refuses to do anything.
I have written previously about the impact of preexisting conditions on a workers' compensation claim. That excuse, like the others, is often not a reason to deny or refuse a claim. For example, in Alabama, you cannot be forced by the carrier simply to give up your rights to medical treatment. While some attorneys routinely let their clients give up medical rights, I typically do not. The security of getting treatment for a significant injury is too important simply to give away. At least, that's how I feel about the issue.
As for problems with the authorized physician or "sticker shock" over a low offer that the carrier insists is all you are entitled to receive, those are common and complicated issues. You do have to seek care with the doctor chosen by the carrier. However, there are legal avenues you can take to change or challenge the situation where you cannot get good medical care. Alabama law provides some methods to change doctors or get a panel of alternative doctors. Also, you can seek court intervention if the carrier is simply refusing to approve recommended care from a doctor who is trying to help you.
As for low settlement offer shock, Alabama law does provide only limited benefits based on certain calculation methods. While I am sure some may disagree with me, I believe that Alabama law fails to provide sufficient benefits. That is why it is so important to understand how benefits should be calculated so that you can obtain what the law does allow. However, the carrier will often use the lowest method of calculating benefits. In many cases, the benefits really owed can be very different. As an example, in many cases, you are entitled to be compensated based on your vocational disability (the impact of the injury on the number or amount of jobs you can now no longer perform). Yet, carriers will typically only offer injured workers a settlement calculated upon the usually much, much lower number assigned as a physical impairment rating. If you don't understand how calculations based on a vocational disability or impairment rating are determined, you are not alone. Many attorneys don't have a good grasp of these terms or the methods of calculating benefits. You can bet that the claims adjusters working for the insurance carrier do understand them and will often offer the lowest method of calculating benefits. So, you better seek advice from someone who fully understands the calculations as well.
Notice of your accident can also be a complicated issue. The requirement of notice can be met in a variety of ways. It is not always the clear bar to a claim that the carrier would lead you to believe.
These issues can be complex. They are too complex to discuss together in detail in this one post. You should not simply accept a denial without consulting a professional in this complicated area of law.
