WANT YOUR WORK INJURY CLAIM TO BE PAID WITHOUT A FIGHT? HERE ARE TEN THINGS YOU HAVE TO DO:

Greg Boles
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Partner at The Boles Firm | Experience Matters

 Adapted from Chapter 2 of  The Wounded Worker: Inside the Pennsylvania Workers' Comp Maze:    

           1.         Treat everyone with respect. 

It’s perfectly understandable if you’re angry over the injury and the way your employer has treated you following the injury.  You might also be frustrated with the insurance company claims representative who treats you like a child.  Nonetheless, one of the most common mistakes people make in dealing with their employer or the insurance company after they’ve suffered an injury is to get angry.  Don’t make this mistake.

            2.         Check to see if you have any obligation to treat with company doctors.

Under Pennsylvania law, your employer has the right to create a list of panel medical providers with whom you must treat if you suffer a work injury.  You have the right to choose from among the medical providers on the list.  Your employer is also supposed to provide you a document in which you acknowledge your understanding of your rights and responsibilities under the Act.  You have no obligation to treat with a company doctor for more than 90 days from the date of first visit, but if you do not treat with the company doctor and your employer has otherwise complied with the law concerning the use of company doctors, your medical bills for your work injury may not be paid if you treat with someone other than those on the company list. Because there is a wide variation in the quality and integrity of company doctors, you should review our page "Reviews of Company Doctors" before choosing a provider.

            3.         Tell the company doctor the truth. 

It seems simple.  Of course you’re going to tell the truth.  You’d be surprised, however, by how many people lie about their past medical history or other issues concerning their work injury.  Company doctors are looking for signs that you are lying.  If you do so and you’re caught, not only will your claim be denied, you may well lose your workers’ comp case.

            4.         Tell all of your doctors about any relevant past medical history.

This means that you need to tell the truth about your past medical history even to a company doctor.  Remember that the aggravation of a pre‑existing condition is a new injury.  It is precisely because you may have injured that body part in the past that makes you susceptible to further injury.  Don’t make the mistake of concealing a past medical history. 

            5.         Consider seeing your own doctor. 

The company doctor may not accurately describe what you said concerning your symptoms, history, and past medical history.  You may want to go to your own doctor to get that doctor to record in his notes exactly what happened.  In the event of a conflict between what’s in your doctor’s records and in the records of the company doctor, most people will believe your doctor’s notes are accurate.

            6.         Speed up your application. 

Even company doctors don’t always send medical records to the insurance company, which sometimes denies claims because they haven’t received medical evidence of an injury.  Make sure the doctor sends the medical records to the insurance company as quickly as possible.

            7.         Ask for copies of your medical reports. 

You have the legal right to copies of your medical records.  Exercise that right.  Make sure you have a complete understanding of what the company doctor is putting in your medical records.  Request updated medical records at each visit.  Only if you know what the company doctor is saying about you will you be able to correct any errors.

            8.         Write things down.

If you are normal, you have a terrible memory. What did I say to the doctor? What are my symptoms today? What did my supervisor say to me about light duty? I can’t remember what I had for breakfast. If you keep track of what’s going on, you have a much better chance of getting your claim paid.

            9.         Beware of the oral statement. 

Be very careful about giving an oral statement to the insurance company.  The claims representative may have information you do not have.  The purpose of obtaining the oral statement may be to find a reason not to pay your claim.  Unless your injuries are minor or obvious, you should avoid giving an oral statement without the assistance of a lawyer.  Most good lawyers will help you with an oral statement at no charge. 

            10.       Make sure you understand the documents issued by the insurance company. 

The insurance company has 21 days from the date your disability begins to accept or deny your claim.  If they accept your claim, you should receive a Notice of Compensation Payable (NCP). If they agree only to pay for medical bills, you must file a claim petition to receive wage loss benefits. They have the right to issue something called a Notice of Temporary Compensation Payable (NTCP), which gives them the right to pay temporary benefits and turn down your claim for a period up to 90 days.  If they keep paying you benefits for more than 90 days, they legally accept responsibility for your claim and must continue paying benefits unless you voluntarily agree to allow them to stop paying benefits or they obtain a court order permitting them to do so, which is not easy.

Treat the insurance company and your employer with respect, tell the truth to all doctors, including the company doctors, understand what’s in your medical records, make sure the medical records are getting to the insurance company, be wary of an oral statement, and understand the documents the insurance company is issuing and you have a reasonable chance, if a not probability, that the insurance company will accept your claim without a hassle.

For more information on this topic, see Chapter 2 of The Wounded Worker:  Inside the Pennsylvania Workers’ Comp Maze.