Be cautious when dealing with your employer, unless proved otherwise.
Many employer-employee relationships, even good ones, turn sour after you are involved in a work injury. Even if you have been working at the same company for 10 or 20 years without ever having an accident, your employer may not believe you when you and your doctor say you cannot return to your pre-injury job after a work injury. This comes as a great shock and disappointment to many workers, but it is a fact that needs to be recognized.
Learn your rights regarding medical treatment.
Many employers give their workers inaccurate information about their rights and obligations. For example, the law permits employers to provide their workers with a list of medical providers (commonly called "company doctors") that they must see for the first 90 days after the first visit to the provider. If they don’t give the worker the list, the worker is free to choose any doctor the worker wants. Furthermore, because few employers comply with the legal requirement for a valid list of medical providers, employees generally may treat with the provider of their choice.
Many employers simply tell the worker where to go and do not advise them of their rights. The only way to avoid acting on false information is to consult with an attorney who specializes in handling workers’ compensation matters. As the laws change and as new cases are decided, you need a lawyer who handles many workers’ comp cases and who keeps up to date with new developments in Pennsylvania workers’ comp law.
Make sure that you have notified the proper personnel about your injuries.
Under the law, you have an obligation to notify your employer about your injury within 120 days of the injury. To receive benefits from the day of injury, you must notify your employer of the injury within 21 days. The law has interpreted that to mean that you must make sure your employer knows about the injury – and not just any co-employee. Don’t assume that because you have been out of work for some period of time after an injury that you have satisfied this requirement. Make sure you tell your supervisor, and that your supervisor fills out a form called an Employer’s Report of Occupational Injury and Disease. Ask for a copy of that form and keep it for your records.
Do not let your employer harass you with phone calls.
After an injury, your employer may call you on the phone to find out how you’re doing. While the first phone call may seem to be out of concern for your well being. At some point it will become obvious that the employer has other motives. You may feel that you have to respond to these calls. This is when a workers’ compensation lawyer can help. Our lawyers at The Boles Firm can contact the employer and demand that the employer direct all further communications with you through the attorney’s office. This will give you greater peace of mind and allow you to focus on getting medical care and aid you in getting better.
If the employer physician gives you advice that you do not agree with, seek treatment with your own doctor.
Sometimes, your employer will refer you to a medical provider who gives you advice that simply seems wrong to you. For example, you tell the doctor that your lower back is killing you, and the doctor recommends that you take the rest of the day off, but go back to work full duty tomorrow without recommending any diagnostic or medical testing. The doctor may not even have asked you any questions about your job duties.
Make an appointment to see another doctor. If the employer gave you a list of medical providers, you can go to one of the other doctors on the list. Or you can go to a doctor of your own choice. If you have been given a list and don’t go to a doctor on that list, the doctor you see will not be able to bill the workers’ compensation insurance carrier. Still, you may have other insurance to cover the visit. And if you don’t, in the long run, it will have been worthwhile for you to pay for the office visit yourself rather than risk having no accurate medical documentation of the extent of your injuries for the first 90 days. Furthermore, for reasons discussed in this article, it is unlikely that your employer has complied with the law governing company doctors, in which case they must pay the medical bills of your doctor.
If you do not have a list of other doctors, the doctor you see will be able to bill the workers’ compensation insurance carrier for your office visit, even if it is not the doctor to whom your employer referred you. If you have questions about what to do, contact a worker’s comp lawyer at The Boles Firm.
If the employer accepts your claim with a Notice of Compensation Payable, review the document carefully for mistakes.
If your employer and its insurer accept your claim by issuing a document titled Notice of Compensation Payable, you should start receiving benefits. However, you may be tempted to ignore the language in the Notice of Compensation Payable. That may be a big mistake. Before you can safely conclude that the Notice of Compensation Payable is accurate, you must review it very carefully for the following information:
- Did the employer accurately calculate your wages for purposes of establishing your compensation rate?
- Did the employer accurately state the areas of your body that were injured, and list all of the diagnoses related to your work injury?
- Did the employer correctly state the date of injury?
If any of this information is incorrect on the Notice of Compensation Payable, a workers’ compensation attorney can get them corrected. Often, the attorney can write to the insurer and get the information corrected without drawn-out legal proceedings. Other times, legal proceedings will be necessary.
However, you will do yourself a great disservice if you ignore the mistakes. The most common mistake is when an employer issues a Notice of Compensation Payable, but doesn’t list all of the areas of injury. Under such circumstances, the employee may be getting his work loss benefits and his doctors may be getting paid for office visits and physical therapy. However, if later on the doctor recommends surgery, the insurer may refuse to pay for the treatment, claiming it is not related to the workers’ compensation injury that they agreed to compensate. The only way to avoid this situation is to seek legal representation as soon as you notice that the Notice of Compensation Payable does not list all of your injuries.
If your employer issues a Notice of Temporary Compensation Payable, it has not accepted full responsibility for your work injury.
The Notice of Temporary Compensation Payable is a form that permits an employer to retain the right to deny your claim for a period of up to 90 days. Make sure you understand this form, which is discussed further in this article.
If the employer issues a Notice of Compensation Denial and you are injured, seek legal representation even if the employer has permitted you to return to a light duty job.
Sometimes, an employer will issue a Notice of Compensation Denial, while allowing the worker to work in a light-duty capacity and paying for medical treatment. Under such circumstances, it may be tempting to not want to “rock the boat.” If you are injured and hurting and cannot perform your pre-injury job, this is a mistake.
Why? Because if your employer decides down the line to terminate your employment without cause (which the law permits under most circumstances since most Pennsylvania employees can be hired and fired “at will”), you will not be able to collect workers’ compensation benefits. Also, if your employer decides not to pay for your medical treatment, you will have no legal recourse. Often, employers will pay for medical treatment that is not costly, even though they have issued a Notice of Compensation Denial. But as soon as the doctor recommends surgery or expensive therapy, they refuse to pay for the treatment. The only way to avoid being in either of those circumstances is to talk to a workers’ compensation lawyer as soon as the Notice of Compensation Denial is issued.
Be prepared for the medical examination requested by the insurance company.
If you are out on workers’ compensation for any extended period of time, your employer or its insurer will at some point ask for you to be examined by a doctor of their choice. Often, they will refer to this examination as an “Independent Medical Examination,” which may mislead you into assuming that the doctor who examines you is truly independent and unbiased, which is false. These doctors are commonly referred to by lawyers who represent injured workers as “defense medical examinations.” In many instances, the doctor performing the examination receives a sizable percentage of his income from examining injured workers on behalf of insurance companies.
It stands to reason that if the insurance company chooses a particular doctor to perform the “independent” examination, it is because they have reason to believe that they will get a favorable opinion. One way to protect yourself is to be sure that you have a witness to the examination. It will be your word against the doctor’s word if you claim later on that you did not tell him something, or that he did not do a certain test that he claims to have done. A witness can go a long way to preventing such an occurrence. Another way to protect yourself is to review all of the facts of your case with an attorney before you attend the examination so that you are prepared for the questions you will be asked.
The practice in our workers’ compensation law firm is to make sure our clients are well prepared before they go into the medical examination. We send them a specially-prepared pamphlet dealing with medical examinations, and review with them all of the facts relating to their particular case. Where necessary, we also send a witness with specialized knowledge, such as a nurse or investigator, to the medical examination to make sure that no unanticipated problems cause long-term harm to their right to benefits or compensation.
Do not settle your claim without first seeking the advice of a workers’ compensation attorney.
Sometimes, an insurance company may offer you some amount of money in settlement of your claim, even if you do not have a lawyer. In our opinion, it is never a good idea to settle a case without a lawyer – mainly because you will not know what it is you are giving up unless a lawyer has carefully reviewed:
- Your medical records
- Your pre-injury job
- Your prior job experience
- The sequence of events from the time you were injured to the present
These factors need to be reviewed with respect to current compensation law. So do yourself a favor: Don’t be fooled when someone offers you what seems to be a sizable amount of money. Review all of the facts with a lawyer who has extensive experience representing injured workers. If the offer is a fair one, the insurer should have no problem holding the offer open until you have had an opportunity to consult with a Philadelphia workers' compensation attorney. And if they tell you they won’t hold the offer open, you can draw your own conclusions.