Workers’ Comp. 101: The Do’s and Don’ts

With an injury on the job, you have entered into the world of Workers’ Compensation. A maze of laws and regulations that most people have no idea even existed prior to their injury. “Workers’ Comp.”, as we call it, is a world of its own, with a very different set of legal rules and laws than in other personal injury cases.

What’s worse is business and insurance groups are constantly at work, trying to change the rules and limit your rights and benefits. Thus, even if you may think you know the rules regarding Workers’ Compensation, it’s highly likely that everything you know has already changed.

With 25 years of experience, it’s my job to stay on top of all the changes so that I can protect your rights and win your case.

As such, I have prepared the following list of Do’s and Don’ts to assist you in case you are ever injured on the job.

DO’s:

• 1. Immediately after the accident, do not try to move if you are hurt. Call for help to get up and for assistance. Insist on an ambulance and immediate medical care if the injury causes substantial pain or appears serious.
• 2. Identify witnesses to the accident (names, addresses and phone numbers). Insurance companies have become very aggressive in denying claims. Thus, more than ever we need to have witnesses corroborate our claims.
• 3. Report the accident or injury as soon as possible to your supervisor. Very often injured workers don’t want to be “whiny”; they try to “shake off” the pain, maybe go home and take Ibuprofen and hope it goes away. Then, after a few days, when the pain is increasing in severity, they decide they need to report it. This is not a good idea. Employers are actually much, much happier if they know about something right away. They become skeptical when a worker comes in after a weekend and reports an injury from Friday. Thus, my advice, report right away.
• 4. Be very thorough reporting to your Employer and to the Work Comp Doctor all of the parts of the body that you think were in any way hurt or injured in an accident. You will likely be limited to treatment only on the parts of the body you reported promptly. Again, often injured workers are only focused on the “main injury” and fail to report the “less injured” parts until later. This too is not a good idea. For example, I am representing a Nurse who fell down a flight of stairs. She severely broke her ankle, which was the main injury. She didn’t report that her back too was bothering her, because she was so focused on the ankle. Six weeks later, when the back was still very sore and getting worse, she told her Doctor and Employer about it. They denied the back and are trying to use it against her that she didn’t report it at the time. Thus, report everything.
• 5. Be sure an accident report is filled out and you get a copy, even on “minor injuries”. I have a case currently pending in which the Employer denied ever receiving an accident report. Fortunately, my client is a saver, and she still had her copy. Once we produced it to them, their tune quickly changed. Thus, keep your accident reports.
• 6. There are very strict timeframes in which you must report the injury, its best to do it immediately. However, do not be misled by Employers who tell you that if you don’t report it immediately, it is not accepted under Workers’ Comp. In Missouri, the worker has 30 days to report the injury to the Employer. No Employer can reduce that time limit.
• 7. Seek medical assistance immediately if pain persists. In Missouri, the Employer has the right to choose the medical provider; however, if they fail to provide treatment or deny treatment, the worker may choose the medical provider and the Employer/Insurer will be responsible for payment. You must keep all appointments, and follow the medical treatment or your benefits can be terminated.
• 8. Obtain all available information on your employer’s Workers’ Compensation insurer. Contact them as early as possible to make certain your benefits are being paid. However, be wary giving a recorded statement to the claims adjuster. The Insurance Companies are looking for ways to deny your claim or limit your benefits. If the questions are not answered very carefully, the case can be denied. The adjusters are very good at asking questions that can lead an injured worker into saying something that can be used to deny their claim. Thus, my advice, before you give your recorded statement, speak to an attorney experienced in Workers Comp. or have one present. Find out if there are any specific tricks or traps that you should be wary of.
• 9. If you are unable to work after three (3) days, request (in writing) that Workers’ Compensation benefits be started as of the fourth day. In Missouri, your weekly benefits are 2/3 of your average weekly wages up to a maximum set by the State; this is calculated from your gross salary before taxes. Do the calculations yourself, do not just go by the calculations of the insurance adjuster, they are often wrong.
• 10. If the insurance company does not begin making payments on your medical bills or refuses to authorize treatment, or if weekly benefits are not being paid, consult an attorney immediately. Do not wait.
• 11. If a Nurse Case Manager is assigned to your case, remember, she is not your friend. She works for the insurance company. Everything you say will be relayed back to the Insurance Company and used against you. Do not offer her any unnecessary or personal information. Further, the Nurse Case Manager does not have the right to be in the examination room with you.
• 12. In Missouri, we have a Statute of Limitations. This means that your case will be closed 2 years after the injury or the date of the last benefit paid unless a Form 21 is filed. Be very, very, very careful here. If you are anywhere near the 2 year mark, consult a Workers’ Comp. attorney.
• 13. When hiring an attorney, be sure the attorney is a Workers’ Comp. specialist. Ask the attorney about his or her experience! Workers’ Compensation is a highly specialized area of law. The laws change quickly and are actually quite complex. It is not an area of law that attorneys should just “dabble in”. The Insurance Companies MUST have a lawyer representing them in Missouri. Their lawyers are Work Comp specialists. Make sure your lawyer is as well. Write down all questions you may have prior to interview and don’t hesitate to interview several attorneys and compare. A good attorney should provide free consultations. Make sure you are comfortable with the lawyer. You will be spending quite a bit of time with him or her if your case is serious. You ought to like him or her and feel confident in your choice.
• 14. Once you hire an attorney, expect excellent service. Go for the best. The fee for a lawyer is based on the settlement they receive you. The better the lawyer, the more you will be compensated on your case. Thus, why settle for a lawyer less than excellent. Expect respect from the lawyer and his or her staff. Do not tolerate rudeness, or impersonal service. Expect to have your case handled promptly and personally. Do not settle for a lawyer that doesn’t care about you or your case. If you are unhappy with your attorney, remember, you are the boss. You can terminate your contract at anytime. It should not cost you anything to terminate the services of a lawyer whom you are unhappy with. The lawyer will be paid for his time on the case, out of the next lawyer’s fee, you do not pay double.

DON’Ts:

• 1. Don’t be talked into not reporting the accident. Some employers will pressure injured workers to run medical bills under their health insurance to help their “safety streak”. This always backfires and could wind up costing you a lot of money. Your personal health insurance is not required to pay for work injuries. They can and will deny payment or if they already have paid, many will seek to be reimbursed for their costs. Under the law, Employers must have work comp insurance or be self- insured. It is the Workers Comp. Insurance Company’s responsibility to pay for work injuries.
• 2. Don’t sign a medical release allowing the Insurance Company obtain all of your personal health records . They are not entitled to these, and they will go on fishing expeditions to find anything they can to deny your case or limit your benefits. As well, again, do not give statements to unnecessary parties without discussing with an attorney first or without an attorney present. The insurance company is always looking for ways to deny your claim. They know the questions to ask that will allow them to get off the hook.
• 3. Don’t sign releases or checks with release language printed on them.
• 4. Don’t settle your case unless you are absolutely sure your condition is as good as it’s going to get. Many insurance companies want to rush you through, have you sign off on a nominal settlement, just so they can close your file. Once you settle, your case is closed forever and you cannot obtain additional treatment, you cannot get anymore benefits.
• 5. Don’t settle your case unless you consult with a Workers’ Comp. specialist attorney and had your rights explained to you. A fair and ethical attorney will tell you honestly if the settlement offer is fair or unfair. He or she will review the likelihood of obtaining additional money, and explain the pros and cons of hiring an attorney.
• 6. Don’t discuss your case with unnecessary people. I have seen several instances over the years where co-workers, neighbors and even disgruntled family members have tried to sabotage a worker’s case out of spite and jealousy. Never discuss your legal case even with your personal doctor, the Work Comp doctor, the workers in the doctor’s office, or the nurse case manager assigned to your case. They are all agents of the Insurance Company, and they will report anything they can to help the company.

The above are just a handful of recommended Do’s and Don’ts regarding work injuries. In the end, if you have any questions or are in doubt about anything, do not guess. Call a Work Comp lawyer and set up a free consultation before you get in over your head, not after. Best of Luck.