Early Traps for the Unwary in Worker Compensation Claims
Here are four, important, but often overlooked things early in self-insured and state fund worker compensation claims, in Washington state. Because consultations are free, asking an attorney whether your case is where it should be is no risk.
Are Your Wage Replacement / Time Loss Benefits Accurate?What is the value of your current payment from the Department or Self-Insured company? How much were you earning before you were injured? Payments are determined by a variety of factors many of which are "missed" by claims managers or claim adjudicators. What were you earning at the time of your injury is only one of those, and its importance varies. Was your work seasonal (many of our clients transition from one employer to another throughout the year)? Did you have other employment (we once represented a minor league football player who suffered a football injury that prevented him from pursuing his day job as a FedEx delivery driver)? Are you married? Do you have children and are they dependent on you? Were you being paid benefits and are those benefits continuing while you are not working? Your claim manager isn't trying to skip these exactly...but they aren't trying to find them either. If you are comfortable advocating for yourself, by all means have at it, but you'd probably be well-served to talk to an attorney about what your time loss rate should reflect.
Are the Necessary Conditions Allowed on Your Claim?Allowed conditions dictate a number of very important outcomes in your case. Often, the Department will pay attention to the initial doctors notes, but lose interest in identifying allowable conditions within weeks of an injurious event or diagnosis of an occupational disease. Other conditions that ought to be allowed evolve over the course of the claim. Still other conditions are hidden or masked by serious injuries (in one jury trial, we successfully equated a hidden injury to an eclipse by a more severe and acute injury). There are many reasons this is important. First, if you don't have conditions allowed on a claim, you won't generally receive treatment for them, or at a minimum, the Department or Self-Insured Company may deny treatment for unallowed conditions that hampers or impedes your ability to fully recover. Second, if your case reaches the point that you are receiving vocational services, your vocational counselor is not going to account for disallowed conditions in determining your return to work. Third, this is also true of medical examiners hired by the Department or Self-Insured (this person can't work because of their unrelated shoulder condition, but s/he can return to work as it relates to the industrial injury, is all too common a line in "IME/DME" reports). Fourth, you only receive disability awards for impairments on allowed conditions. Fifth, similar to the vocational issue, you can only qualify for a worker compensation pension as it relates to allowed conditions. Sixth, and perhaps most importantly because most people do return to work at some time: You can only reopen your claim as it relates to conditions that were allowed on your claim, when it was closed. It is always a worthwhile effort to engage an attorney to review your medical records and the mechanism of injury to advocate on your behalf to ensure your claim is as robust as it can possibly be.
Are There Live Orders?Worker compensation cases generate A LOT of paper and A LOT of mail. It is easy - but perilous - to ignore mail from the Department of Labor & Industries or a Self-Insured Company. Orders refer generically to orders and decisions rendered by the Department of Labor & Industries as it relates to cases. These can impact claim allowance, wage rates, allowed conditions, and many other things. All orders should carry with them "60 day" language that instructs you to request reconsideration, protest or appeal an order. If you do not do any of these things and the order's time period "expires" you will hear these dreaded words from the Department "The order was properly issued. The order is final and binding." Our office - and I would imagine most worker compensation attorneys - have a program to ensure that within hours of retention, paperwork is out to protect the injured worker from suffering a final and binding order. *Quick Caveat - Vocational determinations can have shorter timelines as can issues before the Board. Consult early with an attorney, so these aren't your burden.
Who is Your Attending Provider?This is a huge one and one of the biggest traps for the unwary, because there is so much information out there (and honestly, some of you will be lied to). Some of you may have been driven to a healthcare facility by a co-worker or supervisor. You may have been told that you 'have to' see a particular provider ("the L&I doctor"). The facility where you are receiving your work-related care may tell you that you have to be seen by their "occupational medicine" doctor. You may have a primary care provider or know of another doctor who is familiar with you and who you would prefer to see, but be told that you need to stick with the doctor who is on your claim. This is all 100% nonsense. Although you are ordinarily required to see a provider authorized to treat worker compensation patients (there are exceptions to out of state claimants without access to 'in network' providers), many, many providers have the requisite certification and you are not required to see a particular, assigned person. You have a near absolute right to transfer care to an attending provider of your choice. In areas that our office serves, it is not uncommon for injured workers to be assigned a provider and told they're required to see that person. It is also not uncommon for an injured worker to be assigned to a specialist (a definite hidden and dangerous trap for an injured worker's claim). As a result, we have cultivated a variety of worker-friendly, patient-advocate providers with whom we are able to work on behalf of our clients. A bad attending provider will kill your claim. More importantly, you will not get essential, necessary treatment. Consequently, you absolutely may - and often SHOULD - transfer care early in your claim.