What are the most common pitfalls in a workers’ compensation claim?

The question is about some common pitfalls in a worker’s compensation claim. The first thing that pops into my head—and this happens all the time—is when you’ve been treating with your doctor for a while, and the insurance company’s paying for things, and it feels like it’s going smoothly. Then suddenly, you get a letter, and the letter says, “Hey, you’re going to go see this other doctor you’ve never heard of before that might be an hour away, and that doctor is going to evaluate you.” That is a pitfall because I think most

People don’t realize that they’re often walking into the lion’s den. It’s often a doctor who doesn’t actually treat patients. They’re licensed—they’re medically licensed—but they don’t treat patients, and their entire practice is just working for that insurance company and giving reports that say, “You know, this person can go back to work now. This person doesn’t actually have an impairment. This person should be cut off from medical treatment. It’s not related anymore.” And that happens over and over and over again. It’s actually the number

One driver of clients calling our office. It’s not that they call us right when the injury happens; they call us when their treatment is cut off or their TTD is cut off because this other doctor has been hired. That’s your first sign that the carrier is getting ready to fight you. Usually, the next pitfall I can think of is TTD checks are supposed to be sent to you weekly or every other week, and most of the time, that happens. For whatever reason, there are some adjusters or some insurance carriers that can’t

Seem to make that process happen on a regular basis. And it’s incredibly difficult if you’re already cut down to two-thirds of your average weekly wage, and you’re trying to put food on the table for your family with that. You’ve tightened your belt, and if that check doesn’t show up one week, and you got to go buy groceries, what do you do it with? Unfortunately, that is a hard problem for us to fix immediately. It often takes going to a judge to correct the issue or at least filing the case so an attorney for the defense side gets on it and says, “We have to correct this.” But it’s another thing that sends people in that can be a real problem.

Third pitfall that I can think of is what’s called the bona fide light-duty offer, and here’s the idea behind it. Let’s say your treating doctor says, “You know what? You don’t have to be off work entirely, but you can go back to work with certain restrictions.” And then your employer says, “Yes, we can bring you in. We can comply with those restrictions. We’ll get you in here.”

When that happens, you have to take them up on that offer. If it’s an offer that complies with your doctor’s restrictions, it does cut off your TTD, but it allows you to earn a paycheck again. And usually, our clients are very excited about this because they are going crazy sitting around their house treating. People describe feeling useless during that time, and they want to get back to work. They want to do something. Unfortunately, some employers then completely ignore everything they said. They put you right back in the old job that doesn’t comply with the doctor’s restrictions, and you have to make a decision on what to do.

Do I stay here and keep working this job that doesn’t comply with restrictions and risk hurting myself worse? Or do I say, “No, employer, I’m not coming in?” Now, maybe the employer’s mad. Maybe they don’t voluntarily restart TTD. You’re trying to figure out how to put food on the table for your family again, and your doctor is supporting you, but your doctor is only willing to support you so far.

Right? They’ll put it in the medical record, but they don’t call the employer up for you or anything like that. And that’s going to drive you into hiring an attorney as well because now you’ve got to find support for that third path where you’re not hurting yourself by not complying with restrictions, but at the same time, you’re not starving yourself because you can’t get a paycheck or a TTD check, either one. So if you see something like that happen in a worker’s compensation case, either for you or someone else, make sure you tell that person to call an attorney right away because the situation’s not going to get better.