Five Secrets Workers Comp Insurance Companies Don't Want You to Know
When injured on the job, many workers may be surprised to learn that insurance companies routinely stop payments or deny many workers comp claims. Most workers just want to have their wages and medical bills paid while off from work. Unfortunately, workers comp attorneys exist because many insurance companies cut off an injured worker's benefits without reason or dispute the claim.
Below are five of the most common strategies these insurance companies use to either avoid or minimize their payouts for workers compensation claims. Ideas are also included on how injured workers can protect themselves from a variety of issues.
*Note: While this information applies specifically to Michigan workers comp law, many of these issueslikely affect workers across the country - contact an experienced workers comp attorney in your state if you need assistance with your workers comp claim.
1. Your wage loss benefits are frequently paid at the wrong rate.
Most people assume that they are receiving the correct amount of lost wages. The truth is that insurance companies often make mistakes - and those mistakes are never in your favor.
Workers comp in Michigan is supposed to pay 80% of your after-tax average weekly wage. Insurance companies often fail to include overtime, premium pay, tips, bonus payments, and the value of fringe benefits in your average weekly wage calculation.
Other errors that insurance companies make are failing to include all of your dependents and using the wrong tax filing status. You can also get additional workers comp benefits if you were working a second job.
How to Protect Yourself: If you want to calculate your own workers' compensation rate, you must obtain a copy of your wage records. You have a right to these records - don't let the insurance company or your employer tell you otherwise.
The state of Michigan provides 2011 weekly workers compensation benefit tables for residents to calculate their average weekly wage and 80% after-tax average weekly wage.
Many times the insurance company or your employer will fight you on the correct workers' compensation rate. It is in their best interest to pay you as little as possible. Because of a recentMichigan Supreme Court decision some insurance companies and employers are reducing the workers' compensation rate based upon a hypothetical ability to earn wages in other employment. You should speak with an experienced workers' compensation attorney immediately if this occurs.
2. Insurance companies push you to see their doctors.
One of the most important benefits under workers comp is access to medical care. You are entitled to unlimited medical treatment for your work injury under Michigan's workers comp law.
Be careful treating with doctors recommended by your employer or the insurance company because of a potential conflict of interest. Insurance companies use the same doctors over and over again because they know how they view a particular injury. If your workers comp benefits are ever denied, you need a doctor who will be on your side.
Insurance companies will often deny workers comp benefits based upon an independent medical examination regardless of what your own doctor says. It is common for a doctor who performs an independent medical examination to find no evidenceof an injury or to find that the injury it is not work-related.
How to Protect Yourself: You can pick your own doctor after 10 days from the start of medical treatment. The best way to find a good doctor is by asking your friends and family for a referral. Notify the insurance company of your selection by providing the name and address of the doctor as well as your intent to treat for your injury.
You should attend any independent medical examination that has been scheduled for you and try your best to cooperate. Explain how you injured yourself at work and about your symptoms.
You also have the right to decide for yourself what medical treatment is truly needed. You cannot be forced into a specific course of medical treatment by your employer or the insurance company.
Most importantly, seek out an experienced workers comp lawyer who can stop insurance company abuse and challenge a bad medical opinion in court.
3. It is standard practice for insurance companies to dispute some work injuries.
Insurance companies deny workers compensation benefits for a variety of reasons. The number one reason is because you have some incidental findings of arthritis. Almost everyone develops arthritis as they get older and it does not mean that you did not suffer a real injury at work.
Most people with arthritis have some pain but are able to work. When you have a specific injury, something may have changed. It is important to explain to your doctor how you hurt yourself at work and any new symptoms.
Insurance companies think of arthritis as a magic bullet that gives them license to stop workers comp benefits. They will even ignore the facts surrounding your injury. This is especially true if you have preexisting arthritis in your back or neck. Conditions like degenerative disc disease or stenosis are often used to deny workers comp benefits. It is important to understand that these medical conditions can be made worse by a traumatic injury and can be compensable under workers comp law. This also applies to workers comp claims involving your knees, shoulders, and elbows.
How to Protect Yourself: Report an injury to your employer as soon as it happens and seek prompt medical care. Watch for new symptoms like pain or numbness. If you could work before an injury but cannot now this could be significant to your workers comp claim.
Don't let the insurance company get away with denying your claim for workers comp benefits.
4. Insurance companies are watching you.
Insurance companies hire professional investigators to follow and record the activities of most individuals who claim workers comp benefits. These investigators will scour the Internet and social media websites like Facebook looking for evidence against you. Some investigators will even talk to your neighbors behind your back.
Insurance companies will tell you that they use investigators to stop fraud and abuse. Many times they are just looking for a way to deny workers comp benefits. Insurance companies will attempt to find some proof that your workers comp claim is not legitimate.
How to Protect Yourself: Be cautious of your surroundings and never do anything beyond the medical restrictions given by your doctor. Investigators will take snippets of video out of context and try to prove in court that your work injury is not real. Just because you took a fifteen minute walk does not mean that you can work on a full time schedule.
Also be cautious how you use the Internet, especially social media sites such as Facebook or Twitter. A post or tweet about your recent ski trip when you are unable to work due to a back injury may very well be used against you.
5. Insurance companies will not tell you about all available benefits.
Insurance companies want to save money on workers comp claims. This results in you not being told about all the benefits available under your state's law.
While medical and wage loss benefits are fairly standard, many Michigan workers are unaware of additional benefits including attendant care and vocational rehabilitation. The insurance company must pay for the cost of attendant care from a nurse or other skilled individual to help with activities of daily living. Some examples are assistance with mobility, bathing, using the bathroom, eating, dressing, and taking medications.
Your family members can also receive up to 56 hours per week for providing attendant care. A spouse, brother, sister, child, parent or any combination of these persons can receive payment directly from workers comp. A family member is generally entitled to the same hourly rate as a professional and should be paid accordingly.
Your employer is also required to provide vocational rehabilitation to help you get back to gainful employment. You are allowed a maximum of two years of vocational rehabilitation under workers comp. Vocational rehabilitation could include tuition reimbursement or retraining for another job.
How to Protect Yourself: Be sure to tell your doctor about all the problems you are having at home. Ask for a prescription for attendant care so you can get assistance from your family. Keep a log with hours and services provided to present to the insurance company. Send this log by certified mail return receipt requested to the insurance company for payment.
Don't let your employer or the insurance company trample on your legal rights. An experienced workers comp attorney can discuss all of your options with workers compensation to ensure you receive all the benefits you are entitled to under your state's law. Not only will you better understand what benefits you are entitled to, but you will have the peace of mind knowing that you received the full value of benefits and compensation available to injured workers.
A good workers comp attorney will not charge you anything to meet or discuss your workers comp case. You will pay no attorney fee unless you get workers comp benefits.
