So, you’ve been injured at work. If you have never before made a work comp claim, you are about to enter a strange and sometimes intimidating world. An insurance company claims adjuster will be making important decisions affecting many aspects of your life. If you are unable to continue working, the claims adjuster decides when and how much to pay you for lost wages. The claims adjuster will also decide whether to pay your medical bills, whether to authorize certain medical treatment or whether you can see a particular doctor or specialist.
Along with your lawyer, one of your strongest allies in a work comp claim can be your treating doctor. At first glance, this might seem to be simply stating the obvious. Of course your doctor is an important ally. It is he or she who will diagnose your injury, provide treatment and get you back to work as soon as possible.
However, medical treatment is only part of the service a good doctor can provide for you in a work comp claim. Along with treating your disabling medical condition, your doctor can also be a strong advocate in any disputes with the work comp insurance company. Any number of disputes can arise during the course of a typical work injury claim. For example, the insurance company or your employer may dispute the work restrictions your doctor provides. Or, perhaps your doctor suggests that you see a specialist or that you should have an MRI.
Either of these situations, and there are many more examples, may give rise to a dispute between you and the insurance company. This is where your doctor can be of tremendous help to you and your claim. A physician who will take the time to write a letter explaining why you need specific work restrictions or why you need an MRI can help assure that your benefits continue without interruption. This is true whether or not you have a lawyer representing you.
Unfortunately, there are some doctors who are unwilling to become involved in the litigation process. For whatever reason, they are happy to provide top-notch medical care but will not get involved in the legal aspects of your claim. This can put you in a very difficult situation.
The insurance company has the right to have you seen by a doctor of their choice for what is called an “independent medical examination”, usually referred to as an IME. They may then use their doctor’s report to cut off your benefits, refuse to pay for medical treatment or deny whatever other claims might be in dispute. If your doctor will not step up and write a letter addressing the disputed issues, honestly and with the benefit of being your treating physician, you may find yourself in a tough spot.
What do we recommend?
Simply be aware that your treating physician may be called upon at some point to offer assistance in the legal aspects of your claim. If you have a family doctor who knows you and you are comfortable with, by all means stay with that doctor. Don’t be afraid to ask him or her for assistance if a dispute arises with your claim.
If the time comes when you need to see a specialist for additional treatment or surgery, give some consideration to whether the new doctor is likely to assist you with your work comp claim if it becomes necessary. Ask someone who may have experience with the new physician. This might also be a good time to consult with an attorney if you don’t have one.
Any experienced work comp attorney should be able to give you the names of surgeons or other specialists who provide excellent medical care and who will also be an advocate for their patients if there is litigation involved. This doesn’t mean you have to hire a lawyer, but a consultation at this point might be a very good idea and could save you a lot of grief if a medical dispute arises later on in your claim.