It’s easy to get overwhelmed when you get injured. The pressing need is your recovery, but without the right action you may not get the settlement you have coming to you or you might get much less than you should. As with any insurance claim, workers’ compensation has its do’s and don’ts. Getting to your doctor’s appointments, filling out painstaking paperwork, and dealing with robotic case managers all become part of an injured workers’ life. This experience presents many challenges to those unaware of their rights and benefits. These are the twelve tips for people dealing with workers’ compensation.
1. Don’t pay for your medical bills out of pocket.
If you haven’t spoken with your case manager or an attorney, you may not know that your medical bills are covered under workers’ compensation law. If you pay out of pocket for your medical bills, you are entitled to reimbursement by your insurance carrier. However, you will likely be reimbursed according to a State Fee Schedule. The amounts for treatment in the fee schedule can be far less than what the doctor charged you.
2. Even non-prescription medications are reimbursable.
Many injured workers are paying for their over-the-counter medications such as scar ointment or topical pain relievers. If you obtain a letter from your doctor stating these items are medically necessary, you should be able to receive reimbursement from your insurance carrier.
3. Mental health is as important as your physical health.
After being injured on the job you may not enjoy the same quality of life you had before. This can be very difficult for injured workers, especially those with severe injuries. Often this leads to depression or other mental illnesses. You should have a psychological evaluation if you feel symptoms of depression, anxiety or extreme stress. If you are the victim of assault, you should be assessed for any signs of PTSD. Psychological injuries can be life threatening and should be included in the calculation of your settlement. These issues come under the category of “pain and suffering.”
4. Schedule Loss of Use Award!
If you are hurt and working on getting better, you should take the time you need to fully recover. However, if you injure body parts listed on your Schedule Loss of Use (SLU), you may be entitled to an SLU Award. When calculating the SLU Award the money you were already paid is subtracted from the settlement. Example: Chris is out-of-work for 12 weeks before returning, during which time he collects $10,000. A year after Chris had his accident it is determined he is entitled to an SLU Award of $30,000. Since Chris already collected $10,000 in compensation his SLU Award will now be worth $20,000.
• You are entitled to an SLU Award if you injure your hands, fingers, feet, toes, arms, shoulders, hips, legs and for facial disfigurements. If you injure an SLU body part, always ask your doctor for an SLU report
5. Use available apps to save time and make your life easier.
According to surveys approximately 75% of injured workers don’t know they are entitled to reimbursement for transportation expenses. You are entitled to reimbursement for travel to your doctor’s office, Independent Medical Exams (IMEs), diagnostic testing and various other trips relating to your workers’ compensation case. The easiest way to collect your travel reimbursement is through the RoadCash app. RoadCash is a mileage-logging app specifically created for those receiving workers’ compensation benefits.
6. Know that you CAN get a settlement.
You can almost always receive a settlement, but only if you ask. Many times, if you don’t have an attorney, the insurance company will try to retire your case without even mentioning a settlement. You need to be aware of this because your settlement can be substantial.
7. Get a second opinion!
Part of maximizing your benefits is ensuring you are getting the correct treatment for your injury. If you aren’t getting better, or just don’t feel you are getting the treatment you deserve, you should speak with another doctor.
ALWAYS get a second opinion before going for surgery.
8. Make sure you go to a licensed workers’ comp doctor.
Many states require doctors to obtain a special license to treat injured workers receiving workers’ compensation benefits. If you go to a doctor that isn’t licensed, you will be stuck paying your own medical bills. Ask the question when making an appointment. Is Dr.X licensed to treat workers’ compensation cases?
9. Hire an attorney.
Hiring an attorney is a personal choice when you have a workers’ compensation case. Attorneys will make sure you are receiving the proper benefits and will allow you to receive the highest settlement possible. They don’t work for free, so be sure to get an idea of what the cost will be.
10. Providing your tax returns to ensure you establish the correct average weekly wage (AWW).
Many times, the insurance company will use the Average Weekly Wage provided by your employer, which may be lower than your actual AWW. By submitting your tax returns you can prove your actual earnings and have your AWW increased by the Workers’ Compensation Board. If you receive tips or other benefits they should be included in your AWW as well.
11. Be nice to your case manager.
Case managers in the insurance industry have a bad reputation. They have a lot of responsibility and they get stressed out just like everyone else. If you want to get the best help—treat them with respect and be polite. It is well worth it because they have a lot of control as to how things work out for you. Being nice to your case manager can help expedite requests for treatment and increase the likelihood of them providing you with useful information.
12. Be aware of investigators.
Getting caught can cost you your settlement and could lead to being charged with fraud. Check out the video below of a lady on workers’ comp who claimed to be “Totally Disabled.” The action on the TV show “The Price is Right” would indicate otherwise.