The Honest Truth About Work Comp Injuries
I have to say: this is not legal advice.
As I mentioned, I'm a former legal assistant. I should start out by saying that none of the experience that I am sharing should be taken as legal advice. I am definitely not an attorney. I simply learned a lot at the law firm that I worked at, and wish to share as Workers' Compensation injuries can be so stressful. This is intended to be a place to start. Do know that each state is different, so please do your own research before proceeding on behalf of any of my experience.
My Role At the Firm
The firm that I worked for represented the Petitioners, or the employees and my attorney didn't do litigation. That means that we never went to court, so the injuries we dealt with were not extreme--we dealt with broken fingers, shoulder injuries, pulled backs, etc.--injuries where people could typically stand up and walk afterwards.
I interviewed clients when they first came in to speak to an attorney. I spent at least an hour with the potential clients, asking them tough questions and copying their personal paperwork. By the end, I felt like I knew them pretty decently.
From this time, through their medical treatment and the end of their settlement, I was with them every step of the way. Below are my experiences:
When you're first injured, file an Accident Report ASAP.
Yes. I know this probably seems counter-intuitive, but you need to. Go to your Human Resources department, and request one. Be as succinct on it as you can. Please don't provide any unnecessary details. The insurance companies request these and will scrutinize these accident reports to death to see if you made a mistake in something you probably took two minutes to fill out.
Also, while you're in HR, be sure and ask for their Work Comp insurance information so you can submit any bills directly to them.
The Employer Doctor...dun, dun, dun!
After you tell HR about your injury, they will more than likely send you to their doctor. Basically, most employers should have Workers' Compensation insurance. When you are injured, this doctor is who is contracted to see their employees through this same insurance.
In short, they stink. They aren't there to work for the employees, but the employers, and they consider their job to release the employee back to work as soon as possible. I have heard horror stories about pretty severely injured clients who have been given Ibuprofen for the pain and sent back to work the next day. Or, the employees continue to see the Work Comp doctor and are understandably frustrated with the lack of compassion or progression in treatment.
The doctor doesn't know when you'll be released.
This is one of the most frustrating things about Work Comp. The doctor literally cannot tell you how soon you'll be released back to work. This can be to protect themselves, or simply because they do not know. Expect that. But, they should have an idea of how long specific things should take, like a surgery, or how long an injection should typically last. It may be easier for them to answer if you phrase the questions this way. They should tell you that it can depend on other factors like age and quality of your body.
I will say that the most common injuries seem to be the back, knee, and shoulder. Here's how it usually goes: First, the doctor will want to try pain meds. If those don't work, they'll try physical therapy. Then, injections. You're only allowed a certain amount of injections a year and most don't last forever. You and your doctor have to decide if you want injections for the rest of your life, or if surgery is a more viable option. Surgery is usually the last resort, and physical therapy follows. Sometimes, it can take multiple surgeries, based on how bad the injury was or other medical factors.
Also, you HAVE to be your own advocate. If you don't understand something, please ask. I've talked to too many clients who have no idea what their doctor is talking about when they leave the office. You should. It's your injury and your body, so you should be invested.
You may get to choose your doctor.
This is, of course, after seeing the employer doctor. Some laws, like in Illinois, allow you to pick at least one doctor of your choosing. From there, if you need to get referred, you can ask them for a referral and still keep it at one choice.
Be sure to consult your state's Workers' Compensation laws regarding doctors. This is especially important because when you're injured, you need medical treatment right away, right? Well, with that comes medical bills. If your employer is denying your claim for any reason, (and a lot of employers just do that automatically to try to discourage people pursuing claims) and you wish to pursue a claim with them, they will hopefully at some point pay your medical bills relating to the injury. If you happened to go outside the law with multiple doctors, they may deny payment of those bills. I've seen it happen, and they are not cheap.
By the way, every time you do get medical treatment, give the medical provider the Work Comp insurance information so they can submit the bills from their side. Keep copies of the bills and keep track of them, so you can trace what they've paid and what they hadn't. Sometimes, billing departments forget to submit bills to the right departments, and you don't want your credit to be dinged for human error.
Watch what you say around your doctor.
No matter if its' the employer doctor or your personal doctor, always be careful about what you say. My standard thought is that you need to describe the accident succinctly, and nothing else. No personal stories about how you may have been hungover or how you were doing anything illegal over the weekend. Doctors will write that in their medical records. Yes. You read that right. They can be the adult version of tattle-tales. I used to review medical records, and would see this fairly often. As I mentioned above, the insurance company will jump all over this as it makes the client look bad. Don't do it. The doctors are not your friend.
Also--the pain scale. Doctors use this to gauge your pain, as well to see if you are exaggerating your pain. Most people will state their pain is in the 8-9 area. Doctors consider 10 to be dying, so you may want to choose carefully. Maybe, aim for the 2-4 range and backed up with how you truly feel. Again, don't overstate it. Just the facts.
Should I hire an attorney? The dark truth.
This is a great question, and around this point in your medical treatment is when you may start considering that.
However, do know that I had numerous clients fired over hiring an attorney. Yes--even the ones that had been at the company for 17 years and considered their workplace to be family. I've seen it and it's devastating. The rug has been pulled from under them, all because of an accident injury. It all boils down to money, and employers can get so fickle, so quickly. Just know that that's a real possibility.
Why--you ask? How can employers get away with it? Simply; most states are considered at-will---meaning that they can fire someone for almost any reason--as long as the employee can't proof it's because of any race, sex, etc. discrimination--and don't have to give a reason. It's ridiculous and it shouldn't happen, but it does. Every. Single. Day.
If your employer isn't fighting your claim, and is paying your medical bills/temporary total disability as it was called in Illinois, (which was a certain portion of your wage while you can't work) then maybe this is something to hold off on. Likewise, if you were just fired, and/or they are fighting your claim, or the employer is starting to "play games", this may be a good time to just talk to an attorney. If you have an extensive surgery that will require a lot of time--i.e., a back, knee, or shoulder injury--it might be worth it to talk to an attorney.
You normally don't pay upfront. Again, please consult your state laws, but in Illinois, the attorney was paid a percentage of the settlement.
Ultimately, this is something that you need to discuss with your family. Things can get bad quickly if your HR departments gets a letter from your attorney and you're still working there. I strongly recommend visiting an attorney to understand your options, and then discuss the next few steps.
Do know, that you could discuss any terms of settlement with your employer's insurance company after you're done with treatment, but, it's not probable. Why? First, the insurer is used to talking to other experts who know the law, not employees who don't. This means that you may not know what to ask for in the settlement--and may not know how to counter-negotiate when they low-ball you. And they more than likely will. Their job is to keep their payouts low.
One more note: if you do hire an attorney, tell them everything that you think is pertinent to the case; good or bad. They need to know how to present you as an upstanding employee. Seriously.
IMEs, or Independent Medical Examinations, are mainly a tactic that the employer uses if they are denying their claim and want an "expert" to tell them that. What you may not know, is that they pay these doctors upwards of $300 an hour to pick you apart. These doctors work for the money, and not you. They will normally spend ten minutes with you. They look for an inconsistencies in your story, and look for any ways you are exaggerating your pain. If you do decide to hire an attorney, they should prep you for this.
As usual, with any doctors, tell them only the facts--nothing else. You will more than likely be nervous as these doctors may not be terribly friendly--but stay on message. That's only to your benefit.
Also, show up on time. I've seen IMEs that were cancelled when people were a few minutes late, even if they drove for a couple of hours and called ahead to let the office know. Some of the IME doctors literally don't care. The next before, plan out your route and know exactly where you're going. Plan for traffic. If you're late, the insurance company might try to get you to pay the IME bill. Don't forget, if you're going to an IME, your claim has more than likely been denied. Think of it this way: you are going to this doctor to try and get your medical bills paid. It's about ten minutes of someone not being nice. A necessary evil. Just do it, be on time, and move on with life.
Alright, so you're done with your medical treatment, the doctor has released you back to work, you've waited some time to see if the injury has fully healed, and you're ready for your million dollar check! Right?
Naw. Unfortunately not. The Work Comp system is set up that nobody is really going to make any money and nor is there any mental anguish piece. That's a myth. As I mentioned before, you should research your states' laws to see how your states' specific Work Comp settlement works, or ask your attorney to explain it.
In Illinois at least, at the time I was worked at the law firm, the settlement was based on how much of your body part was permanently injured. How morose is this?--to talk about body parts? Yes. It's a very strange thing to talk about. In the settlement, you should also include any medical bills that haven't been paid by the insurance company and any TTD (temporary total disability) owed. The higher your wage, the higher the settlement will be. This also means the more you are severely injured, the higher your settlement will be. It's very sad, but at least you get something.
If you do decide to hire an attorney, this is where they come in handy. They should know the insurance companies and their contacts, as well as the employer's attorney. Get someone--if you do--that has been doing this for a long time, and read online reviews to make sure they know what they're doing.
In the meantime...
Workers' Compensation is usually not a quick process and nothing will get accomplished in a timely manner. You need to be on time of everything. Ask for help from your significant other or other family to keep track of bills and medical treatment. Know why you're seeing each doctor and what your treatment plan is. Ask as many reasonable questions as you can.
It sucks. It really does. But; just take each day step-by-step. You don't know how things are going to work out, so you can't worry about it. Just do your job of taking care of yourself and making sure you have rainy day funds in the bank. (If you don't have rainy day funds, do not take out a loan from one of those fast cash places--they charge upwards of 20% interest--ask family or your bank for a loan) Again; take it step-by-step.
Keep lines of communication open with your significant other. It will probably be a bumpy ride. Make sure you have some stress-coping mechanisms to use along the way.
Deep breaths go a long way. Know this process is not forever and you WILL get through it. (Hugs).