Hurt at Work? Tell Your Boss!

The worker in my first blog is in trouble.  He didn't notice his employer of an accident, he needs medical help, and is having trouble working a full work day because of back pain.

It's time for him to take action.

The first thing he should do is insist that his employer prepare and file an accident report with his workers' compensation carrier.  This places the employer and the carrier on notice that an accident took place and documents the event for the future when memories and witnesses fade and disappear.  If the employer refuses or doesn't have a mechanism in place to do this (this is true of some smaller companies), then our injured worker must find out the name of his workers' compensation carrier.  This information should be posted on a bulletin board and is usually near a coffee maker, water cooler, or punch clock.  If it isn't, a manager or someone in personnel/bookkeeping should know this information.

If the employer won't contact the workers' compensation carrier, the injured worker can do it.  One should not be discouraged from filing a claim, even under threats of retaliation.  That's illegal and can subject the employer to additional penalties.  Injured workers should also not be told to use their private insurance companies to get medical treatment for their work injuries.  More on that later....

Once the carrier is on notice, they will assign a claim number and ask basic questions.  Where did the accident happen?  Were there witnesses?  What is the injury?  Is medical treatment needed?  They may also ask whether there is a pre-existing history of injury to that area of the body and if the worker has ever had an accident to that area of the body before.  Best advice: Be honest and open about any pre-existing medical or litigation history from the beginning.  It's ok to have had a prior issue, prior litigation, or comp claim(s)....heck, if one works in a laborious field, it would be unusual if one did not have something to report.   And besides, insurance companies have full access to your prior claims for medical treatment and claims.  A simple stroke of a keyboard will reveal ALL.

The carrier will then do an investigation of the claim, usually just a few phone calls to your employer and witnesses.  This should be done promptly after the initial report.  If the carrier finds your report to be credible, and this is usually the case, they will refer the injured worker to a doctor for an evaluation and need for treatment exam.

Those appointments are to be taken seriously and given top priority!  Failure to comply at this stage will result in a prompt denial of future treatment.  It also damages one's credibility when appointments are missed - hey, if you're really hurt, medical treatment is important to you!

Once at the doctor's office, our injured worker tells the doctor about all of the aches and pains related to the work accident.  The doctor will not be authorized to look at or discuss anything other than that, so be very, very clear about what was injured.  For example, if it's an excruciatingly painful back condition, don't overlook the less painful, but also work related foot injury if it happened during the original accident.  IT WILL BE VERY DIFFICULT TO GET THE DOCTORS TO TREAT THE LESSER INJURIES LATER, because first impressions matter.  The insurance company will have serious doubts about causation if those items are reported later.  Patients must insist that doctors put those issues into their medical records.

Around this time, the doctor should be able to assess the ability to work, and if so, whether it's full duty or light duty.  They may not ask....doctors are busy and don't always have the best bedside manners, so it's up to the worker to tell the doctor what his or her job duties are.  Obviously the work duties will have a big part in whether the doctor thinks the patient can work.  A heavy construction worker working outdoors with no office skills suffering with a bad back will have less options available than a receptionist with the same injury and restrictions.

Hopefully, there are no difficulties going forward with medical authorization.  Most injuries, with time and treatment, do get better!

Next time, we'll discuss what happens when the carrier denies your claim and does not approve treatment.

If you or a loved one have a question related to workers' compensation benefits, feel free to contact me at kmdotoli611@aol.com.   If you'd like to learn more about workers' compensation benefits, join me at the Ocean County Library in Toms River on  April 30, 2013 at 6pm.  We are here to help!