Injured on the Job.

 In Social Security & Disability, Worker Compensation

Injured on the job and you become engulfed with a whirlwind of emotions.

Coping with the pain of the injury, your mind is also firing on all cylinders with numerous questions.

  • How long will I be out of work?
  • Can I file for workers’ compensation benefits?
  • Will this affect my employment?
  • How quickly can I get back to work doing what I love to do?

While your brain is playing “20 Questions,” your instinct is to immediately contact an insurance case manager.

This is what you know. Probably taught right after you graduated from nursing school. It’s been instilled in you. A case manager is the person you need to contact immediately in order to obtain the medical care you need. A case manager will serve as a neutral liaison between all parties involved in the workers compensation claim. Including doctors, the injured worker(you), the employer and the insurance company. But that isn’t necessarily the case. In what could eventually become a war between all parties can hardly be considered Switzerland. Neutrality goes out the window because the case manager definitely has a dog in this fight, and it’s a big, nasty pit bull; The Insurance Company.

A case manager acts as an agent for the insurance company, pure and simple. They work towards whatever means necessary to help an insurance company cut off your medical care and benefits. While theoretically they are supposed to work independently of the insurance company. It’s not uncommon for them to provide the insurance company with information about your injury, what medical treatment you are receiving or may need to receive. The insurance company isn’t the only one they are whispering into the ear of.

Case managers are known to discuss the injured worker’s case with the treating physician, without the injured worker even being present. The goal is to “influence” the doctor for a return-to-work as soon as possible in order to save money for the insurance company. The case managers might even imply to the physician that certain tests aren’t really necessary. Maybe even the injured worker is faking their injury in order to receive a higher settlement (“Hey doc, it seems like she is ready to go back to work right now, right?” ). Nothing good can happen when a case manager talks to your doctor outside of your presence. It is merely a way of trying to pressure your treating doctor to take action that will result in savings to the insurance company.

Regardless of whether such action is in your best interest. For example, make sure your doctor is aware that your private health information should not be shared with a case manager, as they may use signed medical authorizations to obtain and review your medical records unrelated to your work injury. They will also share your unrelated medical records with the insurance company. The case manager and insurance company will then use any and all information contained in these medical records as an excuse to refuse paying you the workers’ compensation benefits to which you are entitled. And above all, never permit a case manager to be present while you are being examined by your treating doctor.

At this point you probably feel overwhelmed. Like David when he first saw Goliath come walking onto the battlefield. How can you, just one person, already battling the effects of a workplace injury, hope to go toe- to-toe with behemoths like the insurance company and hospital
administration? All you want is to receive your benefits. It would be great to make sure you get the medical care you need. Maybe even get some rest so you can recover from your work-related injury. Unfortunately, those are the very things that cost the insurance company money.  What you need is an advocate on your side in these troubling times.  Having the proper attorney in your corner will assist you in making sure the case manager knows that he or she cannot provide direct treatment. They cannot tell you what treatment to have or which doctor to go to. The attorney’s job is to rein in a case manager that is overly aggressive. Doing things that may not be beneficial to your claim.

Without an experienced workers’ compensation attorney watching your back, you may not realize you have the right to refuse a case manager handling your claim. You may not know that not only does the workers’ compensation insurance company pay the case manager to save them money, but the case manager also reports directly to them. You have a right to receive copies of all reports provided by the case manager to medical staff, the hospital and the insurance company. As your advocate, an attorney will set specific ground rules which the case manager must adhere to under penalty of dismal.

Most nurses are self-sufficient and only want to enjoy the job they love. They will try to avoid conflict whenever possible. Particularly with their employer, who they have a sense of loyalty to. But sometimes fate, in the shape of a pulled back or a slippery floor, will intervene. And when that happens, nurses need their own big dog in the fight.  You may think your workers’ compensation case manager, insurance adjuster, and human resources person are looking out for you. But at some point you will realize they aren’t.  They’ll ultimately decide your injury has lasted long enough. They may manipulate your medical care and medical providers in order to get them to release you from care or say your injury is no longer from work. Don’t let this happen.

In the end, the insurance case manager will start the injury process by making you think you are the one in the driver’s seat. After awhile you will come to the realization that you’re in a car doing 100 miles per hour and you don’t have your hands on the steering wheel. You need to do what it takes to make sure that never happens. Therefore, think of an attorney as your designated driver.

Bruce Lipsey is a partner with the law firm of Lipsey & Clifford, with office in Hanover, MA, Randolph, MA, Mansfield, MA and Boston. He received his law degree from Suffolk Law School, with honors in oral advocacy and brief writing. While at Suffolk, Bruce was named a contributing editor to the widely used lawyer’s resource, Proof of Cases in Massachusetts. He is a graduate of Brown University with Honors and former chairman of the MBA committee on Workers’ Compensation. Bruce focuses his practice in the areas of disability law, which includes SSDI and workers’ compensation law. He represents injured and disabled individuals before the Social Security Administration and the Department of Industrial Accidents. For more information visit www.elclaw.com.

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