How Insurance Companies Try To Rip Off Injured Workers: A Series – Volume 6: Settling The Case

Insurance Adjuster, speaking to Claimant: “You don’t need an attorney because I’m going to settle the case with you.” Unfortunately, we hear this story quite often. Insurance companies care about one thing – cash. They exist by making large profits, and they do this by paying out a whole lot less money than they take in. All insurance companies have lawyers who are on call, basically, to assist in this regard. They just love it when you don’t have one.

Because of the multitude of benefits potentially available to an injured worker under our Workers’ Compensation Act, it would be very difficult, if not impossible, for an injured worker to even attempt to guess how much his or her case might potentially be worth.  Insurance adjusters know this, so they try to run the settlement show, completely unimpeded.  A typical scenario would be for the adjuster to send the Claimant a letter with various “calculations,” followed by an offer to close the case for a certain amount.  Another tactic is to have their insurance lawyer (most of whom know a whole bunch about workers’ compensation law) approach the injured worker with a settlement number and an offer to draft a set of settlement paperwork for the Claimant to sign. With either option, one thing is pretty much for certain – these insurance folks probably aren’t going to just give away a bunch of money, unless they’re aggressively pressed to do so.

Although the Workers’ Compensation Act has a built in safety provision for injured workers, wherein all settlements have to be approved by a judge, the Commission has the authority to approve a settlement forged by an insurance company and an unrepresented Claimant for an amount that is at the very lowest end of the claim’s fair market settlement value, or even lower, so long as it is deemed to be in the Claimant’s best interests.  Doesn’t it sound like a better option to arrive at the settlement hearing with a deal that’s on the very highest end of the claim’s fair market settlement value, or even more?

At Hart Law, we squeeze every dime of settlement cash out of insurance companies.  Have questions about your settlement or how much your case could be worth?  We’re here to help, anytime.

By:  Neal L. Hart, Attorney at Law

How Insurance Companies Try To Rip Off Injured Workers: A Series – Volume 5: Impairment Ratings

In Arkansas, some workers’ compensation injuries are considered, by law, to be “permanent,” and some are not.  If an injured worker has a permanent injury, he or she may be entitled to receive a permanent impairment rating that is worth money, in the form of permanent disability benefits.  Impairment ratings are usually determined by a doctor (they can also be calculated by a Judge) who uses a book to do so that is filled with complicated tables, graphs, numbers, and charts.

Sometimes, doctors simply get the impairment rating wrong.  Often, insurance companies will try to get out of paying an impairment rating, either in whole or in part, by alleging that the rating is invalid under Arkansas law or failing to request permanent impairment all together.  Many times, an insurance adjuster will write an injured worker who has a permanent impairment and explain the rating incorrectly; misstate the law; miscalculate the benefits owed; and/or advise that the carrier is only paying some or even none of the impairment rating.  One reason insurance companies do this is because they know most injured folks have no idea about how impairment ratings work, and no idea how to correctly value them.  Insurance adjusters also know that if there’s no impairment rating, the injured worker is going to have a very difficult time asking a Judge to award benefits for a loss of earning capacity; permanent total disability; and/or vocational retraining.  These benefits can be very valuable.

If you already have a permanent impairment rating; are in the process of getting one; think you might have one; or think you may deserve one, we’d be glad to visit with you about ratings and your rights, any time.

By:    Neal L. Hart, Attorney at Law

How Insurance Companies Try To Rip Off Injured Workers: A Series – Volume 4: Light-Duty Jobs

How Insurance Companies Try To Rip Off Injured Workers:   A Series –   Volume 4:    Light-Duty Jobs

Under the Arkansas Workers’ Compensation Act, employers have a statutory obligation to provide modified-duty work to injured employees who are in an active healing period and restricted from performing full-duty work, if the company is able to do so.  If the employer provides the injured worker with a light-duty job and the employee refuses to perform same, temporary disability benefits could be suspended by the insurance carrier, indefinitely.  So, how do many employers and insurance companies use this statutory duty to their advantage?  They make up the worst light-duty job available and then order the injured employee to show up and do it, hoping it will cause him or her to immediately quit.  Examples of some particularly shady light-duty jobs we have seen concocted in the past include:  1.   Cleaning all the company toilets and then washing the human resource director’s car.  2.  Feather dusting the shop, repeatedly; and then starting over and doing it again, once that’s been done.  3.  Working in a soup kitchen, 75 miles from the Claimant’s house.  4.  Sitting at a table sorting small screws, day after day.  5.   Walking around the shop in circles, sweeping with one arm.  6.  Sitting on a stool all day, in a dark room.       Should the employer do this?  No.  Can they do this?  It depends on how aggressive and experienced your workers’ compensation attorney is.  If any of this already sounds familiar or you are concerned about a potential return to light-duty work, give us a call.  We’d be happy to visit with you about your options.

Neal L. Hart, Attorney at Law

How Insurance Companies Try To Rip Off Injured Workers: A Series – Volume 3: The Nurse Case Manager

Our Workers’ Compensation Law allows and even encourages insurance carriers to hire ‘nurse case managers’ to handle and direct an injured worker’s medical care in a claim.  Although many nurse case managers are generally good people, make no mistake – they are paid agents of the insurance company, making it heavily debatable whether the nurse could ever really be a ‘neutral’ party in the case.  In a typical scenario, and as discussed in previous blogs, the nurse case manager will contact the claimant in one way or another, often times almost immediately after a work injury occurs, to say that she’s been asked to appear in the case in order to make sure the injured worker gets proper medical care.  The problem with a statement like this is the definition of “proper” medical care.  When the nurse case manager begins directing the medical care in a claim, it is fairly routine, for example, for her to shuffle the claimant away from physicians who are viewed by the insurance company as “claimant friendly”; and to start making appointments for the claimant to see doctors who are well-known in the industry to be “insurance friendly.”  The hope is that by the time the injured worker figures this out, the medical evidence in the case will have already been terminally impaired past the point of no return.  One protection against this is a treating physician who will tell a nurse case manager “no” when she tries to manipulate the claim; but doctors with this kind of backbone are few and far between.  It’s exponentially more helpful for the claimant to be able to rely upon an experienced workers’ compensation attorney who will aggressively tell the nurse “no,” if necessary, which is exactly what Hart Law does.

Have a question about your nurse case manager?  Give us a call, anytime.

Neal L. Hart, Attorney at Law

How Insurance Companies Try To Rip Off Injured Workers:  A Series – Volume 2:  Manipulating The Medical Care

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Unfortunately, under our Workers’ Compensation Law, the insurance company in a workers’ compensation case has an almost unlimited right to direct a claimant’s medical care, throughout the claim.  The insurance carrier often uses this advantage, rather immediately, to attempt to impair or terminally damage an injured worker’s case; instead of just trying to restore him or her to a state of good health.  It would be a common scenario, for example, for a recently injured claimant to first be sent to a ‘company’ doctor, well known to the employer, and who has treated many injured employees of that particular company in the past.  In some instances, the company doctor may have certain instructions from the insurance company and/or employer, such as that an MRI or other diagnostic tests are not to be ordered unless they are imminently necessary.  The insurance carrier may also hire a nurse case manager (which will be discussed in more detail in Volume 3 of this series) to further pressure the treating doctor to save costs in the claim, at the claimant’s expense.

If the company physician feels that the injured worker needs a referral to a specialist, it is very common for an insurance company to once again intervene in the medical decision making process and shift the claimant’s medical care to some other insurance doctor.  If the insurance carrier doesn’t like what the specialist has to say, it sometimes sends the claimant for an allegedly “independent” medical examination, typically conducted by – yes, you guessed it – yet another insurance doctor.  By the time the claim gets to this point, the ‘evidence’ generated by the insurance carrier many times so overwhelmingly disfavors the injured worker that the case can never be successfully revived, even by the most skilled of workers’ compensation attorneys.  Oh, but it doesn’t stop there.  Insurance companies have been known to continue paying nurse case managers, for example, to try to collect additional medical evidence, favorable to them, even when a claimant has finished treating and the case is in active litigation.

If some of all of the above sounds familiar, we’d be glad to visit with you, anytime, about how we may be able to repair your case, before it’s too late.

Neal L. Hart, Attorney at Law

How Insurance Companies Try To Rip Off Injured Workers: A Series – Volume 1: The Weekly Compensation Rate

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As outlined previously, in this blog (http://hartlawfirmllp.com/the-weekly-compensation-rate-in-workers-compensation-law/), an injured employee’s weekly compensation rate is extremely important to a workers’ compensation case, because it often represents the only source of a worker’s household income, while he or she is disabled and off work; and, generally, larger weekly compensation rates generate larger workers’ compensation settlements. Adjusters know all this, and will try to calculate the weekly compensation rate in a manner designed to make it as low as possible.  It is important, therefore, to analyze an employee’s actual wage records closely, in order make sure that the carrier’s compensation rate numbers are legally accurate; and, if they are not, to force the insurance company to adjust them (upward) accordingly.  At Hart Law, we receive (and are happy to answer) compensation rate questions from injured folks frequently, because the weekly compensation rate calculations done by an insurance company are sometimes very wrong.    

Neal Hart, Attorney at Law

Is An Independent Medical Examination Really ‘Independent?’

Independent medical examinations (IMEs) are very common in Arkansas workers’ compensation claims.  The way it typically works is that the insurance company or one of its agents contacts the injured employee, in the middle of a claim, and says:  “We’re going to set you up for a second opinion.” Most claimants don’t know a whole lot about workers’ compensation law and just want to get physically better, so they usually think seeing another doctor for free is a great idea.  But is it?  Insurance carriers are typically very interested in two things:  1.  Getting a case closed.  2.  Saving as much cash as possible while doing so.  In order to better facilitate this, insurance companies often reuse the same physicians they’ve retained (and paid a bunch of money to) for IMEs in past cases; hoping that the IME doctor will once again arrive at a medical conclusion that will somehow impair an injured workers’ claim.

Under Arkansas law, an IME must be, among other things, reasonable, necessary, convenient for the claimant, and actually ‘independent.’  If a proposed IME doctor is generally well known in workers’ compensation system circles as an ‘insurance’ doctor, it would be difficult to contemplate that an IME conducted by that particular physician either would or ever could actually be ‘independent’ in nature.  Unfortunately, many lawyers just go ahead and allow their clients to attend an IME scheduled by an insurance company, without putting much thought into either the IME itself or the potential damage it could ultimately do to the case.  Legally resisting an independent medical examination that isn’t actually ‘independent’ could mean the difference between developing a solid case for a client, while he or she remains in a state of improving physical and mental health; and having a denied claim with medical evidence too damaging to possibly ever overcome.

Have questions about an IME?  Give us a call or send us an e-mail.  We’re always here to help.

Neal L. Hart, Attorney at Law

Using Your Right to a Change Of Physician Wisely

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Under Arkansas Law, the insurance company in a workers’ compensation claim has the right to direct an injured employee’s initial medical care.  Often times, this means that an injured worker will be sent to a “company doctor” who is familiar to both the insurance carrier and employer.  If the injured worker needs a referral to a specialist, the insurance company might tell the company doctor where to send a claimant for further evaluation. Under this scenario, it may not take very long at all for a work injury claim to become so overloaded with insurance-friendly physicians that it completely sinks the entire case, before the claimant even knows what happened.

Thankfully, our Workers’ Compensation Act allows an injured worker to ask for a one-time change of physician, to a doctor he or she wants to see, at basically any point during the claim.  The problem is that the insurance company may only have to pay for one office visit to the new doctor, unless the new physician provides the parties with some pretty compelling medical opinions to advance the evidence in the claim.  Because of this, knowing exactly when and how to use a physician change may be extremely important to the outcome of the claim.  If, for example, an uninformed claimant asks for a physician change at an unwise juncture in the case, to a doctor who thinks most folks alleging work injuries are scam artists, the physician change may have just been completely wasted, or worse.

Have questions about a physician change?  Give us a call.  We’re always here to help.

Neal L. Hart, Attorney at Law

AWCC Bacis Facts including Change of Physician

Knee Replacements in Workers’ Comp

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A fairly common work injury scenario in Arkansas goes something like this:  A middle-aged employee, with a history of heavy manual labor jobs, twists his knee at work.  He’s never really had any knee problems to speak of before; or at least none that he knows about.  The treating physician does surgery to fix torn cartilage, or maybe a torn ligament.  The operation doesn’t work, and the doctor says that the claimant needs his knee replaced.  The claim seems to be going great, right up until the doctor recommends the knee replacement.  The insurance company then alleges that the surgery isn’t work-related.

Unfortunately, this happens to working Arkansans far too often.  Knee replacements are expensive, involve substantial residual permanent impairment, and can make it so all or at least portions of an injured worker’s claim will remain open for life.  Insurance companies know this, and routinely try to skirt paying a partial or total knee replacement claim by making the argument that the claimant had “chronic” or “degenerative” knee problems that were present before the work injury.  While it is true that many knee claims we handle involve claimants who have chronic, preexisting knee problems they don’t necessarily know about, the fact remains that if a work injury is found to be even the slightest cause of the need for a knee replacement, the insurance company is probably going to have to pay for it.  If you’re content, however, to blindly rely upon the insurance carrier’s kindness and good will in this regard, you may be out of luck.

Have knee injury questions?  Feel free to give us a call anytime.

Neal L. Hart, Attorney at Law

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