What is a Workers’ Compensation Claim Denial?
Have you received a Denial of your workers’ compensation claim? After you suffer a work injury, you as the injured worker are required to give “Notice” to your employer of your injury as soon as possible but no later than 120 days from the date of the injury or from when you receive a diagnosis from a physician relating it to your work.
After you give “Notice” to your employer, your employer must relay the notice of the work injury to their workers’ compensation carrier. From the date the assigned workers’ compensation adjustor receives the claim, they have twenty-one (21) days to either accept or deny your claim. There are several ways that your claim can be accepted and if a Denial is issued, there must be a reason checked off as to why it is being denied. For purposes of this article, let’s focus on the reasons why your claim could be denied.
A layoff can be legal even while you are receiving workers’ compensation. But despite being laid off, you may be legally entitled to continue receiving your benefits until you are medically fit (released) to work. However, when this happens, your former employer will not rehire you as you were already laid off.
Assess Your Employer’s Actions
In this peculiar situation, it is important to closely assess your employer’s action. Your employer has a right to lay you off even when you have an active workers’ compensation claim in Pennsylvania. But the condition is that the layoff must not be related in any way to your claim.
If a number of workers have been laid off together, a work facility or an entire department has been closed (where you worked), your employer is not legally obligated to protect your job merely because you are receiving workers’ compensation.
But if you are the only worker who has lost the job, it is a matter that requires closer scrutiny. If the employer intended to protect themselves from liability and terminated your employment in the guise of a “layoff,” you may have a strong claim for wrongful termination, retaliation, or discrimination. It is best to seek legal advice from a proven and capable workers’ comp attorney in PA.Read More
WHAT IS A VOCATIONAL INTERVIEW?
HOW CAN IT AFFECT YOUR WORKERS’ COMPENSATION BENEFITS?
Did you know… If you have an open workers’ compensation claim, and are receiving wage loss benefits, your employer’s workers’ compensation carrier can and will try to reduce or stop your benefits at some point in time.
They will first send you for an Independent Medical Evaluation (IME) with a doctor of their choice, which you must attend or face suspension of your benefits. Once their doctor issues a report as to your condition and ability to return to some type of work, be it heavy, medium, light, or sedentary (desk work), the carrier will then approach your employer to see if there is work available within those restrictions. If your employer does not have work for you to return to, then the workers’ compensation carrier will hire a vocational expert to interview you to review your past employment, transferable skills, and educational background. You should always be represented by an experienced workers’ compensation attorney during this interview process.
Today’s e-commerce driven market has created many job opportunities for warehouse pickers. Given the nature of this job, there are various workplace injuries that can occur – some more obvious than others.
For order pickers at large e-commerce warehousing facilities, lifting heavy packages and objects can cause back injuries, which is one of the most common risks.
However, order pickers at warehouses also face other serious injury risks, such as falling objects, arm, elbow, shoulder, and musculoskeletal strains, repetitive motion injuries, and trips and falls. Some accidents may also involve forklifts, cranes, and other forms of large material handling equipment.Read More
Understanding a Suspension of Workers’ Comp Benefits
A Suspension of Workers’ Compensation Benefits is when the Workers’ Compensation Carrier tries to stop your wage loss benefits but not your medical benefits alleging that you are able to return to work in some capacity, whether it be regular, medium, light, or sedentary work according to an Independent Medical Evaluation (IME) report or your own treating Dr’s report.
From the time you begin to receive workers’ compensation wage loss benefits once your claim has been accepted, it is the workers’ compensation adjustor’s job to try and find a way to stop paying you compensation, as it is costing the carrier and your employer premium dollars to have you on workers’ compensation. The workers’ compensation carrier will receive ongoing reports from your treating physicians and if there is an hint that you can return to your job, or the same category of job…ie., desk type work, light, medium, or heavy duty work, that pays the same as your pre-injury work, the carrier will hire an attorney to file a Suspension Petition to try to stop your workers’ compensation wage loss benefits altogether.
My client injured his lower back while lifting metal piping, working as a welder.
He properly gave “Notice” of his work injury to his employer who reported the same to their workers’ compensation carrier, who in turn denied the claim, indicating that he had a pre-existing work injury.
As my client could not work due to the current work injury, he had to apply for short-term and long-term disability benefits. As he knew that he truly injured his back at work, he wanted to pursue both wage loss and medical workers’ compensation benefits.
I filed a Claim Petition that was assigned to a workers’ compensation judge, who recently ruled in my client’s favor after about nine months of hard-fought litigation.Read More
Research has shown that injured workers who are administered higher doses of opioids for pain relief end up spending more time off work following their injury than those who are prescribed low-dose or non-opioid painkillers.
The National Safety Council has cited a study which revealed that administering opioids for one week soon after a worker’s injury will double the risk of the worker not returning to the workplace even one year after the injury.
Increased Workers’ Comp Claim Costs
The challenge with opioid use is that the patient can quickly develop a tolerance to it. In other words, an injured worker using opioids is more likely to require incrementally higher doses of the drug to maintain the same effect. As the worker uses more of the opioid, it increases sedation and reduces their ability to work. This can result in delayed return to the workplace, which in turn means higher lost wages for the injured worker.
According to a study conducted by Johns Hopkins University published in the Claims Magazine, long-acting opioids were associated with a nine-fold jump in the average workers’ comp claim costs. These additional costs could also include treatment for opioid dependency and addiction.
Healthcare facilities often have to provide round-the-clock patient care. As a result, nursing staff are exposed to shift work as well as long working hours, which increases the risk of sleep disturbances and sleeplessness.
Pressures of the nursing profession take their toll, and as many as one-third of healthcare workers in PA report that they don’t obtain a sufficient amount of sleep.
Challenges of Inadequate Sleep for Nurses
Researchers have associated getting regular sleep of 7 to 8 hours every night, with a reduced risk of diabetes, obesity, hypertension, myocardial infarction, sleep apnea, and cerebral vascular accidents, apart from a lower risk of workplace injuries.
Nursing staff in hospitals as well as long-term care facilities often have to sleep at irregular times as well as during periods that are not in sync with circadian rhythms. This misalignment leads to problems with disturbed sleep, falling asleep while working, early awakenings and frequent arousals during sleep.
This results in poor sleep quality and shortened sleep duration. Competing demands of workplace and home as well as inadequate rest between work shifts increase the worker’s health risks.
In addition, financial pressures may push a nurse to work longer hours or take on a second job. For these reasons, healthcare ranks in second place among all industrial sectors for the number of workers reporting insufficient sleep duration.
Termination of Worker’s Comp Benefits
The first sign that your workers’ compensation wage loss benefits may be in jeopardy is when you receive in the mail a notice for you to attend an Independent Medical Examination (IME). This is a quick one-time examination by a physician of the workers’ compensation carrier’s choice. Keep in mind that the physician is paid directly by the carrier, and in most instances will find a way to side with the workers’ compensation carrier’s position that there is nothing wrong with you regarding your work injury and that you are fully recovered from your work injury.
After a Workers’ Compensation Carrier receives the Independent Medical Examination (IME) report and if it states a full recovery of your work injury, the Workers’ Compensation Carrier will hire an attorney to file a Termination Petition against you, the injured worker, in an attempt to stop all of your wage loss and medical workers’ compensation benefits that you are receiving.
What is an IME?
An Independent Medical Evaluation, also known as an IME, is scheduled by the Workers’ Compensation Carrier to evaluate the injured workers’ current medical status. This medical exam is performed by a doctor, relevant to your injury, selected by the insurance carrier – which is ‘independent’ from the doctor currently treating you. So, for example, if you have a back injury and are treating with an orthopedic surgeon, you would be sent to an orthopedic surgeon.