When you are going to meet with your workers’ compensation attorney, there are several things that you should do in preparation:
1. Make sure you have all your documents ready. These would include the following:
a. Medical records regarding your injury including diagnostic studies, as these are important to understand the nature and extent of your injury. Also, sometimes the doctor will not note all the injured body parts, so your workers’ compensation attorney must make sure that all the injured body parts are accounted for in the medical records. If the doctor has missed a body part, your attorney may tell you to speak with the doctor to make sure the missing body part is included. Many times when the worker goes to an Agreed Medical Evaluator or a Qualified Medical Evaluator, the evaluating physician will make determinations based on what was previously noted in the treatment records. If the treating doctor did not list all the injured body parts, it may be difficult to get the evaluating doctor to include these as industrial down the road.
Also keep in mind that the company doctor and workers’ compensation insurance may be working together to minimize what the insurance has to pay. Many times the company doctor will only treat the body parts authorized by the workers’ compensation insurance
b. Any letters which the workers’ compensation insurance company has sent you. These letter will allow the attorney to obtain important information about your case including the claim number and date of injury noted by the insurance. The letters will also have the claims adjuster’s name and phone number. The name of the insurance is necessary to properly fill out the Application, which will be filed at the Workers’ Compensation Appeals Board (WCAB), so it is important that you bring this information to the attorney.
c. Bring pay stubs to help your attorney figure out whether the insurance company is paying you at the right rate. The carrier must pay you at two-third’s of your regular salary. If you are working more than one job, your second job will also be considered when deciding what rate the workers’ compensation insurance will be paying you.
2. Be ready to discuss what happened.
Try to have the event(s) leading up to your injury organized in your mind. California workers’ compensation is a no fault system; this means that you get the same amount of benefits no matter who caused the injury. Many times a worker will feel the need to state all the bad things the employer did to cause the injury; this is just not needed in a workers’ compensation claim.
Another issue that has to be determined is whether we are dealing with a specific injury. A cumulative trauma or some combination of both. Specific injuries are easy to determine; they involve one event were the worker suffered an accident which in turn caused a physical or psychological injury. Many times the company doctor will attribute a large part of the injury to degenerative changes. If a worker has been doing the same kind of work for many years, the attorney can argue that the degenerative changes are also related to the rigors of the job and add a separate cumulative trauma injury in order to deflect what the company doctor is saying.
It is important that all injured body parts are accounted for. Adding another body part six months down the line will be difficult if the worker has been off work during that time period. The carrier will ask why the omitted body part was not discussed from the get go. At the same time, some consequences of the initial injury do not show themselves for months or years. The workers’ compensation insurance is responsible for all compensable consequences of the original injury; so, for example, if you are taking anti-inflammatory medication and these cause an ulcer, the carrier is responsible for all the treatment the ulcer needs and for any disability the ulcer has caused.
3. Your attorney will need to make sure you are with a doctor who will treat you well both medical and legally.
Most workers’ compensation insurances have Medical Provider Networks (MPN’s). By law the worker must use an MPN doctor in order to receive benefits. If your lawyer is trying to send you to a doctor outside of the MPN, you should ask him/her why they are not playing by the rules. The attorney’s job is to find a legitimate doctor within the MPN. The treating doctors “run the show” in work comp cases, so it is very important that the doctor will at least be fair to both parties.
MPN doctors are told to get the worker back to work ASAP. It will be very difficult to find a doctor that will take the worker off work. More than likely, the doctor will place restrictions on the worker. It is up to the employer at that point to determine if light duty will be available. If no light duty is offered, then the workers’ compensation insurance will pay temporary partial disability until the doctor releases the worker from active care.
It is important for the worker to go to all scheduled medical appointments. Settlement offers are based on both the disability and the amount of medical care needed. If the insurance company sees that the worker is missing a lot of appointments, they will factor that into the settlement proposal and lower the offer.
4. Finally, the attorney should be able to provide you with a “game-plan” as far as what to expect in the foreseeable future.
Many things may be uncertain, yet, the attorney should be able to tell you how these uncertainties will be resolved.
A worker has the right to interview with more than one attorney prior to deciding which attorney to hire. The main complaint workers have is not being able to contact their attorney to discuss their case. You should ask the attorney whether he/she will be handling the case or whether an associate will be delegated the decision making duties, how accessible they are, and any other question which you think is necessary.
I personally handle all my cases. If you think your attorney is not properly advising you or keeping you informed, I can provide you with a free consultation. However, before seeking out a different attorney, you should try to work things out with your present attorney. This will avoid unnecessary delays. Keep in mind that the workers’ compensation system is very slow and highly regulated, and there are limits to what an attorney can do when it comes to medical treatment being denied even at the request of your doctor. Changing attorneys may not be the answer for you.