FAQ

I have an open workers compensation case. Insurance investigators followed me in my car and seems to know exactly where I am during specific parts of the day. Are they allowed to follow me?

Yes. Insurance companies are allowed to follow you and film for investigative purposes however they cannot invade your right to privacy. Investigators are often assigned to a case to determine how active an injured person is or to determine if the injured worker is in fact working and collecting temporary disability at the same time. The bottom line is if you are off work and collecting benefits then you should not be earning a wage on the side. Insurance companies are allowed to use reasonable means to determine how active you are and your ability to perform certain functions.

Should I avoid using social media when I have a workers compensation case?

Yes. Investigators and adjusters often use social media as investigative tools. They will go on your Facebook page or Instagram account to see your habits and see your daily activities. Instead of having to track an injured worker down in public, investigators will go online to determine when and where you will be before wasting time and resources to find you. If you routinely post online then you are making yourself an easy target.

Someone told me to apply for state disability through the Employment Developement Development (EDD) even though the workers compensation insurance company is paying me. Is this illegal?

No.  If you are collecting disability benefits from the insurance company then you should not be collecting benefits through the state at the same time.  This is duplication of benefits and you will be responsible for paying back the duplicative benefits.  Even though you are receiving benefits through the insurance company, it is a good practice to also apply for state disability benefits at the beginning of your claim.  It is recommended that an injured worker apply for state disability because you will be in the system at the time of application and your wages will be locked in.  If EDD knows that the insurance is paying benefits then EDD will likely reject your claim for state disability.  Nevertheless you are now in the system and may be eligible for state disability if your disability runs past 104 weeks.

The adjuster told me I have to treat for my work injury within their Medical Provider Network. Is this true?

The short answer is probably yes.  Most employers now have created a Medical Provider Network (MPN) and if your claim is accepted you will probably have to treat within the network.  There are some exceptions to the general rule.  Please contact our office for a free consultation.

I am currently unrepresented. Adjuster requested a Panel QME for me and I got a list of 3 doctors in the mail. What do I do?

You have 10 days to pick a doctor and schedule the appointment with this doctor of your choice. But how do I know which one to pick? This is where an experienced attorney that specializes in workers compensation practice can help you. We are familiar with these doctors and will usually know which one to pick to evaluate you. Also there are certain circumstances that will allow you to request a new list of doctors to pick from. Contact us if you have received a panel list.

I sustained a work injury. The injury was reported and the company sent me to their company doctors. The company doctor however said I was fine and I have to go back to work. What options do I have?

You have a right to object to the doctor’s determination and seek a second opinion from another doctor within the Medical Provider Network (MPN). Alternatively you can obtain a Panel QME from the Medical Unit. This process can be confusing. This is where you need the assistance of attorney to help you navigate the workers compensation system. Please contact our office for assistance.

I get mail from the insurance Utilization Review denying all my medical treatment needs. What do I do with the mail?

If you intend on fighting the denial of medical treatment, you will need to request an Independent Medical Review. You will need to request the appeal within 30 days of the denial of treatment. If you fail to file an appeal within 30 days of the denial, the denial will stand for one year. In another word, the treatment you are requesting will remain denied or rejected for one whole year.

I got injured at work and properly reported the injury to my employer. The employer simply ignored me. What can I do?

You need to properly document your injury.  You should make a note of when and who you reported the injury to, list of potential eye witnesses, and document the manner of which you reported the injury.  If you emailed the employer, print out the email.  If you called the employer, document the time and date you reported the injury.  If you are seriously hurt then you should seek immediate medical attention.  Make sure to tell the examining physician that you sustained a work injury and accurately describe how the injury occurred.  Proper documentation is always the key.  Weeks or months can go by and often times it is your word versus the word of the employer.

I am about to settle my workers compensation claim. I am also on social security disability. Will my workers compensation settlement somehow affect my social security benefits?

Yes a settlement in workers compensation can affect your social security benefits. This is often referred to as an “offset”. Sometimes the settlement from your workers compensation case will cause you to exceed the maximum amount of income allowed by social security. If this happens, your social security benefits may be reduced. Speak to an attorney who is familiar with this scenario and who can offer you different options in order to avoid this offset.

I have a workers compensation claim and I have decided to leave my future medical care open. Now the adjuster is calling me to buy out the future medical care portion of the case. Should I accept their offer?

This option is the decision of the injured worker however there are several issues to consider before making that decision. First and foremost, has it been 5 years past the date of injury? If the case was originally settled via a Stipulated Award (case settled with future medical care open), then there is a possibility of re-opening the case for new and further disability within 5 years of the date of injury. If the injured worker has the right to re-open a case for new and further disability then I believe the insurance must also pay a premium to buy out this right. Other considerations must also include the liklihood of future surgeries, is this case a life pension case, or are there home health care costs involved.

I sustained a work injury and I am looking for an attorney. I called 3 attorneys. One attorney did not return my call. The second attorney said he cannot tell me how much is worth. The third attorney said he can get me a lot money. Which attorney should I retain?

While there is no right or wrong answer, I would say be wary of any attorney who makes promises without having any medical evidence or know all the facts particular to your case. Workers compensation cases and their value are always based on medical reports. Without having you attend an evaluation how can he/she tell you over the phone how much your case is worth?

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