WHAT
IS THE WORKERS COMPENSATION
INSURANCE COMPANY NOT TELLING ME?
 |
| Law Office of Stewart and Stewart, P.A. |
When
injured on the job, the first people you are likely to come in contact with are
your employer / supervisor, the adjuster for the worker’s compensation carrier,
and those employed with the hospital or medical facility you’re instructed to visit. People
occupying any of the aforementioned positions are more likely to have questions
for you than any answers. Even if you
receive what you believe are answers to your questions, the source from which
you received answers does not have your best interests in mind; certainly not
in the same way your attorney would.
Another issue we often see is that the answers our clients received
before we undertook representation were wrong.
There is no guarantee that the source of your answers is actually
knowledgeable with respect to what worker’s compensation benefits you’re
entitled to. You may be inclined to
think or expect that the insurance adjuster would be knowledgeable. Unfortunately, that is not always the
case. Even if the adjuster is
knowledgeable, we have seen examples wherein people were misled regarding their
benefits. You should feel comfortable contacting us and
asking questions. The feeling of comfort
comes from understanding that having questions is completely normal. Questions are expected. Furthermore, consultations regarding your
questions are free. There is no
obligation to retain us as your attorneys just because we answered your
questions. We’re happy to answer your
questions whether we undertake representation or not.
There is no reason why
you would know all the ins and outs of Florida’s Worker’s Compensation
laws. So, what are some of the benefits
injured workers are entitled to receive that insurance companies don’t
disclose?
1. Reimbursement for medical mileage or providing
transportation to and from medical appointments. If you sustain an injury while in the course
and scope of employment and do not have transportation to attend medical appointments,
physical therapy, or to obtain prescriptions from your pharmacy, the worker’s
compensation insurance carrier has an obligation to provide transportation for
you. The obligation to provide transportation
comes about if you do not own a vehicle, cannot drive, or have an otherwise
valid reason why you are unable to travel to and from medical
appointments. If you drive yourself for
such reasons, or have a friend of family member drive you, then the carrier is
obligated to reimburse you for the distance traveled. The amount is calculated based on the miles
traveled. Medical transportation can be
in the form of a cab service the insurance company uses to pick up you up from
your residence and return you home. The
generally accepted rate of reimbursement is .445 cents per mile. While this amount may not seem significant,
if can add up if you continue treatment for an extended period of time. Keeping track of your miles is easier with
access to Google Maps, or some other navigation service. If the carrier has not provided you with the
medical mileage reimbursement sheets, you should request them. We generally provide our clients with a form
to use in keeping track of their mileage.
Most clients find that driving themselves to their appointments or being
driven by a friend or family member is preferable over receiving transportation
provided by the carrier. The reason is
that the transportation services can vary in how reliable or on time they tend
to be. If you have any questions about
this issue, please contact us.
2. The
right to change physicians. You have a
right to a one time change in authorized physicians provided by the worker’s
compensation carrier. Such a request can
only occur as the name suggests – one time. That mean once during the life of your
claim. We prefer to discuss utilizing
the one time change option with our clients before they make such a request to
help ensure doing so is in their best interest.
One time change requests generally occur as a result of an employee not
agreeing with the opinion of their treating physician, or not feeling as though
they are making adequate progress with the physician they have been treating
with. There is no guarantee that the
doctor you end up seeing in place of the one you changed from will have a
different opinion, or that you will get along any better with a different
doctor. However, you do have the right
to change physicians. Upon written
request, the carrier has an obligation to provide you with alternate physician
within a specific period of time. The
change in physicians occurs within the same specialty. Meaning, if you are requesting a change from
an orthopedic specialist, you would be see an alternate orthopedic specialist. If you are requesting a change from a
neurosurgeon, you would be authorized to see an alternate neurosurgeon / spine
specialist.
3. Payment
if Impairment Benefits. Impairment
benefits are a monetary benefit paid once you reach a point of Maximum Medical
Improvement. Some work related / on the
job injuries are successfully treated within a matter of months. Other work injuries require a number of years
in treatment. Regardless of the duration
spent undergoing treatment, you will reach what is known as Maximum Medical
Improvement. This is most commonly referred
to with the acronym, “MMI.” Even if no
physician has determined that your curative treatment is complete, you will
reach what is called statutory MMI two years from your date of accident. It doesn’t mean that your treatment
stops. Unless you are permanently and
totally disabled, wage loss benefits will stop upon reaching MMI. Reaching MMI simply means that everything
that can be done in the way of providing curative treatment has been
provided. Depending on the nature of
your injury or injuries, you may not experience any residual limitations. Again, depending on the nature of your injury
or injuries, you may indeed have limitations upon reaching MMI. MMI can be explained as reaching a plateau in
a medical sense. Described another way,
MMI means you are as good as you are going to get. Once you reach MMI, an opinion will be provided
by your authorized treating physician concerning the degree of your permanent
impairment. For example, an injury to
your right arm may have caused you to lose 20% or more of your range of motion,
weight bearing ability, etc., in your right arm. However, that does not mean your impairment
rating is 20%. For worker’s compensation
purposes, the impairment rating is determined by considering your body as a
whole. Even though your right arm may be
considered 20% impaired, your final impairment rating may be expressed as 2%, 5%,
8% - it depends upon where you fall when your injuries are considered against
the guidelines in use for determining impairment ratings. If you
have questions about the guidelines or your impairment rating, please contact
us. Once a percentage is determined, we
can address how much money you are entitled to receive in the form of
impairment benefits. There is a specific
formula used for calculating your impairment benefits and a specific number of
weeks considered based on the percentage given.
The amount of money paid in the form of impairment benefits will vary
widely depending upon the final percentage.
We make sure our clients receive all monetary benefits they’re entitled
to, whether such benefits are lost wages, impairment benefits, medical mileage,
or reimbursement for certain covered expenses.
If you have any questions about being
injured on the job, please contact our office at 727-847-1115, or visit us online at www.stewartattorneys,com
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