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Five Signs That Your Workers' Compensation Benefits May Be in Danger

Posted Dennis Kergick on Jun 27, 2014 in Workers' Compensation

After a Pennsylvania worker has been injured on the job there are many things happening.  As an injured worker, ideally, you would be able to take your time, focus on recovering, and eventually get back to work when you're ready.  Unfortunately, the insurance company has another agenda.  They want to do everything they can to make sure they pay as little as possible toward your wage loss and medical benefits.  If your injury has been accepted and you are receiving these benefits it doesn't mean that everything is going to be smooth sailing.  There are several ways that the insurance company will try to limit, modify, or terminate your benefits.  The following is a list of warning signs that the insurance company may be looking at stopping your benefits.  

1. Your medical treatment has started to wind down.

At some point during your workers' compensation benefit period, your medical treatment will begin to wind down.  Your physical therapy sessions may have stopped, there may be no further need for surgery, the doctor may have stopped prescribing the strongest pain medicine.  This does not necessarily mean you're ready to go back to work.  The insurance company will try to look at it that way though.  The insurance company is paying for these medical treatments so they know when the treatment is winding down.  They will see this as an opportunity to try to get your doctor to say you can return to work, do other jobs in the economy, or say that you have made a full recovery.  

2. You have been told it's time to get a "second opinion".

It may be presented to you as a "second opinion" but most likely if the insurance company is setting it up, it's an appointment with an IME doctor.  You've probably heard of what IME doctors do but if not, they are basically paid by the insurance company to get an opinion that helps the insurance company in litigation.  The insurance company is looking for the IME doctor to say that you are fully recovered, that you are able to return to unrestricted work or your normal job, or at least to lift some of the restrictions your treating doctor has placed on you.  

3. You are being set up with a vocational interview.

Another popular tool for the insurance company is the labor market survey.  This is designed to show a workers' compensation judge that you are capable of working jobs in your local economy.  The expert is not hired to actually get a job for you, just to show that jobs exist within your restrictions, or more accurately within the lesser restrictions that the IME doctor has probably placed on you.  If you've been set up for a vocational interview you should call an attorney IMMEDIATELY.  

4. The adjuster starts gauging your interest in settlement.

If the adjuster has reached out to you and asked if you're interested in settlement, they are probably up to something.  The insurance company is not in the business of just giving out money.  If they are making you an offer, you can be confident that it's far below what your case is worth.  To truly know what your case might be worth and the factors that go into the value of your case, you need to talk to a lawyer.  The insurance adjuster is not to be trusted.  

5.  You just have a feeling that something is up.

Sometimes you just have to trust your gut.  Clients call all the time saying, "I think they're up to something." and they are often correct.  Maybe you've received your checks on the same day of the week, every week for the last year, then all of a sudden your check is a few days late.  Maybe the adjuster just has a different tone when you speak to her.  Maybe your doctor or nurse case manager says something that just seems off.  If you're getting a feeling that something is going on, you might be right.  

If you're on workers' comp and you're worried that the insurance company may be trying to cut off your benefits or you just want to know more about your rights, contact the experienced team at Schmidt Kramer.  The consultation is free and you will feel better knowing you're taking steps to protect your rights.