Most states in the United States consider worker’s comp a legal requirement. While most employers are confident that the services of a worker’s attorney are unnecessary, there are some signs you need to look out for so you do not find yourself between a rock and a hard place.
1. You are Unable to Contact Your Adjuster Despite Numerous Attempts
Worker’s comp (WC) insurers must respond to a benefit request within 30 days of receiving it. Additionally, the law requires WC insurers to recognize communications from and react to the insured promptly.
If WC insurance does not comply with these regulations, you may be able to take legal action against them. When you speak with a lawyer, you will have the opportunity to explain your position to a qualified individual who understands the distinction between an underperforming insurance adjuster and an overworked one. Finding a more effective means of communication with your adjuster could be the answer. A complicated remedy might involve suing the insurer for improper conduct.
2. The Insurer Requests an Independent Medical Examination
WC insurer may demand that a claimant undergo a medical examination at the insurer’s expense. Although insurance companies refer to these physicians as “Independent” medical examiners, they are frequently anything but independent. The insurance company may be looking to gather medical evidence against you.
Therefore, they often go for out-of-state physicians, or “hired guns” that can be trusted to give a biased assessment. These medical professionals frequently offer a medical opinion following a brief examination, which the insurance will use to revoke your benefits. To make matters more challenging, your benefits may be revoked if you fail to abide by an independent medical examination (IME) request.
3. Your Medical Professional Rates You as Having Reached Maximum Medical Improvement (MMI)
As defined by the law, being at maximum medical improvement (MMI) is when “further meaningful functional improvement would not reasonably be expected from primary medical treatment”. Your injury has healed, so receiving further medical attention is no longer reasonably expected to improve your prognosis. This stage of any workers’ compensation claim is crucial because your insurer may cease providing benefits and start making settlement offers once you reach MMI. Due to the severity of your illness at MMI, you can even find yourself in a scenario where you cannot return to your job.
4. You Are Informed That Your Benefits Will End
Insurers must provide a 14-day written notice before terminating a claimant’s benefits. Once the insurer is aware that the claimant has been permitted to return to work or identified as MMI, they often issue this notice. A claimant is typically sent to an IME after receiving therapy for their injury for a few months. The insurer ends coverage based on the IME’s findings. This may place you in a challenging financial condition and exacerbate an already difficult circumstance.
5. You Need Assistance With Your Claim
Managing your WC might take time and can be frustrating as well as challenging. Consider hiring counsel if you believe you require assistance and direction for whatever reason. By doing this, you will have a supporter on your side who can help you navigate the process while defending your rights and any therapy you might require to recuperate.