“One Man’s Opinion”- An insurance investigator comes clean

May 22, 2015 by · Comments Off
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I just read an article written for a workers’ compensation advocacy group by a man who spent 30 years as a private investigator for the insurance company. While it is unclear exactly which state or states he operated in, the insight he reveals is horrifying!

The writer talks about how the insurance company knows that most injured workers are not educated on the rules of the workers’ compensation system and how they exploit this in order to deny claims and save money.

“In all my years in the business, I can count on one hand the number of Claim Adjusters and/or Examiners who provided assistance and/or real advice to an injured person; an exception to the rule. Most I’ve worked and/or have interacted with believe all claimants represent some type of exaggerated or fraudulent claim.”Private investigator

He even goes as far as to reveal some of the tricks investigators use to “tip the scales” and catch an injured worker breaking their restrictions on camera. Things like leaving change on a person’s front porch to get a video of him or her bending over to pick it up- Just awful!

The writer does explain a lot of the inner-workings of the system and points out a lot of the flaws in this bureaucracy. If you have a few minutes, it’s a good read. Click here to read the full article.

If you would like more information on the Virginia Workers’ Compensation system order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.

~Author
Michele Lewane, Esq.

How to get your mileage reimbursement

May 15, 2015 by · Comments Off
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Virginia Law allows for Injured Workers to be compensated for their travel expenses for trips to the doctor’s office, therapy, meetings with vocational rehab counselors and job interviews.. They don’t cover expenses to driving to the pharmacy or going to a hearing. The insurance company will reimburse expenses for uncontested (or accepted) claims; they will not however reimburse expenses for contested (or denied) claims until the claim is approved.Car Cartoon

Follow the steps listed below to fill out the IWLF MILEAGE REIMBURSEMENT FORM and submit it for payment:

1) Completely fill in the MILEAGE REIMBURSEMENT FORM including your name, address, employer (at the time of the injury), social security number, date of birth and date of accident.

2) Fill in the chart including the dates you traveled, TRAVELED FROM information (including address), TRAVELED TO information (including address), the total ROUND TRIP MILEAGE and any BRIDGE TOLLS/PARKING/PUBLIC TRANSIT expenses in the appropriate column.

a. If you have to take a taxi or other form of public transportation you do not                         have to fill in the mileage amount; you can simply list the TRAVELED FROM                        and TRAVELED TO addresses and the cost of the taxi ride or bus ride but you                      MUST keep your receipt.

Cartoon public bus

3) For ROUND TRIP MILEAGE, Log on to MapQuest or Google Maps and print out the directions page showing the distance to the desired locations; you need to do this for each different location you have traveled too. The print out will show you the trip distance for one way; double this number and this will be your ROUND TRIP MILEAGE. These directions/distance print outs need to be attached to the form when the form is submitted for reimbursement.

4) Once you have completed the chart, total up all the miles in the ROUND TRIP MILEAGE column and list this figure in BOX A.

5) Once you have the amount of BOX A, multiply it by $0.555 (or multiply by $.505 for mileage expenses incurred prior to October 1, 2011). This will give you the dollar amount of your reimbursement for the miles traveled; list this figure in BOX B.

6) Total up the cost of any public transit, bridge tolls, turnpike fees or cab fare and insert this total into BOX C.

7) Add BOX B and BOX C together and insert this figure into BOX D, this is the amount of your total reimbursement.

8) For any trips made or costs you are requesting reimbursement for, you MUST:

a. Show that you were at the appointment – this can be done by getting a print out from your doctor’s offices or counselors showing which days you were seen. The easiest document that shows you were actually seen at the doctor’s office is called a “Bill Payment History”. An appointment card is not sufficient proof to show that you were present for an appointment.

b. Show the total distance of travel that you are requesting – this is done by the MapQuest or Google Maps print out.

c. Show the cost of any of your out of pocket expenses – this is done by attaching any receipts for any public transit, bridge tolls, turnpike fees or cab fare.

REMEMBER – IN ORDER TO GET YOUR REIMBURSEMENT, YOU HAVE TO ACCOUNT FOR THE MONEY YOU ARE REQUESTING – THE INSURANCE COMPANY WILL NOT JUST TAKE YOUR WORD FOR IT!

9) Sign the MILEAGE REIMBURSEMENT FORM at the bottom and attach all necessary documentation.

10) Keep a copy of the documents for yourself and send one copy to the insurance adjuster and, if applicable, send one copy to your attorney’s office for your file. If the attorney’s office needs to follow up on the progress of your mileage reimbursement, they will need a copy of the form and all of the documentation in order to do so.

11) If you have not received your mileage reimbursement check within 3 weeks, call your attorney’s office and let them know. If you do not have an attorney working on your claim and have not received your mileage check, you can call the insurance adjuster directly.

If you would like more information on the Virginia Workers’ Compensation system or if you need mileage forms, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.

~Author
Michele Lewane, Esq.

GUIDELINES FOR VOCATIONAL REHABILITATION

May 8, 2015 by · Comments Off
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I get a lot of calls from injured workers wondering what is all this talk about vocational rehabilitation is (I call it voc for short). Voc is the process of working with a counselor to help the injured workers re-enter the workforce, usually under physical limitations that they did not have prior to their work accident. This below is what the Commission has laid out as the guidelines for Vocational Rehabilitation.

A) Vocational rehabilitation services, including vocational evaluation, counseling, job coaching, job development, job placement, on-the-job training, education, and retraining, shall take into account the employee’s pre-injury job and wage classification; age, aptitude and level of education; the likelihood of success in the new vocation; and the relative costs and benefits of such services. Retraining should be considered if job placement efforts are not successful, or the employee’s transferable skills are not readily marketable.

B) The provider should not ask the employee to engage in a job search or vocational rehabilitation until he/she is medically released for work. However, the provider may require the employee to meet in order to assess the employee’s potential for work, and to prepare resumes and to schedule other appropriate actions, such as attending job preparation training, in anticipation of employment.

Paperwork and 2 ppl at deskC) The two goals of vocational rehabilitation are to restore the employee to gainful employment, and to relieve the employer’s burden of future compensation. Rehabilitation providers should attempt to find employment consistent with the employee’s pre-injury position and salary level, and the provider should take into account such factors as distance, transportation costs, and actual anticipated earnings from the potential job, when considering such alternative employment.

D) It is the rehabilitation providers responsibility to assess employment opportunities by direct contact with potential employers, and to determine whether a suitable position is presently available that is within the employee’s restrictions and for which the employee is qualified. Until such prescreening contacts have been made to purge inappropriate leads, the provider should not ask the employee to attend interviews, but the provider may ask the employee to complete resumes and to attend job preparation training. The provider may ask the employee to attend interviews for present employment opportunities Where it is anticipated that the employee will be released to such work within a reasonably brief period.0511-1001-1820-1158

E) Telemarketing and commission sales positions are not appropriate job placement, unless the employee has demonstrated aptitude or ability in this line of work. Interviews with sheltered workshops and selective employers who are subsidized by employers/carriers are also inappropriate, if they do not provide the potential for legitimate rehabilitation, such as learning work skills or restoring the employee to a productive place in the labor market.

F) Requiring employees to look in newspapers contact a specific number of potential employers per week, check listings at the VEC, or register with temporary services does not constitute appropriate “vocational rehabilitation.” However, an employee may volunteer to do these activities. It would also be inappropriate for the rehabilitation provider to impose a blanket requirement on the employee to submit all job applications within twenty-four hours. It is not unreasonable for the provider to request written confirmation of the employee’s job interviews or applications, where possible.

G) Rehabilitation providers may not advise the employee to withhold information about his/her injury or job capabilities during job interviews or on applications. However, the employee may not discuss them in such a way as to sabotage the interview or application process.Job Interview with Smiles

H) Employees are not required to give rehabilitation providers personal or financial information, such as number of children, spouse’s employment, or credit history, unless such information relates to a bona fide occupational qualification for employment. An employee is required to disclose whether he/she is legally eligible for employment, has a valid driver’s license, or has been convicted of a felony, and to provide his/her previous employment history.

WATCH OUT!!!! These rules are about to change and unfortunately for the benefit of the insurance companies. I will update you when the changes are finalized and go in effect. In the meantime, click here for more information from Section 65.2-603(A)(3) of the Workers’ Compensation Act.

If you would like more information on the Virginia Workers’ Compensation system, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.

~Author
Michele Lewane, Esq.

Will I have to go to Court if I file a workers’ compensation claim?

April 24, 2015 by · Comments Off
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Not necessarily. If the workers’ compensation insurance carrier is willing to accept your claim and accept responsibility for paying your benefits (medical care and/or lost wages) then an Award Agreement will be drawn up reflecting the benefits the carrier is agreeing to pay and all parties can sign off and submit this form to the Commission. When the Award Agreement is signed by all parties and submitted to the Commission, this tells the Commission that there is no dispute so there is no reason for a hearing to be scheduled. The Commission can then issue an Award Order (your enforceable document protecting your benefits).

If the insurance carrier is not willing to accept your claim (or any part of your claim), you may also have the option to pursue settlement of your claim. Settlement is a mutual agreement between the insurance carrier and the injured worker to resolve the claim for a lump sum. Settlement can be Gavel & Legal Bookcomplicated and you need to understand the details of the settlement process, I always recommend talking to an attorney before exploring settlement as an option because an experienced workers’ compensation attorney can guide you through the legal process and help you to strategize and settle your claim at the appropriate time to ensure you get the maximum value allowable under Virginia Law.

If the injured worker and the carrier are not able to resolve the issues in the case, then the matter can be set for hearing before the Virginia Workers’ Compensation Commission. The Deputy Commissioner will review all the evidence in the case (so long as it was properly and timely filed with the Commission according to the rules of the Commission) and make a determination as to whether or not the injured worker is entitled to benefits. This too can be a complicated process and I always recommend talking to an attorney if your claim is going before a Commissioner.

If you would like more information on the Virginia Workers’ Compensation system, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.

~Author
Michele Lewane, Esq.

The insurance company sent me a medical release – should I sign it?

April 17, 2015 by · Comments Off
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I get this question from injured workers a lot. We like to think that our health information is completely private and protected by the HIPPA laws; however, if you read this article further, you will learn that workers’ compensation is a category outside of the HIPPA laws and is treated differently.
The truth is, if you want workers’ compensation medical benefits, the carrier DOES have the right to gain access to your medical health records (even medical records prior to the accident and non-workers’ comp doctors you have seen) to investigate the claim and the medical treatment the doctor is recommending. Below, I clarify some of the legalese in parenthesis and delete some portions of the law to make this a little easier to understand.
Section 164.512(l)–Disclosures For Workers’ Compensation
“we include a provision that clarifies the ability of covered entities (Medical Providers) to disclose protected health information without authorization (by the patient) to comply with workers’ compensation programs that provide benefits for work-related illnesses or injuries without regard to fault. Although most disclosures for workers’ compensation would be permissible under other provisions of this rule, particularly the provisions that permit disclosures for payment and as required by law, we are aware of the significant variability among workers’ compensation and similar laws, and include this provision to ensure that existing workers’ compensation systems are not disrupted.
Under this provision, a covered entity (Medical Providers) may disclose protected health information regarding an individual to a party responsible for payment of workers’ compensation benefits to the individual, and to an agency responsible for administering and /or adjudicating the individual’s claim for workers’ compensation benefits. ”
“The Virginia Workers’ Compensation Commission has interpreted this provision in several decisions. The Commission has held that the parties in a workers’ compensation proceeding have the right to subpoena and review ALL medical documents which are, or may be, related to the claimant’s condition, under the Virginia Workers’ Compensation Act and the exception found in Code § 32.1-127.1:03(C) . Additionally, Code § 65.2-607(A) provides a waiver of the physician/patient privilege in workers compensation cases. A more complete discussion of these issues can be found in the Commission’s decision Randall v. SHS International, Inc., VWC File No. 214-26-37 (March 29, 2004) . See also Scarafino v. CVS Drugs, VWC File No. 206-30-17 (July 8, 2004)”
To view the entire article by the Commission, follow this link.
As you see in the last paragraph from the Commission’s website, even if you don’t sign the medical release, the carrier may issue a Subpoena through the Commission and gain access to this information without your consent – the difference really boils down to timing. If you sign the release the insurance company will get access to this information more quickly rather than if they have to go through the formal court process – this will usually delay the processing of your claim significantly. During the delay, I am sure the insurance company will not pay for your medical care or your weekly check.medical release icon

If you are not sure about signing a medical release or if the release is asking for more than your medical records (which they often do ask for things like tax records, credit reports and so on) I would recommend talking to an attorney’s office before you make your final decision.

If you would like more information on the Virginia Workers’ Compensation system, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.

~Author
Michele Lewane, Esq.

The Top 4 Mistakes to avoid during a Deposition

April 10, 2015 by · Comments Off
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Basically, you will be sitting down with the attorney for the insurance company, your attorney (if you have one) and a court reporter who will type a transcript of all the testimony given that day. Testimony is given under oath and will be presented at the hearing to determine whether or not an individual is entitled to workers’ comp benefits.
Mistakes during a deposition can be extremely costly so I have put together a list of thing to avoid for injured workers who may be faced with a Deposition

1) No LYING! Never ever tell a lie during your Deposition. This is testimony given under oath and more often that not, the insurance company and defense attorney have been dealing the workers compensation system longer than you have and they will uncover the truth. Lying destroys your credibility and could even get you into other trouble later on down the road (fraud!). Like they told us grade school, “honesty is the best policy”!
2) Don’t show up unprepared! Review your answers to the Interrogatories you have already answered (many of the questions you will be asked will come straight from this document). It is also important that you review your medical records, accident reports and recorded statements before the deposition to make sure you remember everything.ppl in a depo
3) Don’t talk too much! What I mean is, don’t volunteer information that has not been asked of you. Answer the question and nothing more, if the defense attorney wants more explanation, he or she will ask you to elaborate. This is not the time to plead your case or give a speech about how this injury has impacted your life. Your job at this phase of the litigation process is to answer the questions only.
4) No guessing! Remember, this is testimony under oath, you can’t swear to something you are not certain of. Your answers should only consist of things you are certain about. If you don’t know the answer, it is ok to say “I don’t know”.

If you would like more information on the Virginia Workers’ Compensation system, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.

~Author
Michele Lewane, Esq.

Healthcare workers suffer neck and back injuries in record numbers

April 3, 2015 by · Comments Off
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I represent many folks who are injured while working in the health care industry. It is so sad to see how badly injured some people are simply by doing their job and caring for others.

I read a blog today from NPR about work place injuries for hospital employees, nurses and other health care providers. It is staggering how many people are injured in the health care field every year, but what makes it worse is that many hospitals out there are using techniques that are considered to be outdated due to the advances in modern technology. Many hospitals simply are understaffed or underfunded and can’t afford to make the necessary updates to their facilities and training programs; and nurses and other employees are paying the price!nurses

Many people who are injured while working in health care suffer serious injuries and do not recover to the point that they can return to their job and if they are one of the “lucky ones” who does recover enough to go back to work, chances are, they will likely get injured again – or they may not have a job to go back to.

I’ve listed a few interesting snippets I found within the blog:

“As NPR has reported in our investigative series Injured Nurses, nursing employees suffer more debilitating back and other injuries than almost any other occupation — and they get those injuries mainly from doing the everyday tasks of lifting and moving patients.”

“As NPR’s Injured Nurses investigation reveals, hospitals are not generally required to make their injury statistics public, so it’s difficult to compare them. NPR also found that officials at most hospitals across the country have failed to do much about the epidemic of back and other injuries that affect their nursing staff.”

“Nursing employees have very likely been getting hurt moving and lifting patients for as long as there have been nurses and patients. But studies by the U.S. government and university researchers in the 1990s began showing that hospitals can prevent many of those injuries, if hospital administrators invest enough time and money. They have to buy special equipment to move patients, such as powered ceiling hoists, and they have to conduct intensive training for the staff.”

You can find the entire blog here.  If you work in the health field, I strongly recommend taking a read through this.

This is why you need to protect yourself! You can’t count on your employer to protect you so YOU NEED TO BE INFORMED! Make sure you know what steps to take if you get injured – who you need to report it to and where you can get medical care if your injury needs treatment – knowing these things before an injury happens can make things go a lot smoother if you do get injured at work.

If you would like more information on the Virginia Workers’ Compensation system, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.

~Author
Michele Lewane, Esq.

KidsChance of Virginia – Scholarships for the children of injured workers

March 27, 2015 by · Comments Off
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I have written about KidsChance before – it is an program that is very near and dear to my heart! Click here for my KidsChance Announcement from back in July 2013, I’m so proud to be a part of such a wonderful organization! KidsChance of VA

For those of you who may not know, Kids Chance is a program that assists the children of injured workers by giving them the financial means to pursue a higher education. Let’s face it, anyone who has suffered the lasting effects of a work injury knows all to well the devastating effects the system can have on your finances.

The deadline for applying is rapidly approaching!! Applications for scholarship must be received by KidsChance no later than May 1, 2015. Don’t delay!

College Students-GraduationQualifications:
• A student between the ages of 16 and 25
• A child of a parent whose work related injury caused a significant decline in family income and circumstances
• A student who plans to pursue a post-secondary or trade school education in the Fall semester of 2015

Know someone deserving of a Kids Chance scholarship? Pass on this info or direct them to the website at www.kidschanceva.org. You can also follow this link to apply online or you can download a printable version of the application.

Good luck everyone!

~Author
Michele Lewane, Esq
Kids Chance Vice President, Virginia Chapter

Should I settle my Workers’ Compensation claim?

March 20, 2015 by · Comments Off
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People often contact my office because they are not sure if they want to settle their workers’ compensation claim. There are major differences on how to move forward on your case depending on if you are keeping your Lifetime Medical benefits or if you decide to settle your case. BE INFORMED! If you are considering settling your case, make sure you understand what you are giving up and what you are gaining; there are pros and cons either way. Make sure you understand the differences between the two so you can be comfortable with the decision you make and there are no surprises later on.

I have listed below some of the good and bad of either option. If you have additional questions or would like to discuss his with someone, please feel free to contact my office

Settlement -legal-settlement green men

 Some of the Good:
*No more waiting for approval – Once you settle the case, you are in the driver’s seat, no more waiting for approval from the insurance company because they are no longer involved! You decide what treatment you do or do not want.
*You get to see any doctor you want – After the case is settled, you are in charge of your medical care. Don’t like your doctor? No problem, find a new one who you are comfortable with. Get a second opinion. You are the sole decision maker in your medical care after you settle the claim.
*You get a lump sum of money- Instead of the insurance company paying the doctor for medical care, they pay you that money. Use it for medical care or any other thing you want. You have total freedom of choice.

Some of the Bad:
*Giving up Lifetime Medical coverage – When you settle a case for a lump sum, you give up your medical benefits and take the money instead. From this point forward, the medical care becomes the responsibility of the injured worker.
*Liens on settlement – Medicare, Social Security, child support and Medicaid have liens on the settlement money. Medicare goes so far as to say it has an interest in the workers’ compensation settlement if there is a reasonable expectation of you receiving Medicare within 30 months after settling your workers’ compensation claim. This can make the settlement process long and drawn out because approval from one or more entity may be required. You most definitely need to talk to an attorney if you are in this situation and are interested in settlement. The paperwork needs to carefully written to protect your interests.
*Resignation - Resignation of your employment is typically required as part of the settlement terms. However, if you dislike your job or if you are injured to the point that you can never return to your pre-injury employment, this may not be an issue for you. This is an insurance issue not an employment issue. The insurance company doesn’t want to pay you a lump sum of money for your hurt back and then you hurt your back at work the very next day and they are stuck with a new workers comp injury.
*Settlements are final – Once you settle a case, there is no going back to add this or that. You need to make sure you get it right on the first try!

Lifetime Medical Benefits
Some of the Good:
*The insurance company pays for your medical care- you don’t have co-pays and deductibles to worry about. You don’t have to stay with your employer to keep the insurance. The insurance basically covers the bills.
Some of the Bad:
*The burden of proof is on you forever– Just because the doctor says you need a specific treatment or diagnostic test does not mean that the insurance company will approve it. This means that even though you have the Lifetime Medical benefit, even if you have an Order, you still have to show that the current treatment requested is reasonable, necessary and related to the workplace injury. The insurance company does not assume anything.
*Medical providers generally require the insurance company to pre-approve your treatment – Medical providers have been burned by workers compensation insurance companies too many times. Having Lifetime Medical Benefits does not mean that you can just go to the doctor whenever you want. The Insurance carrier still has to pre-approve everything and they can (and will) deny anything that they believe does not meet the standard of reasonable, necessary and related to the workplace injury. This process slows down medical treatment.
*You may not get lost wages when you are out of work for surgery– Lifetime Medical coverage does not always mean that you are entitled to lost wages. If the doctor takes you out of work for a medical procedure, you may be off of work without pay. You may even lose your job if you are out of work too long. This is a case by case situation depending on your Award Orders for lost wages. Sadly, this happens more often than you might think. I get tons of calls from people who have surgery 5 years after their injury and they are not eligible for lost wages because too much time has lapsed since they last collected lost wages pursuant to an Award Order.
*Litigation – If the insurance carrier denies treatment, you will likely be going to a hearing so the Commission can determine whether the requested treatment should or should not be covered under your claim. This is expensive, time consuming and delays treatment for injured workers. However, it is within the insurance carrier’s rights to take a treatment issue before the Commission for a ruling. It is very common to go to a hearing 3 or 4 or more times with disputed medical treatment and tests. Like I said earlier, the burden of proof is on you!

Remember folks, this is all generalized information, to get specifics about your particular situation you should speak with an experienced attorney.

If you are dealing with a work injury or if you would like more information on the Virginia Workers’ Compensation system, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” by clicking this link, or call our office today (804) 755-7755.

Author
Michele Lewane, Esq.

Michele Lewane, Super Lawyer!

March 16, 2015 by · Comments Off
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We are thrilled to announce that our very own principal attorney, Michele Lewane has been selected to be included in the listing of Super Lawyers!

superlawyers

The selection process is not a simple one and includes a patented, multi-phase selection process of peer nominations, evaluations, and independent research. Candidates are evaluated on twelve indicators of peer recognition and professional achievement, and then selections are made yearly, on a state-by-state basis.

michelle_pic_sm

The Super Lawyer distinction is given through an impartial third-party rating system, and further demonstrates a lawyer’s credibility to both attorneys and consumers. Bar associations and courts countrywide recognize the Super Lawyer selection process as a comprehensive, detailed, and ethical process of acknowledging lawyers who have demonstrated substantial achievements within their field.

 

Congratulations on this accolade, Michele! We’re proud of you.

 

See her full listing on Super Lawyers, here

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