I want an MRI but the doctor ordered Physical Therapy – Do I have to do it?

April 16, 2014 by · Comments Off
Filed under: Virginia Injured worker 

Seeing a workers’ compensation doctor is different that seeing your family physician.  When you are injured at work, the insurance carrier gets to dictate which doctor you see – they give you three doctors to choose from which they have hand picked!  I have a lot of injured workers’ tell me that they feel something is wrong with their neck/back/knee (you get the picture) but the doctor has ordered physical therapy and the injured worker is upset because they asked for an MRI but the treatment they asked for was not addressed. MRI Machine

Here’s the trick folks – for workers’ compensation, WHAT THE DOCTOR SAYS GOES!  What I mean by this is that you can request treatment or testing all day long but the insurance carrier does not have to address it because you are not the doctor (the medical professional licensed by the state of Virginia).  Only the doctor has the authority to say what treatment or testing is appropriate for your current medical condition.  I understand that this may not be a doctor you like or a doctor that you would ever choose to see again but in Virginia, this is currently how the system works.

So, if the doctor orders physical therapy, even if you feel that you can’t or shouldn’t do the therapy, you have to make an attempt at it.  If you go to therapy and are too physically injured to do the necessary work in therapy, the therapist can report this to the doctor and then the doctor can make the necessary changes to your treatment plan or possibly send you for an MRI or other testing at that point.  The problem is, if you don’t at least attempt to follow the doctor’s orders, even if you are in disagreement with them, the insurance carrier can say that you are not cooperating with the medical treatment and terminate your workers’ compensation benefits altogether.  Believe me, you don’t want to be in that situation because once benefits are terminated because of an injured workers’ unwillingness to follow doctor’s orders, it is EXTREMELY difficult to get these benefits reinstated and it takes a very long time. 

 

If you have questions about your benefits 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.

 

Transportation issues DO NOT affect your ability to work!

April 14, 2014 by · Comments Off
Filed under: Job Injury, Virginia workers compensation 

I get this question a lot.  Injured workers who have been released to return to work are sometimes under limitations that restrict their driving abilities; or are on medications that affect their ability to drive, or they may have a manual shirt car that is uncomfortable for them to operate due to their injury and they want to know if they still have to return to work.  The answer is YES!  The Virginia Workers’ Compensation Commission views driving or transportation issues as a PERSONAL RESPONSIBILITY and they are not concerned with HOW you get to work, be it by your own car, a ride from a friend or family member or even by public transit (taxi or bus).  Transportation to and from work was the responsibility of the worker before the injury and it remains that way after the injury, even if the injury impedes your driving abilities.

The next question I get is from folks who drive for a living (truck driver, delivery people and so on).  They want to know, if the doctor will not let them drive, per their CDL license, can they work?  The answer is YES!  If the employer is willing to accommodate your restriction of no driving (maybe by letting you work in the office), then it is still your responsibility to get to and from work because at work, you will not be doing any driving and the work is within the doctors limitations.

Cartoon public bus

If you chose not to show up for work because the doctor has placed you on driving limitations or because your car is inconvenient for you while you are injured, you run the risk of the employer reporting to the insurance company that your are not cooperating with the work they are offering you and having your Workers’ Compensation benefits terminated!

I understand that this is inconvenient for some folks but you need to know the rules in order to protect your benefits and make sure you are doing everything that is required of you under Virginia Law.  Bottom lineif the doctor says you can return to work, you need to do it regardless of the transportation issues you may encounter.

 

If you have questions about your benefits 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.

 

I don’t like my WC doctor. Can I see someone else under my Health Insurance?

April 11, 2014 by · Comments Off
Filed under: Hurt on Job, Work Injury, Workers Compensation Claims 

I get this question daily!  Let me warn you folks, this is a slippery slope

I know all too well the stress and inconvenience a work injury can put on a person, then it is often times compounded by the fact that the injured worker doesn’t’ even get to pick their own doctor and they may be stuck seeing someone that they don’t feel comfortable with.  Medical treatment is intimate and I can certainly understand the desire to go to another doctor, after all, you only get this one body!  I can understand how this would make sense to an injured worker in the short term; however the long term is where the real trouble comes in.

Cartoon doctor 2The Short Term Issues

If you do go to another doctor and he or she does to treatment or testing that you wish to pursue, the problem is that the workers’ compensation insurance carrier doesn’t have to pay for it because their doctor did not request it and the insurance carrier did not pre-approve it.

The other problem I see right away for injured workers who seek treatment on their own is that now they are terribly confused not only about what treatment they should be getting but even about their diagnosis; it is not uncommon for doctors to have conflicting opinions as medicine is not yet an exact science, especially when you are in the early stages of your treatment and diagnosis.

The Long Term Issues

In most cases, in order to get any testing or treatment under your health insurance you have to disclose if this was indeed a work injury or an injury stemming from something else.  The health insurance company may be none the wiser at first, but once they see that this is a work injury, they may refuse to pay for treatment because they will likely say that workers’ compensation should be paying for treatment, not your health insurance.  Then when you ask the workers’ compensation insurance carrier to pay for it, they will probably refuse because you chose to seek treatment outside of their network of medical providers.  This means you are now stuck with the bills for expensive medical care because neither insurance company is willing to pay for it!

Some injured workers will try to side-step this whole thing by not listing their current problems/treatment as a work related injury BUT when they to go back and try get their treatment covered under workers’ compensation this will DESTROY their case (remember documentation is key!).

WC Form & StethascopeEvery situation is different so if you have a situation similar to any of the scenarios listed above or if you are contemplating seeking treatment on your own, you should talk to an experienced workers’ compensation attorney who can give you some guidance before you do anything that you might regret.

 

If you have questions about your benefits 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.

Meet Joanne Monticelli, Esq.!

April 9, 2014 by · Comments Off
Filed under: General Law 

Everyone, I’m pleased to introduce to you Joanne Monticelli, Esq.  Joanne is an attorney and a personal friend of mine who I trust to help my clients with their Social Security needs.  Joanne has a direct line here at my office and works closely with me and my staff to make sure all the needs of injured workers can be met.  As you probably already know, Social Security and Workers’ Compensation benefits can overlap and affect one another, that is why I always tell injured workers’ to consult an attorney BEFORE filing for any additional benefits.

I still only handle workers’ compensation claims so that I can stay on top of the ever-changing laws here in Virginia.  I do this to ensure that my clients can receive the most knowledgeable up to date information from me and my staff for their work injury needs.  I can advise my clients on how filing for Social Security can affect their workers’ compensation benefits, but I leave the questions about the Social Security system itself to Joanne!

If you have questions about a Social Security claim, contact Joanne Monticelli, Esq., here at my office at (804) 755-7655.

JCM

Should I be getting TTD or TPD pay for my lost wages?

April 7, 2014 by · Comments Off
Filed under: Light duty, Loss of Wages 

This question comes up a lot for injured workers, especially when the have been bounced between light duty work and completely off of work.  TTD or Temporary Total Disability is pay for an injured worker when the workers’ compensation doctor has deemed it appropriate for them to be completely out of work due to their injury or injuries.  TPD or Temporary Partial Disability is pay for an injured worker who is working in a lesser capacity due to their injury and therefore making less money.  For example, if you return to work on light duty and are making a lower hourly rate than before the injury or if you are making the same hourly rate but working less hours because you are on light duty you may be eligible for TPD benefits.  Workers’ comp basically makes of the difference between the new lower wages and the pre-injury wages (up to your “comp rate”).Twisted dollar bill

Some people find that once they have been released to light duty, their employer is not able or not willing to accommodate their light duty restrictions and has the injured worker remain out of work.  In this scenario, the injured worker could then receive TTD benefits because they are still out of work and not earning any wages.  However, if you are NOT under an OPEN AWARD, you are required to be looking for light duty work (called “marketing”) in order to receive your benefits.  When the doctor says you can do some kind of work/light duty but not your regular job, you must be looking for that kind of light duty job unless you are under an open award.  It is best to contact an experienced workers’ compensation attorney to find out if you need to be marketing in order to protect your benefits and to get you under an open award as soon as possible.

 

If you have questions about your benefits 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.

 

Injuries from fights at work are not covered!

April 4, 2014 by · Comments Off
Filed under: Job Injury 

Cartoon fightI get several calls from employees that were injured at work, not because of faulty equipment or an accident, but because they got into physical altercation with their boss or a co-worker.  Sadly, I have to tell these folks that in most cases, their injuries are NOT going to be covered by Virginia Workers’ Compensation benefits.  For Virginia Workers’ Compensation benefits to apply, the person injured must be injured doing something related to their job (within the course and scope of their employment) and this typically does not include fighting.

I know not all situations are this cut and dry so if you are unsure if your situation meets the requirement in Virginia to receive workers’ compensation benefits, contact an experienced attorney who can shed some light on your circumstances.

 

If you have questions about your benefits 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.

The new health care laws could have a negative affect on workers’ compensation!

April 2, 2014 by · Comments Off
Filed under: General Law, Workers Compensation 

The new healthcare rules are a hot topic and have been for some time now.  I read a very interesting article today on the insurance journal website (www.insurancejournal.com) by Andrew Simpson.  To sum it up, Mr. Simpson says that now that everyone is required to have their own health insurance, we could see less workers’ compensation claims because everyone should have access to their own healthcare plan and this may limit the desire to pursue workers’ compensation.  However, on the other side of that coin, the author says that because everyone will have healthcare, the health insurance carriers may tighten up their limitations and networks, forcing people back to the workers’ compensation system.  The concern it that the insurers could then cap the reimbursements costs to health care providers (likely making it harder for injured workers to find a doctor willing to treat them) and flooding a system that we all know is very slow moving to begin with.

We don’t have any solid figures yet but I found this to be an extremely interesting read. Click Here to Read the Full Article

While I agree with Mr. Simpson that insurance companies are very profitable machines always looking out to make more profit by increasing premiums or putting caps on health insurance etc., I also like to see some of the bright things.

Obama Care LogoI am a strong opponent against ObamaCare. It is insulting that Americans have no freedom of choice and are forced onto health insurance that they do not want. Nuns having to pay for abortion is nonsense, just like Congress, the Senate, the President and UNIONS are exempt from participating in the program. So those that had the power to create it do not have to comply with it (and oh yes, neither do their best friends/the biggest deep pockets).

However, there is a bright side to ObamaCare. He wanted it all inclusive and it includes “pre-existing conditions to include work injuries”. In their infinite wisdom, the powers that created this law, forgot to exclude workers comp (or most likely didn’t read it to know that it wasn’t in there). It used to be that if you were hurt at work, you couldn’t use your regular health insurance but had to go through workers compensation to pay the doctors. There was a specific exclusion for workers comp injuries. The problem was that if you settled your case, got a job and new insurance, and needed medical care for the settled claim, the insurance company could refuse to pay it. Now, the injured worker has complete access to healthcare and won’t be denied. So there will be tons of changes to ObamaCare to include eventually the workers comp exclusion but it make take 6 months or 60 years to make the amendment. I think it will be sooner than later since insurance companies have the money to convince the powers that be that they too can be a best friend and need this little favor.

 

If you have questions about your benefits 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.

Workers’ Compensation Terms – Part 5 – Other Lingo (Continued)

March 31, 2014 by · Comments Off
Filed under: Virginia workers compensation, Workers Compensation Attorney 

Remember folks – These additional benefits can affect your workers’ compensation claim in Virginia so if you have applied or even if you are thinking of applying for these benefits, consult your attorney first to prevent any potential problems!

SS: Social Security:  A United States federal program of social insurance and benefits developed in 1935. The Social Security program’s benefits include retirement income, disability income, Medicare and Medicaid, and death and survivorship benefits. Social Security is one of the largest government programs in the world, paying out hundreds of billions of dollars per year” (source: http://www.investopedia.com).

SSA: Social Security Administration:  An agency of the federal government that administers and regulates benefits paid through Social Security, headquartered in Woodlawn, Maryland.

SSD: Social Security Disability benefits:  A federal program funded through payroll taxes that pays benefits to individuals who have been injured.Social_Security_Logo(1)

SSI: Supplemental Security Income:  A need based program according to income and assets that provides disability benefits from low-income disabled people who don’t qualify for Social Security in the form of a monthly check.

SSRI: Social Security Retirement Income:  Income based on the average amount of wages earned over a workers’ lifetime that is then paid to them monthly after the worker has reached retirement age.

Medicare: “A U.S. government program of hospitalization insurance and voluntary medical insurance for persons aged 65 and over for certain disabled persons under 65” (source: http://dictionary.reference.com)

Medicaid: A U.S. government program, financed by federal, state and local funds, of hospitalization and medical insurance for persons of all ages with certain income limits” (source http://dictionary.reference.com/)

Unemployment: “A source of income for workers who have lost their jobs through no fault of their own. Workers who quit or are fired are generally not eligible for unemployment insurance. Workers who are self-employed are also not eligible to receive unemployment insurance and must provide their own rainy-day funds to cover times when no work is available” (source:  http://www.investopedia.com/).

 

 

Workers’ Compensation Terms – Part 5 – Other Lingo

March 28, 2014 by · Comments Off
Filed under: Virginia workers compensation, Workers Compensation Attorney 

Several terms that are not necessarily workers’ compensation terms can also be thrown in the mix when you are injured at work.  I have provided these because they are terms a lot of my clients have come across though out the course of their workers’ compensation case.  Collecting or even applying for many of these benefits can affect your workers’ compensation claim so if you have or, even if you are considering applying for any of these additional benefits I strongly suggest you talk to your workers’ compensation attorney first!

*Please remember these terms are provided to give you a clearer picture of what is going on with your workers’ comp claim, the meanings given in this context are not necessarily the legal definition nor are they the only definition of that term.

FMLA: Family and Medical Leave Act-  Job protection for time out of work for up to 12 weeks (may not apply to everyone).  This is unpaid leave from work.FMLA

OSHA: Occupational Safety and Health Act- This is the entity in Virginia that regulates employers and work safety – workers’ compensation does not address this.

STD: Short Term Disability- Disability benefits paid though one’s private insurance or provided through their employer that furnishes pay for time out of work, not related to workers’ compensation injuries.  STD is typically paid for a period of 6 months but can vary depending on the individual policy.

LTD: Long Term Disability- Disability benefits paid though one’s private insurance or provided through their employer that furnishes pay for extended time out of work, not related to workers’ compensation injuries.  LTD typically kicks in after a disability has lasted for a period of 6 months but can vary depending on the individual policy.

 

If you have questions about your benefits 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.

 

Workers’ Compensation Terms – Part 4 – Insurance and Voc Rehab Lingo

March 26, 2014 by · Comments Off
Filed under: Virginia workers compensation, Workers Compensation Attorney 

When you are dealing with a work injury there are also several terms that are used when you deal with the workers’ compensation insurance company or doing vocational rehab.  Read on and get familiar with the lingo because if you were injured at work, you are going to need to have a solid understanding of these terms.

*Please remember these terms are provided to give you a clearer picture of what is going on with your workers’ comp claim, the meanings given in this context are not necessarily the legal definition nor are they the only definition of that term.

Ins. Carrier: Insurance Carrier-  The Insurance Carrier or Company that is administering and processing the claim for workers’ compensation benefits

ADJ: Adjuster – The representative who works for the insurance company and administers their policies, this is typically the person you will be dealing with regarding your claim (unless you have hired an attorney) as they are the person who has to approve or deny any medical care and/or payment for time lost from work

Marketing/Job Search: The requirement to look for light duty or modified duty work while you are under the care of a doctor who has placed limitations on your current work abilities and clearly tracking these attempts at finding suitable employment. Construction Workers on the Street. jpg

Voc. Rehab: Vocational Rehabilitation –  A program that the insurance company uses to restore the injured worker to some form of employment

Voc. Rehab CounselorVocational Rehabilitation Counselor – the person who will oversee the injured worker and assist with job searching/marketing and, in some cases, resume’ revision to assist the injured worker in finding some form of employment

Gainful Employment: Work that a person can pursue and perform for money or activities intended to provide an income to a person (however this term is very vague and can be interpreted in many ways)

 

If you have questions about your benefits 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.

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