I just had my FCE, is my claim OVER?

May 12, 2014 by · Comments Off
Filed under: Claims for Benefits, Hurt on Job 

Not at all! The FCE or Functional Capacity Exam is an exam where the therapist has you do a series of movements and measures your strength and range of motion.  This usually means that you have reached a medical plateau and the doctor does not expect any significant improvement, this DOES NOT mean that your medical care is over; you may still be seeing a doctor for pain control.  Based on the FCE results, the doctor will determine your new physical abilities for rejoining the work force. Basically, if you need to be on a form of permanent light duty, this is the test that determines what those limitations will be into the foreseeable future.Puzzle Pieces

Then, once the FCE results are known, this may also determine whether you can return to your former employer or position.  Depending on the situation, you may be returning to your employer in a different position than before, you might be looking for work with a new employer that meets your physical abilities or you may not be able to return to work at all.  Another piece of this puzzle is that depending on the situation, you might be working with a vocational rehab counselor, trying to find employment. This might be a good time to start settlement negotiations since you will know your physical capabilities and your medical condition should be stable.

Each situation is unique so this is why I always recommend speaking with an experienced workers’ compensation attorney who knows the ins and outs of this tricky process.

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.

 

Psychological conditions are not covered unless you have a PHYSICAL injury first!

May 5, 2014 by · Comments Off
Filed under: Hurt on Job, Work Injury, Workers Compensation 

There seems to me a misconception out there among some workers that they can get workers’ compensation benefits for things like stress, depression or anxiety.  The truth is that in Virginia, workers’ compensation benefits are only awarded for psychological injuries if the injured worker first has a PHYSICAL injury.  For example, the state of Virginia won’t award you workers’ compensation benefits for depression alone, however, if you had an injury that required surgery and then you developed depression and the doctor says this stems from the work injury then you could have depression recognized as part of your workers’ compensation claim. PTSD and Anxiety

The truth is, many injured workers can develop psychological injuries after they have been a victim of a work place injury, the trick is that the doctor has to be able to say that the mental condition was a result of the physical work injury and not due to something else.  Psychological injuries are tricky and if you are pursuing benefits for a psychological condition, I always recommend speaking to an attorney who is experienced with these complicated cases.

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.

 

Failed Back Surgery Syndrome

April 30, 2014 by · Comments Off
Filed under: Back Injury 

The sad truth is that surgery is not a 100% guarantee to a full recovery after a back injury. Sometimes injured workers have surgery and don’t get any relief from their pain and/or their physical limitations and sometimes they get even worse! It is very sad but medicine is not always an exact science, back-pain-spine-300x200especially when it comes to the spine. When a person has had several back surgeries with no relief, it is typically referred to as failed back surgery syndrome or FBS. From the research I have done, FBS is not technically a medical diagnosis but is a commonly used term that can be broadly applied to patients who have continued lumbar (lower back) pain after surgery. Doctors can treat the FBS in several different ways including therapy, medication, injections and in some cases, additional surgery.

If you have experienced a failed back surgery after 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.

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.

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