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.

HOW BEST TO DEAL WITH A VOCATIONAL REHABILITATION COUNSELOR IN WORKERS’ COMPENSATION CASES

Once you have permanent restrictions and you cannot go back to your former employment due to the restrictions, the insurance carrier may assign a vocational rehabilitation counselor to you. This person’s sole job is finding you employment as soon as possible to save the insurance company money by cutting off your workers’ compensation benefits. Their goal is not to boost your career, encourage knowledge fulfillment, self-improvement, or any type of job satisfaction. There is much litigation in this area due to the antagonistic situation injured workers are put into. Here are a few tips that may help you if you are in this situation.

1. Always have your lawyer present at your first interview with the vocational rehabilitation specialist. One of the main purposes of vocational rehabilitation counselors is to wear down the worker and harass the worker to the extent that he or she becomes willing to settle the workers’ compensation claim cheaply. They create a lot of busy work for the injured employee. Vocational rehabilitation counselors will, for instance, send workers in search of jobs that they know the workers are not qualified to perform. They will send them letters saying “I’ve attempted to contact you by phone several times” and, in fact, have not actually contacted you at all by phone. Hopefully, this first meeting with the lawyer will help discourage the vocation rehabilitation worker from unprofessional activities and make the vocational rehabilitation a little bit easier for the injured employee.

2. Don’t make conversation with the rehabilitation counselor. He or she is not your best friend or buddy. As stated elsewhere in this book, one of the defenses in a workers’ compensation case is that the employee refused to cooperate with the vocational rehabilitation counselor. Therefore, it’s very important never to say “I’m not going to be looking for any job that doesn’t pay at least $8.00 an hour,” or, “I can’t do any work so I’m not even going to look.” Vocational rehabilitation counselors love this because they can twist it to make it appear that the worker is refusing to cooperate. The insurance company will file an application to cut off workers’ compensation benefits when these types of statements are made, alleging that the worker refused to cooperate with vocation rehabilitation efforts. The law allows them to suspend the benefits as long as the refusal to cooperate continues. As a practical matter, it is difficult to get benefits reinstated once they’ve been suspended for failure to comply and, at a minimum, you’d be without a check for several months until a decision by the Virginia Workers’ Compensation Commission is made (assuming that the other side does not appeal). All of your actions and words should convey to the counselor that you are willing to cooperate fully and completely with any and all reasonable efforts at vocational rehabilitation.

3. Return to work as soon as possible. At our law firm, we always encourage injured workers to return to work as quickly as possible. You would be earning more income and you would have a more positive image of yourself when working. It helps the financial and mental health of the entire family. Also, if you choose your work, you are choosing your own destiny and making your own choices, as opposed to the vocational rehabilitation counselor forcing you into a job that he or she finds for you. This does not mean, however, that you should just jeopardize your health and go back to work before your doctor says that you are ready to do so. It’s important to make sure that the job has been approved by your treating physician. Don’t allow the vocational rehabilitation counselor to talk you into inappropriate situations. Many rehabilitation counselors try to coax a worker into saying that he is capable of doing almost any type of work, even when the worker knows he can’t. The counselor will take these statements, blow them out of proportion, and use the statements against the worker in a termination hearing. They will ask the worker such things as whether he climbs a ladder or if he can use hand tools and whether he does his own dishes or mows his own lawn. If the worker says, “No, I can’t climb a ladder or use the tools,” the counselor will say, “Are you sure? Aren’t you willing to try?” Again, such statements will be blown out of proportion and used against you. Another thing that the vocational rehabilitation counselor may try to do is convince someone to go into business for himself. Many times, workers are lulled into settling their case for less by vocational rehabilitation counselors who convince them that they could start their own business with money that they receive from settling their workers’ compensation claim. This is a very dangerous proposal and needs to be considered carefully. Remember that the vocation rehabilitation counselor is not your friend. She is being paid by the insurance carrier and her agenda is to try save the insurance company money by getting your benefits terminated—whether by finding you work, by settling your claim for little to nothing, or by terminating your benefits because you refused to cooperate with her.

4. Do not let the vocational rehabilitation counselor into your house. There’s no reason for a rehabilitation counselor to come into your home. Always meet him or her in a public place such as a restaurant or a library. The danger of having them in your home is that it gives them access to your personal life and they will gain information about you and your family that can be turned against you. Your personal life is none of their business and you should not share your personal life with them. Here is an example. While you’ve not been working you do not have your children in day care and they have been at home for obvious convenience and financial reasons. If the vocational rehabilitation counselor comes to the house and sees the children in the home, he or she may try to set you up and say that you were not cooperating because you do not want to put your children back in day care. The less the insurance company, the nurse case manager, and the vocational rehabilitation counselor know about your personal life, the better off you are.

5. Insist on “suitable” employment. The rules require that the job must be suitable for the employee. I’ve seen many times where the vocational rehabilitation counselor would instruct the worker to go to the want ads and apply for every job in the want ads. Other times, they would get a list of potential jobs from the Virginia Employment Commission and ask the employee to spend his time and money to travel around this 30 mile radius seeking jobs without any prior determination as to whether the jobs were suitable for the worker.

6. Always go to job interviews. This may seem inconsistent with the statement above about insisting on suitable employment; however, two wrongs don’t make a right. Even though the vocational rehabilitation counselor may frequently violate the Virginia Workers’ Compensation Commission’s rules, you should keep your hands squeaky clean. Therefore, go to all interviews even though you believe that it is clear that the job is not suitable for you. There are several reasons to do this. First, you do not want to give the insurance company any reason to terminate your benefits. Even if you fail to attend a job interview that was not suitable employment for you, the insurance company may request termination of your benefits due to your lack of cooperation with their efforts. It is best not to put yourself in this position because it may mean months of waiting for a hearing without receiving a workers’ compensation check. Another reason is that, if there ever is a hearing, you have done everything possible in your hands necessary to do what you are supposed to do. Therefore, you’ve given the defense attorney no ammunition whatsoever, to be able to suggest that you should not get your workers’ compensation benefits.

7. Document, document, document. In the appendix, I have a copy of a job search log. As stated before, if your claim is denied, it may be many months before you ever get to a hearing and you will not be able to remember where you’ve looked for jobs, what activities you’ve done, and so forth. It is best to document everything that you do so that you will be able to refresh your memory and testify accurately. Put a date and time on all documents. Also, if the vocational rehabilitation counselor notes that you were documenting everything, she will know that you are prepared to contest any allegation that you might not be cooperating with her. Remember to document job searching as well as job interviews. If you look for a job, you need to document that just as much as if you fill out an application. This ensures all your efforts are documented. MAKE A COPY OF EVERYTHING!

8. Stay in close contact with your attorney. Usually, once a vocational rehabilitation counselor has been assigned to your case, it is the time that the insurance adjuster is most desperate in trying to cut off your benefits. The insurance company does not care if they are cut off by finding you employment or due to the appearance of a failure to cooperate on your part. You need to let your attorney know each and every time a job is offered, each time that they suggest any type of vocational training, and anything that occurs that makes you feel uneasy. This way, the lawyer can stay on top of whether it is suitable employment and whether it’s a legitimate job that you would interview for. Make sure you have your attorney advise you at each stage of this complicated process.