Three Signs That Your Workers' Compensation Claim Is In Trouble

Workers' compensation benefits are designed with the idea that they should make it easier for injured employees to collect benefits and easier to keep claims out of the courtroom. Unfortunately, that isn't always how they work. How do you know when you should trust to the system and when you need to find an attorney? Look for these 3 warning signs that your workers' comp claim is in trouble and know how to handle them:

1. Your employer starts checking on you at home at random times.

You might expect your employer to call to see how you are doing once or twice while you're off work, but if the calls seem to be coming with increasing frequency and don't seem to have much purpose to them, it's probably time to worry. While studies show that only 1–2% of workers' comp claims are actually fraudulent, there's a rather pervasive myth that the fraud level is much higher.

One of the warning signs of fraud that employers are told to watch out for is an injured employee that's "hard to reach" at home. The expectation is that since you're injured you should essentially be stuck at home all day, with nothing better to do than answer the phone. Unfortunately, this fails to consider things like the possibility that you're in physical therapy during the day or just trying to sleep. If your employer is calling regularly (or has taken to actually visiting your home), you can bet that they are suspicious.

Since your employer is likely to be documenting each call, make sure that you keep a record as well. Note the time and date of each call and write down where you were actually at and what you were doing. Make sure that you return the calls as soon as practical. Avoid being confrontational about it, because there's nothing for you to gain by calling the actions out. If the phone calls or visits start to feel like harassment, take the issue to an attorney.

2. The insurance company sends you to an independent medical examination or assigns you a nurse case manager.

Either of these things is a sign that the insurance company that's paying your workers' compensation benefits is trying to close out your case. The independent medical exam (IME) isn't all that "independent" because the doctors doing them frequently rely on the insurance companies for their primary source of income, so they have an incentive for seeing things in the light most favorable for the company, not you. 

A nurse case manager is another weapon in the company's arsenal against injured employees. A nurse case manager is supposed to go with you to your doctor's appointments and help make sure that you are getting the treatment that you need. Instead, they often try to push the doctors into pushing injured workers back to work before they are ready. 

If you're being sent to an IME or suddenly have your own designated nurse attending your doctor's appointments with you, contact an attorney before you proceed any further.

3. A "notice of appearance" has been filed on your case.

Every workers' compensation claim has an attorney involved in it, somewhere. Usually, the attorneys work with the insurance adjusters behind the scenes. If everything is going along without a problem, they will stay behind the scenes. This is a normal part of the process and designed to protect both the company and you from running afoul of the law.

However, a "notice of appearance" is a formal notice to the court that the attorney is working on the case. What that should do is put you on alert that the company anticipates filing a motion of some sort on your claim. There's no reason that's favorable to you for that to happen, so you can anticipate a motion to reduce or stop your benefits for some reason. At this point, you absolutely want to find an attorney of your own so that you aren't trying to defend your claim yourself.

For more information on what you should do to protect your right to benefits, contact an attorney like Hamilton Law Firm, P.C. near you that handles workers' compensation claims.