Do I need an attorney?
The adjuster’s job is to save insurance companies money. No matter how nice they may seem, they are not working for you and cannot be relied upon to provide you the straight truth. That is because they are paid to work against your best interest. There is no law requiring them to tell you the truth or to explain your legal rights. They are not lawyers.
You hire an attorney because you understand that you will get a better result than if you represented yourself. You hire an attorney to make your life easier and to get meaningful guidance at a difficult time. You hire an attorney to get you every dollar you are entitled to.
Retaining an attorney gives you the freedom to focus on healing from your injury because we handle all the confusing legal stuff for you. We will deal with the insurance company, answer your questions, and even help you find the right doctors.
Why should I choose you as my attorney instead of the guys I see on billboards and TV?
Bigger is not always better. You simply can’t be an effective attorney if you have too many cases. If you don’t have the time to talk with and listen to your clients you can’t represent them well. You can’t get the best results for people you barely know.
At large firms, cases are tossed around like footballs. When you call, you never know which attorney has possession of your case. Jenifer is a solo practitioner and handles all the important legal stuff herself. She is there for you however long your case lasts. When you call, she knows who you are and remembers what is happening in your case. She recognizes how stressful being out of work can be and that you are going to have questions and concerns about your future. You deserve to understand the process. Being injured affects you and your family in so many ways.
Unlike the large firms, you don’t need to make an appointment to talk to Jenifer, you just have to call. She is at her office every day. Our office is conveniently located in Abington. You don’t need to drive into Center City or pay to park to meet with her. She will also meet you closer to home if you are unable to travel to her office.
What will it cost me to hire you as my attorney? I have no money.
Workers’ comp attorneys work contingently, which means we only get paid if we are successful in getting or defending your right to wage loss benefits and a Judge approves our fee.
The standard workers comp attorneys’ fee in Pennsylvania is 20% of wage loss benefits awarded to you. No attorney can legally charge you more than 20%. Unlike many attorneys, we never charge a fee on medical benefits. If we are successful, the insurance carrier will deduct our fee and send it directly to us. You never write us a check. We also never charge you for our costs. If we are successful, most of these will be reimbursed by the comp carrier.
Can I sue my employer for negligence? Can I get compensated for my pain and suffering?
The answer to both of these questions is no. That may seem unfair but let us explain why that is. The workers compensation system is limited to medical coverage and payment for any wage loss. There are also some special payments if you lose hearing or vision, suffer an amputation, get a scar on your face, or are killed on the job. But that’s it. Even though being injured on the job causes real pain and suffering, there is no additional financial compensation for it. We empathize and recognize that it is unfair, but that’s the law.
Relative to suing for negligence, in Pennsylvania it is the law that you are not allowed to sue your employer if you are hurt at work. Your only choice is to seek workers compensation benefits. That is because workers compensation is an exclusive remedy.
The exclusive remedy is not all bad though. The flip side of the law not allowing you to sue for employer negligence is that workers’ comp, as a result, was designed to be a “no fault” system. Unlike in personal injury cases, the Judge does not make an initial determination if you were at fault for causing the accident. Even if you were not as careful as you could have been on the job, you can still get workers comp (with the exceptions being self-inflicted injuries and the injury being caused by you being under the influence). Ultimately, no fault means you get workers comp regardless of whether the actions of you, your employer, or some combination caused your injury.
Do I Need to Treat with the Company/Panel Doctor for 90 Days?
After you are hurt at work, your employer may give you a list of approved “panel” doctors that you are allowed to treat with. Some Employers will advise that you MUST treat with a certain doctor. You are then told that it is the law that you are required to treat with their doctors for the first 90 days after an injury.
While there is technically a 90 day treatment rule in workers comp, it is very rare that you are legally required to treat with the company doctor at all, let alone for the first 90 days. For the 90 day treatment rule to apply, your Employer must do all of the following, and accept liability for your injury. If your claim has been denied, you 100% do not have to treat with the panel doctor:
(1) Give you the list of approved panel doctors at the time you are hired;
(2) Give you the list after you are hurt; and
(3) Post the list in a common area such as a breakroom or lunchroom.
If your Employer does not do all three, you are NOT required to treat with their doctors. It is actually very uncommon for an Employer to do all three things above, unless they are a very large or municipal employer.
To recap, you do not need to treat with the company/panel doctor if:
(1) You were not provided a list of doctors to choose from at all; or
(2) You were told you have to see a certain doctor or not told where to treat; or
(3) You did not get the list when you were hired and when you were hurt; or
(4) Your claim has been denied, even if you were given the list.
Should I Treat with the Panel Doctor Anyway?
Even when a proper list is not provided, many injured workers feel that that they should treat with the doctor their employer sends them to. They believe that seeing the panel is in their best interest. Unfortunately, that is not generally the case.
The panel doctor is chosen, hired, and paid for by the workers’ comp insurance company. They are working under contract for the insurer, and the insurer sets all the rules. The panel doctor is required to make medical decisions that are in your Employer’s best interest, even if the they are not in your best interest. The panel doctor is expected to save your employer money by getting you back to work (even light work) as soon possible. If the panel is unsure whether you can work or not, he or she must break the tie by sending you back to work. They also avoid getting MRIs to save your employer money and to hide your full diagnosis from you.
On top of all of that, many panel doctors are not really doctors, but are nurse practitioners or physician assistants. At some panel medical practices, you will never see a doctor let alone see the same person twice!
It is always best to select a doctor that is looking out for you, not the insurance company. Panel doctors see many patients a day and often don’t have the time nor the incentive to listen to you and to provide the treatment you need. This can delay the healing process and lead to missed diagnoses.
Who Is This Nurse Case Manager (NCM) Person?
Sometimes the insurance carrier will assign a Nurse Case Manager to your case. This is most likely to happen if you have a severe or complex injury. This person is usually very sweet and nice, and like the government, will say she is here to help you. But make no mistake, the NCM is working on behalf of the insurance company, not you. Her job is to limit the duration of your medical treatment, to keep the cost of your medical treatment as cheap as possible, and to get you back to work quickly. NCMs also try to keep you treating with the panel doctors who are also working for the insurance company.
NCMs sometimes even attend your doctor’s appointments with you and often discuss your case with your doctors when you aren’t around. Some of the lies they might tell you with a friendly smile include:
(1) The NCM/insurance company gets to pick where you get MRIs done and that only they can schedule the appointment;
(2) Telling you that you need their approval to see a specialist or a different doctor;
(3) Telling you that you can’t schedule your own doctor’s appointments and that only they can;
(4) Telling you that you must treat at a certain physical therapy practice.
None of those things are true. NCMs may also tell your doctor which medicines to prescribe you based upon the cheapest option, or try to get the doctor to stop giving you medicine all together. Sometimes they even get your doctor to change your work restrictions so a light-duty job can be offered.
At Kaufman Workers’ Compensation Law we can help. We can get the NCM off your back and your doctors’ back so you can take control of your medical care. While we can’t make them disappear altogether, we can make their job harder by not allowing them to talk with you or your doctors.