February 24, 2015
The medical profession significantly effects how the legal profession can help injured individuals seeking compensation for their losses. Though there is a multitude of ways the healing profession interfaces with the legal profession, I’d like to provide insight into common situations, relevant to workers’ compensation and personal injury cases, where the two professions intersect. My hope is that this series of posts will give you valuable insight for making the most of your interactions with medical professionals in the unfortunate event that you must pursue a legal claim for compensation regarding an injury.
In workers’ compensation cases, treating doctors not only make medical decisions that affect a worker’s health, but they also make decisions that can affect the worker’s economic future. Errors in those decisions have serious financial consequences to an injured worker.
Two examples of situations where a doctor’s determination can greatly affect a worker’s finances follow:
Example 1
A determination of medical stability under the workers’ compensation system provides legal authorization for the insurer to stop paying Temporary Total Disability (TTD) benefits. Without this income, the patient is likely without financial support and he/she must return to work, if able. This is as is should be, so long as the doctor makes the correct calls on medical stability. If returning to work is not possible because the determination of medical stability is incorrect and the worker is not healed enough to return to work, he/she will most certainly encounter a financial crisis.
The situation is made worse when the injured worker also suffers a medical crisis because their medical benefits are cut off by the finding of medical stability. Medical benefits do not always end with a finding of medical stability but they frequently do. And, if medical benefits are cut off pre-maturely, this inevitably stalls the worker’s healing process.
In conclusion, an incorrect decision on medical stability by an attending physician will leave an injured worker both financially destitute and without medical benefits. Because of the great impact on an injured worker’s life, it’s very important that the doctor get it right.
Example 2
Treating physicians are frequently asked whether they predict that an injured worker will have some permanent impairment after he/she reaches medical stability. The answer to this question, yes or no, can have a huge impact on the injured worker’s future related to receiving re-employment benefits:
- If the doctor says, “No,” then the worker is automatically disqualified from receiving a re-employment evaluation.
- If the doctor says, “Yes,” then the worker may receive an evaluation, which is the first step in the process that can lead to retraining.
A re-training benefit, under the workers’ compensation system, can be a very valuable benefit. A retraining program can be worth up to $13,300, plus payment of a bi-weekly stipend equal to 70% of the worker’s spendable income, for the length of the program. The retraining program cannot exceed 104 weeks (two years). A retraining benefit for a high-income earning employee can be worth $100,000 or more.
Whether the worker gets a shot at receiving this benefit hinges on how the doctor answers a simple question:
“Do you predict the worker will suffer any permanent impairment once he/she reaches medical stability?”
Unfortunately, many physicians are not well versed in the workers’ compensation system. In fact, they may strongly dislike being involved in the system at all. They do not know how to fairly evaluate when a patient has reached medical stability. Further, only a few physicians are trained in evaluating permanent impairments. Some physicians have an inadequate basis for accurately predicting whether the worker will have a permanent impairment when he/she reaches medical stability. Notwithstanding this inadequate preparation, treating doctors regularly write opinions that have huge adverse effects on the financial future of their patients.
So, when selecting your physician, determine what experience he/she has with the workers’ compensation system. You need a good medical provider and a physician knowledgeable about the workers’ compensation system. Try to find a physician who understands and respects the system.