What Employers and Insurance Companies Don’t Want You to Know About Workers’ Compensation
When you are injured at work, you may assume that your employer and its workers’ compensation insurance carrier will simply provide the benefits you need to recover. After all, workers’ compensation exists to help employees who suffer job-related injuries and illnesses. In practice, however, injured workers may encounter delays, disputes, and efforts to limit the benefits they receive.
Employers and insurance companies have financial incentives to control the costs of workers’ compensation claims. That does not mean every employer or insurer acts improperly, but it does mean injured employees should understand the tactics that can be used to question a claim, limit medical treatment, reduce wage replacement benefits, or encourage a worker to settle before the full impact of an injury is understood.
At Lee Cossell & Feagley, LLP, we help injured workers in Indianapolis get the Indiana workers’ compensation benefits they are entitled to. Understanding how the workers’ compensation system works and recognizing potential problems early can help you protect your rights when an employer or insurance company challenges your claim.
Insurance Companies May Question Whether Your Injury Is Work-Related
One of the most important issues in any workers’ compensation claim is whether the injury arose out of and in the course of employment. Insurance companies may investigate the circumstances surrounding an accident and look for reasons to argue that the condition was not caused by work. This can become particularly complicated when an injury develops gradually. Repetitive stress injuries, occupational illnesses, and conditions involving cumulative trauma may not have a single identifiable accident. An insurer may argue that the condition resulted from aging, a pre-existing medical problem, or activities outside the workplace. That said, even injuries caused by a specific accident can be disputed. An insurer may question what happened, where it happened, whether the incident occurred during work activities, or whether the worker reported the injury promptly.
A disputed claim does not necessarily mean that benefits are unavailable. Medical records, accident reports, witness statements, employment records, and other evidence may help establish the connection between the injury and the workplace.
Pre-Existing Conditions Can Become a Point of Attack
A previous injury or medical condition does not automatically prevent an Indiana worker from receiving workers’ compensation benefits. However, insurers frequently examine an employee’s medical history when evaluating a claim. Suppose you previously experienced occasional back pain but were able to perform your regular job without restrictions. You then suffer a lifting injury at work that causes significantly worse symptoms and prevents you from working. The insurance company may argue that your current condition is simply a continuation of your previous back problem. However, the existence of a pre-existing condition does not necessarily decide the issue. If work activities aggravated or accelerated an underlying condition, the resulting disability may still be compensable. The medical evidence must be examined carefully to determine what changed and whether employment contributed to that change.
Delays Can Put Financial Pressure on Injured Workers
Another problem injured workers may encounter is delay. Medical treatment, wage replacement benefits, or decisions concerning a claim might not move as quickly as the employee expects. For someone unable to work, even a relatively short interruption in income can create serious financial pressure. Mortgage or rent payments, utility bills, medical expenses, and other household costs continue while the worker is recovering. Delays can also make injured workers more willing to accept an unfavorable settlement simply because they need money immediately. Before agreeing to a settlement, it is important to understand what rights you may be giving up and whether you have fully recovered from your injury.
Medical Treatment May Be Scrutinized
Workers’ compensation insurance carriers may question whether particular medical treatment is reasonable, necessary, or related to the workplace injury. Disputes can arise over diagnostic testing, physical therapy, injections, prescription medications, surgery, and other forms of treatment. For instance, an insurer may rely on a medical review or an Independent Medical Examination (IME) to argue that treatment is unnecessary or that an injured worker has recovered sufficiently to stop receiving benefits. These disputes can become especially important when a treating physician recommends significant treatment, such as surgery. A disagreement between doctors can delay treatment and create uncertainty about who will pay for it. Workers should continue following their physicians’ instructions and keep records of medical appointments, recommendations, restrictions, and changes in symptoms. If an insurer refuses to authorize appropriate treatment, an attorney can help determine what legal options are available.
Independent Medical Examinations Can Affect Your Claim
An Independent Medical Examination is another part of the workers’ compensation process that can significantly affect an injured employee’s benefits. An IME physician does not treat the worker. Instead, the physician evaluates the employee and provides an opinion concerning issues such as diagnosis, causation, work restrictions, treatment, maximum medical improvement, or permanent impairment. Although the examination is called “independent,” the insurance company may select and pay the physician. The resulting report can be used to support decisions to reduce or terminate benefits. That does not mean an IME automatically determines the outcome of a claim. An injured worker can challenge an unfavorable report with medical evidence from treating physicians and other qualified professionals. Because an IME can become an important piece of evidence, injured workers should take the examination seriously and understand their rights before attending.
Employers May Push Workers to Return Too Soon
Getting back to work can be an important part of recovery, but returning before you are medically ready can put an injured employee at risk of reinjury. An employer may offer light-duty or modified work after an injury. If the work is consistent with the employee’s medical restrictions, returning to work may be appropriate. Problems arise when an employee is pressured to perform tasks beyond those restrictions or is encouraged to disregard medical limitations. If your doctor has restricted lifting, standing, bending, driving, or other activities, those restrictions should be taken seriously. Performing work outside your restrictions can potentially worsen your condition and create disputes about the cause of subsequent symptoms.
A Light-Duty Position Can Affect Your Benefits
Returning to a modified position can also affect Temporary Total Disability benefits. If an injured worker is capable of some work but cannot yet return to their regular job, the difference between the worker’s pre-injury earnings and reduced earnings may become important in determining available benefits. Insurance companies may argue that an employee is capable of earning more than the worker actually can. Employers may also offer positions that technically exist but do not realistically accommodate the employee’s restrictions. In these situations, documentation matters. Keep copies of work restrictions and written job offers, and make sure your physician understands exactly what duties the employer expects you to perform.
Insurers May Argue That You Have Reached Maximum Medical Improvement
Temporary disability benefits generally do not continue indefinitely. At some point, a physician may determine that an injured worker has reached Maximum Medical Improvement, meaning the condition has stabilized and significant additional improvement is not expected. Insurance companies may rely on an MMI determination to stop temporary benefits. The problem arises when an employee has not actually recovered or still needs significant treatment. Reaching MMI does not necessarily mean that an employee is completely healthy or has no remaining disability. A worker may have permanent restrictions or impairment even after reaching MMI. This is why the medical evidence surrounding an MMI determination should be carefully reviewed.
Settlement Offers May Not Reflect the Full Value of a Claim
An insurance company may offer a settlement before an injured worker fully understands the long-term consequences of the injury. A lump-sum payment can be appealing, particularly when an employee has been without regular wages. However, accepting a workers’ compensation settlement can affect the worker’s ability to seek additional benefits later. If the worker still needs medical treatment or has not yet reached a clear understanding of their permanent impairment, accepting an early settlement can have significant consequences. A settlement should be evaluated based on the worker’s medical condition, future treatment needs, permanent impairment, lost earning capacity, and other relevant factors, not simply the amount of money offered today.
What Injured Workers Should Do to Protect Their Claims
The best way to protect a workers’ compensation claim is to create a clear record from the beginning. Report your workplace injury promptly, seek appropriate medical treatment, follow medical restrictions, and keep copies of important documents. Be truthful and consistent when describing how the injury occurred and how it affects you. It is also important to avoid assuming that a verbal conversation is enough. When possible, keep written records of communications with your employer, insurance adjuster, and medical providers. Documentation can become particularly valuable if the insurer later disputes what was said or what occurred. Most importantly, do not assume that an insurance company’s decision is necessarily the final word. If your claim is denied, benefits are stopped, treatment is refused, or an insurer disputes the extent of your disability, you may have options for challenging the decision.
The Importance of Working With an Experienced Workers’ Compensation Attorney
Workers’ compensation claims can become complicated quickly, particularly when an insurer disputes causation, medical treatment, disability status, or the amount of benefits owed. Having an attorney involved can help ensure that important deadlines are observed and that the evidence supporting your claim is properly developed. At Lee Cossell & Feagley, LLP, we understand the tactics that can arise when employers and insurance companies challenge workers’ compensation claims. Our attorneys work to identify disputes early, gather medical and employment evidence, challenge improper benefit decisions, and represent injured workers when a claim requires action before the Indiana Workers’ Compensation Board. You should not have to navigate a complicated workers’ compensation claim while simultaneously recovering from a serious injury.
Frequently Asked Questions About Indiana Workers’ Compensation
Can an employer deny my workers’ compensation claim in Indiana?
An employer or its insurance carrier may dispute or deny a claim, but an injured worker can challenge that decision. The evidence concerning the workplace injury, medical condition, and employment relationship can be important in determining whether benefits are owed.
Can workers’ compensation insurance stop my benefits?
Benefits may end when certain legal or medical conditions are met, but an insurer’s decision to stop benefits can be disputed. If you believe benefits were terminated improperly, an Indiana workers’ compensation attorney can review the circumstances.
What if my employer says my injury was not caused by work?
You may still have a valid claim. Medical evidence, witness statements, employment records, and other documentation can help establish that an injury arose out of and in the course of employment.
Should I accept a workers’ compensation settlement offer?
Do not accept a settlement without understanding its effect on your future benefits and medical care. An attorney can review the proposed settlement and help you evaluate whether it adequately addresses your circumstances.
What should I do if my workers’ compensation claim is denied?
A denied claim may be challenged through the Indiana workers’ compensation system. Speak with an attorney promptly so the denial, supporting evidence, and applicable deadlines can be evaluated.
Contact Lee Cossell & Feagley, LLP
A workplace injury can leave you dealing with medical treatment, lost income, and uncertainty about your future. The last thing you need is to discover that an insurance company or employer is challenging your claim after you have already been injured. Understanding your rights and recognizing potential problems can help you take action before a dispute becomes even more difficult.
Lee Cossell & Feagley, LLP represents injured workers in Indianapolis and throughout Indiana. Our attorneys can evaluate your workers’ compensation claim, address disputes with employers and insurers, and pursue the benefits you are entitled to receive. Contact Lee Cossell & Feagley, LLP today for a free consultation. If your workers’ compensation claim has been denied, delayed, or reduced, our team can help you understand your options and take the next step toward protecting your rights.
