Workers’ Compensation tips from an “Inside Man”

I have a unique perspective regarding helping injured workers.  For the first 8 years of my practice I defended a large multi-national corporation.  While I cannot say the name, I can say it was founded by a guy named Sam.   During that time I learned from the best  how to maneuver a claim and resolve it by paying the least amount of money to the injured worker.  After years of legal wrangling, I finally saw the light and now only represent injured workers in Minnesota.  My paralegal, Karen, similarly spent the previous 12 years as the lead workers compensation adjuster  for one of the largest insurance companies in the country. You can imagine we learned a thing or two about how the corporations manipulate the law.   With that in mind, here are some insider tips you should know:

1) The insurer may have miscalculated your average weekly wage. This is generally calculated by averaging the 26 weeks of gross wages you earned prior to the work injury. Frequently, insurers miscalculate the AWW in their favor ~ not yours. often overtime, bonuses, or other types of compensation (room, lodging, etc.) that should be included in the calculation are not factored in. Since most Work Comp benefits stem from the AWW calculation, this can result in a huge difference in the value of your claim.

2) You deserve the best medical care. Frequently, the employer/insurer will try to steer your medical treatment and have you treat with a physicians assistant or a general practice doctor because they are cheaper.  That’s fine if you have a minor injury and recover quickly. However, most physicians are not well-versed in workers compensation and are simply in a rush to return injured workers back to the job that injured them in the first place.

3) Medical Authorizations. The insurer will require you to sign medical authorizations to allow them to obtain your medical records from the time you were born until the current time. Read those authorizations and cross out anything you do not agree with prior to signing. For instance, the insurance company is not allowed to communicate with your doctors unless you authorize it, that shouldn’t be there.  No good will come from the insurance company calling your doctor to control your medical treatment and get you to return to work early. If the authorization covers protected data (mental health treatment, alcohol or drug treatment, sexually transmitted diseases, etc.), cross it out. Rarely does an insurance company have a legitimate business need for this information and it can be used against you later.

3) Often an insurer will assign a Qualified Rehabilitation Consultant (QRC) to your claim to provide medical management services and to assist with return to work. The insurer selects your QRC from its  “approved vendor list”, i.e. companies under contract with the insurer. If a QRC is assigned to your claim, you have the automatic right to change QRC’s within the first 60 days of assignment. It is absolutely critical to your claim that you have a QRC looking out for your best interest and we know the best QRC’s for the job.

We receive numerous calls from injured workers with a variety of questions, but the common theme is that they are confused about what benefits they are entitled to and they have a feeling the insurance company is not looking out for them. Given our unique background, my staff and I know all the tactics the insurance companies can employ to manage your claim. Call me if you’d like to discuss your claim or have specific questions and I will answer them without any obligation. Stay tuned for more Insider’s Tips to come.

Rosengren Kohlmeyer, Law Office Chtd.
Mankato, Minnesota