Our Workers' Compensation Q & A
Q. I just got hurt, how do I get medical care?
When an injury occurs, you must fill out a claim form and demand medical care immediately. Your claims administrator is
required by law to authorize medical treatment within one working day. While your claim is being investigated, you are
entitled to receive up to $10,000 of medical care.
Unfortunately, many insurance companies deny authorization for medical care while a claim is being investigated, and
many doctors will not treat you without authorization because of the recent changes in the law. This results in significant
delays in medical treatment. We can get your case in front of a judge to get the care you need.
Trust in over 24 years of experience when you come to our law office. We provide personalized services to ensure your
needs are met. You can also get a FREE case evaluation, and you don't have to pay anything unless
Q. Can I predesignate a personal doctor to treat my industrial injury?
Yes, you may, and it is a good idea to do so. You can predesignate your personal doctor if your employer offers group
health coverage; the doctor has treated you in the past; the doctor has your medical records; and the doctor agrees to
treat you for work injuries. The predesignation form is available through your employer or at the DWC website.
Q. Is the medical care recommended by my doctor limited?
Insurance companies are now armed with the Occupational and Environmental Medicine's (ACOEM) Practice Guidelines and
Utilization Review (UR). The process, in theory, should enable a doctor to treat most injuries according to accepted
practices in a cost effective way. In practice, however, this medical delivery system is unchecked and permits great
abuse by denying needed medical care.
The process to overcome these denials varies in different situations. We appeal Utilization Review to get the medical care
that you are entitled to have.
Q. My claims adjuster will only authorize treatment for some parts of the body and not others. How do I get medical
All too often, the claims adjuster will notify your treating physician that he/she may only treat certain parts of the body.
Depending on the doctor, this may cause him/her to refuse treatment for all affected parts of your body. This is a part of
the medical delivery system that is left unchecked and subject to great abuse. We get the medical evidence you need
and prepare for trial.
Q. What are the temporary disability benefits?
Temporary Disability (TD) is paid biweekly when you are completely unable to work due to a work injury. This is also
known as Temporary Total Disability (TTD). Subject to minimum and maximum caps, you should receive 2/3 of your
average weekly wage while you are unable to work. Your doctor will determine your need for TD.
Be aware that the recent changes in the law have limited the amount of time that you can receive TD for injuries after
4/19/04. Currently, you are limited to 104 weeks of TD. There are a few exceptions to this rule.
Q. My claims adjuster denied my claim. Can I receive TD?
You may not collect TD for a denied claim. You can, however, claim State Disability. Your doctor will need to certify you
for this. We work to get a judicial decision that requires your insurance company to accept your claim.
Q. Who determines my permanent disability?
Once your doctor finds your condition has reached Maximal Medical Improvement (MMI), either your treating physician or
another doctor will determine whether you have any impairment. Your compensation is dependent on the level of
permanent disability you are assigned.
Q. What if I don't agree with the PD assigned?
You may be able to present additional facts that the doctor may not have considered. You may also be entitled to further
Q. How does my claim finally get resolved?
You can resolve your whole claim through one lump sum settlement called a Compromise and Release (C&R). A C&R is best
when you want to control your own medical care. The insurance company will not be responsible for any further medical
care with this type of settlement. In return, you receive a lump sum amount representing unpaid benefits that you may
have been entitled to.
If you want to forgo your medical care available, you can agree to a settlement called a stipulation with request for
award (stip). A stip allows your insurance company to continue the biweekly payments until your PD is paid out and
leaves your future medical care open to you.
Your future medical care will remain subject to ACOEM guidelines and Utilization Review. In practice, this means that your
insurance company will be able to deny and delay medical treatment whenever it chooses to do so. You will need to have
a judge to enforce your award in order to get medical care.
If all else fails, you can have a Workers' Compensation Judge decide your case. The judge issues a Findings and Award
(F&A). The F&A is similar to a stip. The only difference is that the judge decides all issues in your case instead of the
parties coming to an agreement.
Q. Are benefits available for a work-related injury causing death?
Death benefits vary depending on the date of injury/death, types of dependents, and ages. Other issues of causation may be present.