Ten secrets the insurance company does not want you to know about workers’ compensation

Michigan workers’ compensation lawyer exposes ten secrets the insurance company does not want people to know about their claims.

1. Wage loss benefits are frequently underpaid

Most people assume they are receiving the correct amount of lost wages. The truth is that insurance companies make mistakes and they are never in your favor. Workers’ compensation is supposed to pay 80% of the after-tax average weekly wage. Insurance companies regularly fail to include overtime, premium pay, tips, bonuses, second jobs, and the value of discontinued fringe benefits. Other errors include failing to list all dependents and using the wrong tax filing status. Sometimes the insurance company will just estimate the amount instead of obtaining wage records from the employer.

2. You can choose your own doctor after 28 days

One of the most important benefits under workers’ compensation is access to medical care. You can select your own doctor after 28 days from the start of medical treatment. Be careful using doctors recommended by the insurance company because of a potential conflict of interest. If workers’ compensation benefits are ever disputed, you need a doctor to support the claim. The best way to find a good doctor is by asking friends and family members for a referral. Notify the insurance company of your selection by providing the name and address of the doctor as well as your intention.

3. Family members can get paid to help around the house

Insurance companies want to save money on claims and you will not be told about all benefits. Family members can receive up to 56 hours per week for helping with attendant care. Some examples are assistance with mobility, wound care, bathing, using the bathroom, eating, dressing, and taking medications. Sometimes a relative can be paid just to sit with you. A family member is generally entitled to the same hourly pay rate as a professional.

4. Some medical conditions will always be disputed

Insurance companies deny claims for a variety of dumb reasons. The number one dumb reason is because you have some incidental findings of arthritis. Insurance companies think of arthritis as a magic bullet to dispute a claim. Almost everyone develops arthritis as they get older and it does not mean they did not suffer a real injury at work. When you have a specific injury, something might have changed. It is important to explain to your doctor how you hurt yourself at work and newly developed symptoms.

5. You will be sent for a biased medical examination

Watch out if you are scheduled for an independent medical examination (IME). These doctors are used over and over again because the insurance company knows the result. Some doctors make careers out of testifying against injured workers and earn millions along the way. We hear stories of IME doctors taking less than five minutes and not even making eye contact with the claimant. It is important to challenge a biased medical examination in court with treating medical evidence.

6. There are lawyers working against your claim

Many people are shocked to learn that a defense lawyer has already reviewed their claim. This occurs even when workers’ compensation benefits are still being paid voluntarily. A strategy will be formulated to defend any future case. This includes setting a person up for a fake job offer or giving them work outside restrictions. The goal is to get you to quit and forfeit benefits. Other strategies include setting up appointments with defense oriented medical and vocational experts.

7. You will be followed by a private investigator

Insurance companies hire professional investigators to follow people. They are looking for evidence that a claim is fraudulent. Even simple activities like grocery shopping will be taken out-of-context and used against you. Investigators will also review social media and even speak with your neighbors. We tell our clients to be cautious of their surroundings and never do activities beyond medical restrictions.

8. Vocational rehabilitation is an option

Michigan law allows insurance companies to reduce or stop payment based upon wage earning capacity. A vocational counselor will be hired to perform a transferable skills analysis and labor market survey. Jobs will be found that you could theoretically perform and fake wages will be used as an offset. It is important to remember that vocational rehabilitation is more than just a one-time evaluation. It is possible to get the insurance company to pay for additional items such as retraining and/or college credits.

9. A closed claim can be re-opened

Insurance companies often tell people their claim is closed and no further benefits will be paid. What is not shared is that it can be re-opened if additional medical treatment is needed. The same is true with lost wages if a person is unable to continue working. We have sought additional workers’ compensation benefits years after the insurance company had already closed its file.

10. Future benefits can be traded for a settlement

Some people want to do their own medical and vocational rehabilitation without interference from the insurance company. Workers’ compensation benefits can be traded for a lump sum cash settlement. This money is tax free and can be used for anything. Attorney fees are just 10% of the settlement if benefits are currently being paid.

Michigan Workers Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 35 years. Call (844) 201-9497 for a free consultation today.

Related information:

How insurance companies use IME doctors to abuse the workers’ comp system

Photo courtesy of Creative Commons, by Images_of_Money.

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