Michigan workers compensation attorney explains the purpose of a third-party administrator and what you need to know about your legal rights.
Many of our clients are surprised to learn their workers compensation claim will be managed by another party. A frequent question is why not the employer or the insurance company?
A third-party administrator (TPA) is a separate company that manages claims for the responsible party. Hiring a TPA is like outsourcing administration of a claim.
The TPA is hired because it has experience managing claims that an employer might not. This includes obtaining defense lawyers and independent medical examinations.
Third-party administration is big business and results matter. Here are some issues to watch out for when a TPA is involved in your claim.
It is common for a TPA to ask for a medical release or authorization. This will allow them to obtain medical records from your doctors. Many times this is nothing more than a fishing expedition to see if you have a pre-existing condition.
You may also be asked to provide a recorded statement. Some of these interviews turn hostile as the questions asked are overreaching.
Failure to cooperate with the TPA can result in a dispute of benefits. Contact an experienced lawyer if you feel something is not right.
Notice of Dispute
There are many reasons why a TPA might dispute a claim. You should be given a document entitled Notice of Dispute if your benefits are stopped. Take note of line 23 that should list a reason.
The most common is the independent medical examination. This is when you are examined by a doctor of the employer’s choosing. You might be told that your injury is not work related or that you have fully recovered.
You might also find that your wage loss benefits are reduced or stopped. This is usually based upon a hypothetical wage earning capacity.
Your legal rights
You have the right to a hearing if your medical or wage loss benefits have been stopped. A state magistrate will order the payment of benefits if appropriate.
The TPA is in the business of saving money for the employer and insurance company. Don’t let this come at your expense.
Call (855) 221-2667 to speak with one of our Michigan workers compensation attorneys. There is no fee to review your claim.
– Alex Berman is the founder of Michigan Workers Comp Lawyers. Hes been representing injured and disabled workers exclusively for more than 35 years. Alex has helped countless people obtain workers comp benefits and never charges a fee to evaluate a case.
– Photo courtesy of Creative Commons, Siri Hardeland.