Monthly Archives: July 2012

Watch Out On Social Media: Your Facebook Profile Can Impact Your Disability Benefits

Today’s post comes from guest author Kit Case from Causey Law Firm.

When applying for disability benefits, keep in mind that decision-makers at administrative agencies, insurance carriers or their representatives may look up information about you on the internet and/or they may call you and hear your voice mail recording.

By applying for benefits, you are stating that you are sick/injured and are unable to work or only able to perform part-time or intermittent work. Information available on the internet or your voice mail recording that appears to contradict your application for benefits can result in your being turned down for those benefits. This could be information about your professional or personal accomplishments, a home-based business, or even volunteer activities, which may be no longer current or may not accurately reflect your level of functioning since you applied for benefits. THUS, WE ADVISE OUR CLIENTS TO REMOVE SUCH OUT-DATED INFORMATION FROM THEIR FACEBOOK PAGE, TWITTER PAGE, VOICE MAIL, ETC…

With regard to Facebook and similar social networking sites in particular, pay attention to your privacy settings for both written information and photos. Also, keep in mind that not all of one’s friends and acquaintances may be equally supportive of the notion that one is applying for benefits, especially those who are not entirely familiar with the medical problem or problems that are preventing you from working. We suggest that you think twice before sharing information about your medical condition, application for benefits and/or appeal status in such an internet forum.

Emergency Medical Treatment Does Not Need To Be Authorized

Today’s post comes from guest author Matthew Funk from Pasternack Tilker Ziegler Walsh Stanton & Romano.

As a note, Wisconsin does not utilize payment guidelines of a worker’s compensation Board for payment of medical bills. Emergency medical care simply should be covered by the worker’s compensation insurance carrier. Wisconsin injured workers should make sure that the hospital or medical provider submits the bill to the insurance carrier directly.

When an injured worker needs emergency medical care, prior authorization isn’t always possible and obtaining it does not bar a workers’ compensation claim. When a worker is hurt at work and is rushed to the emergency room for treatment, there often isn’t enough time to seek authorization from an insurance company and to obtain a claim number.

At the time of the treatment, if possible, the injured worker should let the hospital and medical provider know that the injury occurred at work and the exact details of all his or her injuries. This is sometimes an effort since emergency staff are rushed and understaffed. After the emergency care is provided the worker should immediately seek the guidance of an attorney to assist in filing a claim and obtaining reimbursement for the medical care.

At the time of the treatment, if possible, the injured worker should let the hospital and medical provider know that the injury occurred at work and the exact details of all his or her injuries. 

The law provides that the cost of Continue reading

Nurse Case Managers: Friend Or Foe?

A nurse case manager is hired by the insurance company

Know your rights when it comes to nurse case managers in a worker’s compensation case. Nurse case managers are hired by worker’s compensation insurance companies and routinely attend actual doctor visits with the injured worker. Most workers—who are unfamiliar with a worker’s compensation injury and process—simply accept the insurance company nurse’s presence. These nurses generally pitch their services as easier navigation of medical care for the worker and facilitating communication with the insurance company. While many nurse case managers are helpful for workers not familiar with medical treatment and providers, not all have the worker’s best interests at heart.

An injured worker always should remember who pays the check. A nurse case manager is hired by the insurance company. The insurance company wants to avoid payment of claims. Thus, there is an incentive for a nurse case manager to push an early return to work or to question the severity of a doctor’s limitations. Over the years, I have heard from countless clients who tell me about how an aggressive nurse case manager was pushing for a premature return to work while the client was still recovering from an injury. My clients also have seen nurse case managers argue with the treating doctor about<!–more–> “loosening” restrictions or about lessening the percentage of disability. These stories are not an indictment of nurse case managers as a whole, but injured workers must be aware of the proverbial “wolf in sheep’s clothing.”

More importantly, injured workers need to know their rights. There is no Wisconsin legal authority for an insurance nurse case manager to have contact with an injured worker at all—especially at their doctor’s visits. Most clients are shocked when they understand this information. Also, anything a worker tells the nurse case manager can be shared with the worker’s compensation insurance adjuster. Even if the nurse acts as their best friend, potentially confidential information will be passed to the insurance company, with negative consequences on a worker’s claim and medical care.

I generally tell my clients that if they believe the nurse case manager is helpful, they can maintain communication. However, if the worker (as a responsible adult) can manage their own medical care, my advice is to politely tell the nurse case manager to have no further contact. Consultation with an experienced worker’s compensation attorney can help navigate any issues with nurse case managers.

If You Have Symptoms, Tell Your Lawyer Immediately!

We represent a client whose hands were directly injured a few years ago. The insurance company, as part of its defense, is raising a provision in the law which requires an injured worker to file a claim for a direct injury within two years of the accident (WCL § 28). While interviewing the client, we learned that she had been feeling symptoms in her hands years ago, at the same time as she began experiencing the symptoms to other areas of her body. But because she only mentioned that her hands hurt now, we may not be able to get her the compensation she deserves.

Our client told me that originally brought up the symptoms of numbness, tingling and weakness in her hands with her doctor, but he felt these symptoms were related to her neck, another

If you are hurt, tell your attorney everything, even if you aren’t sure if it is relevant.

area where she was injured. The doctor tried to treat her hand symptoms by treating her neck first. He Continue reading

“In the Course of Employment” is Broadly Defined

If you are hurt while eating lunch at work, you may be covered by Wisconsin’s workers’ compensation law.

A headline today caught the attention of many who feel worker’s compensation may be too broadly defined. “Officer Hit by Car While Walking to Get Coffee Due Worker’s Comp.” An Oregon court ruled that a police lieutenant who was struck by a car while she was going to get a cup of coffee across the street from her office was entitled to worker’s compensation. The Police Department claimed she was injured during a “solely personal mission” and denied benefits, but the Oregon Worker’s Compensation Board awarded benefits and the Court of Appeals unanimously upheld the Board’s ruling. The Court said the officer was still at work during her coffee run since she was expected to perform community policing duties while not in office.

In Wisconsin the course of employment is similarly broadly defined. A worker does not have to be at his or her specific work station (or in many cases not even on the employer’s premises) to be covered under worker’s compensation.

Such widely varied activities as skiing, shopping, drinking, and swimming have been found compensable under the traveling employee statute.

While on premises, workers are covered during breaks, including bathroom breaks, smoke breaks, fresh air breaks, and meal breaks. Employees are also covered if injured while Continue reading

Path to Federalization: A National Workers Compensation System — US Supreme Court Validates

Today’s post comes to use from our friend Jon Gelman from New Jersey.

United States Supreme Court has taken a giant leap forward to facilitate the Federalization of the entire nation’s workers’ compensation system. By it’s recent decision, upholding the mandate for insurance care under the Affordable Health Care for America Act (ACA) 2009, it has set the precedent to federalize the nation’s fragmented and chaotic workers’ compensation medical delivery system.

John G. Roberts Jr.,
Chief Justice US Supreme Court

Validating Mechanism
In a 5 to 4 ruling, Chief Justice Roberts validated the individual mandate as a permissible exercise of congressional power under the Taxing Clause of the US Constitution. Under 26 U.S.C. Section 5000A. The law requires that: (a) an individual must maintain minimum essential coverage for each month beginning after 2012; and (b) if there is a failure to maintain minimum essential coverage, a “penalty” is imposed “on the taxpayer” of $695 per year or 2.5% of family income, whichever is greater. The penalty “shall be assessed and collected in the same manner as taxes.”

The Chief Justice, writing for himself, stated, “Every reasonable construction must be resorted to in order to save a statute from unconstitutionality.” If it is “fairly possible” to interpret the statute as merely imposing a tax on those who’ve failed to purchase insurance. Writing for the majority, the Chief Justice stated, that the penalty is not a tax for anti-injunction act purposes. The Court, he wrote, needs to look beyond the label when assessing the constitutionality. For constitutional purposes Justice Roberts reasoned that the penalty may be considered as a tax when: it is not so high that there is no choice; and it is not limited to willful violations; and the penalty is collected by the IRS through normal means.

Constitution of the
United States

The Court indicated that the assessment is not really a “penalty.” “Taxes that seek to influence conduct are nothing new,” the Chief Justice wrote. He reasoned for the Court that Continue reading

How To Deal With Adversaries

Today’s post comes from our colleague Leonard Jernigan of North Carolina.

NegotiationAs a workers’ compensation lawyer, by the time clients come to me they have often already had a series of frustrating interactions with their employers, insurance adjusters and sometimes even medical professionals. Clients come to me feeling stressed by these experiences.

My adversaries are not always easy to negotiate with, and over a long career I have honed in on a few methods that seem to work best for me. When meeting with clients, I try to pass along my methods so they can better navigate some of the new and confusing situations they have been thrust into as a result of a workplace injury.

Recently I came across some advice from Psychologist Jay Carter, who offers tips that closely mirror what I pass on to my clients. The following are some of his tips for dealing with difficult people:

See it for what it is. Rather than internalize the criticism or dwell on what you might have done to deserve the attack, recognize that the nasty person has personal issues.

Get away. Exit the room or the conversation calmly, efficiently, and without saying anything you’d regret.

Diffuse with humor: This is a Continue reading

Can I Be Reimbursed For Medical Bills I've Already Paid?

Last week we posted on what to do about medical bills and workers’ compensation. We learned that the, in general, you don’t have to pay medical bills while on workers’ comp, with some exceptions. But what about medical bills you’ve already paid? 

Question: My private health insurance paid while my workers’ compensation claim was in dispute. I have been making payments to my doctor’s office, too, for co-pay and other charges. Can I be reimbursed? What about my prescription costs?

Answer: Yes, you can be reimbursed for your expenses!

Many employee claims for medical expenses will be paid by health insurers, even if the injuries are work-related and should be paid by the worker’s compensation insurance carrier. In some instances, the health insurer pays because it does not realize the accident or disease was work-related, and in other cases, the claims will be paid by the health insurer because the worker’s compensation carrier disputes that the injury was work-related (or the employer directs the employee to file the claim under the health insurance policy). In either case, the health insurer has the right to recoup the payments, because health insurance policies exclude payments of medical expenses covered by the worker’s compensation carrier.  While the group health carrier is prohibited from intervening in worker’s compensation proceedings, the department may direct reimbursement by the worker’s compensation insurer for payments made by health insurance carriers, when the department finds a work-related injury.

Additionally, if an injured worker pays for any work-related treatment of out of their own pocket (co-pays, prescriptions, mileages), they absolutely are entitled to be reimbursed if the claim (and resulting treatment) is deemed work-related.  An application for hearing, with the assistance of an attorney, generally is necessary. Reimbursement can occur through either a settlement or prevailing at a court hearing.

As medical expenses now eclipse indemnity (or actual compensation dollar) benefits in Wisconsin worker’s compensation claims, reimbursement for past medical expenses can be a significant issue—and drive the need for many cases and the need for representation.