WORKERS COMPENSATION
On this subject, I get cranky and opinionated. (If you want the scientific minded engineer, read the benzene and toxic mold sections.) Insurance companies, employers, lawyers, some doctors and an occasional judge annoy me to no end in worker's comp. These laws should protect workers and get them well. Sometimes they work. I hardly ever see that. I see the senseless problems.
For the life of me, I cannot understand why everybody fights over worker's compensation. It's just a special kind of insurance. No one fights so much over life or health policies. But, employers, personnel officers and insurance carriers seem to be intent on treating workers differently when hurt at work. Since they do, let me give you a quick run down on the common issues that crop up in the cases. I will go over both Alabama and Mississippi where the laws differ.
Medical Care
When you get hurt at work, worker's compensation should do two things:
- pay 100% of your necessary medical care; and
- pay for some of your lost income.
A wise surgeon in the town of West Point, Mississippi, told me one time that when a patient gets well, it is because of three equal parts: 1) the patient's attitude; 2) the doctor-patient relationship; and 3) the surgeon's skill. The surgeon went on to say that a patient with a good attitude who trusted his doctor-even a very average doctor-would get well faster than the patient with the best surgeon in the world who didn't trust the doctor. (By the way, the same thing can be said about clients and lawyers.) I think the ole doctor is right. So, let's talk first about getting you to the right doctor.
When you are hurt at work, the employer sends you to a doctor. They choose this one. You can keep the doctor or change. It is up to you. Don't change just because the company picked the doctor. Make up your own mind. If you like the doctor, stick with him or her. If you don't like or trust them-run away. (Again, same advice on lawyers.) You will get better faster with someone you trust.
If you want to change in Alabama, you tell the person handling the worker's comp that you want a "panel of four". If you don't like the first doctor they gave you, they must give you a list of four doctors with the same qualifications in the same geographical area. You get to pick from that group. Choose well-you're stuck with this one. (Call me and if I know them, I will pass on what I know.) This applies to each specialist that a doctor sends you to see. So, you always have a choice.
If you want to change in Mississippi, you tell the worker's comp person you want a new doctor. You pick a second doctor-without a list, anyone you want-but you are then stuck with that doctor throughout the case. So, be careful.
Find the doctor you trust and follow their advice. Their opinions control your case.
Medical care can continue for all of your life in Alabama and Mississippi under certain circumstances-different for each state. In settlement, the carrier will try to cut these off. Never, never sign away your rights to future medical care without talking to a lawyer about this. Never.
The Employer In The Examining Room With You
Throw these people out!
A lot of insurance claims people, employers and rehab nurses want to come in the room with you and your doctor. They can only do this if you let them-no matter what they say about where they "have to go" or "have a right to go". Bull!
They can talk to the doctor themselves-on their own appointment. They can get a copy of your medical records. None of this means they can be there when you meet with your doctor.
Your relationship with your doctor has enough problems, strains and suspicions without a third person in the room. You need to get well. That person the insurance company hired is there to protect its interests. They are not your friends if they want to sit in with you and the doctor.
It is the doctor-patient relationship. (Kind of like a husband-wife relationship, third parties putting their two cents in causes problems.) It's the doctor trying to get you well and you trying to heal. That's all you and your doctor need to talk about. You don't need or want anyone else there.
Disability Checks
When you get hurt, workers' comp pays you for the time off until you can come back to work or get as good as you are going to get. This doesn't mean you're well enough to go back to work, only that you are as good as you're going to get.
These checks are for temporary total disability. This pays two-thirds of your average check up to a maximum set in Montgomery by the Industrial Relations Board or in Jackson by the Mississippi Worker's Compensation Commission. (Note: If you are getting less than two-thirds, ask the worker's comp folks if you've hit the maximum. If not, get the pay records for the last 52 weeks to see how they came up with their figures. Call me if you want me to check.)
You have to be off work five straight days before your employer owes you a check-four and a half doesn't do it. It's got to be five straight working days. Then, they have fourteen days to pay you. So, it can take as long as three weeks to get these checks started.
When the doctor says you are as good as you are ever going to be, the temporary total disability checks stop. (The technical term is maximum medical improvement, abbreviated MMI.) If you have a permanent disability, you should still get some money for permanent total disability, abbreviated PTD, (rare) or permanent partial disability, abbreviated PPD. This is where the worker's compensation settlements happen.
The permanent disability payments may pick up right after your temporary total ends. If you are hurt badly enough, many companies decide it's easier to keep the weekly checks coming but call it permanent partial disability rather than temporary total disability. You wouldn't see a change except on the face of the check. However, it does count towards your future benefits and counts against your settlement, so keep an eye on it. The insurance company will put PPD or something with "permanent" in the phrase on the check. The permanent partial benefits do have a set limit that varies with each injury and people argue about the amounts all the time. Those will run out.
Now, sometimes the companies decide to put pressure on you and stop paying you anything once the temporary disability ends. They don't have to keep the weekly checks coming, even if you cannot go back to your job, unless somebody forces them to do so. If they want to play hardball, they can cut the checks off entirely. Definitely call a lawyer at that point.
The permanent total benefits can be paid in one of two ways: either a lump sum, with Court or Commission approval, or weekly. It is up to you. But the amounts often come about by dickering and negotiating. That's why you need a lawyer who knows the ins and outs of worker's comp law. It gets real complicated at this point: about whether you have a scheduled member or an unscheduled member injury ; whether you have a medical disability versus a vocational disability; your loss of earning capacity. You don't need to handle this on your own. At the very least, take the offer from the insurance company and have a lawyer take a look at it. Never sign anything without at least having a lawyer to take a look at the paperwork. I will look at anybody's settlement for free if you don't have a lawyer already. I will tell you what I think needs to be done. I don't want people going to court without knowing what is happening.
Settlement
For this stage, get a lawyer-at least to look over the paperwork. If everything has gone alright before: you like your doctors and worker's comp has paid for all your medical care while keeping your disability checks on time, you do not need a lawyer. In fact, don't hire one-"if it ain't broke, don't fix it." However, at the end of the case, have a lawyer check out the "forever and ever" paperwork. Let's look at the process so you know what's going on.
Most of the settlements will work out fine. Most of the claims adjusters are honest, believe it or not. But, understand that they do not have your best interest at heart. They have their own insurance company's best interest at heart. You need someone to look over the paperwork to make sure it is right for you-someone looking out for your interests.
One last little tip: when you have an offer in hand from the insurance company, have a lawyer look at it. Sometimes a lawyer will say you need to get more money out of this. If he or she says that, make sure any fee that they charge (15% in Alabama; 25% in Mississippi; subject to Court or Commission approval) is based on what they get you over and above what the insurance company has offered. You have earned the money for the first part of the settlement. The lawyer should only get what he or she gets you, that is, the extra that he or she adds. If the lawyer doesn't think they can get much more than the insurance company's first offer, then it probably tells you that you have a pretty good offer and you might want to take it. This is a good check on both lawyer and insurance company.
If you want to take this one step further, you may use my name with any insurance company in Alabama and Mississippi and tell them that I will review the case. I'll do this for free but do me the courtesy of calling me first and giving me your name so that I know that I will be reviewing the case. The insurance company may call me. Tell them that you have not hired me yet but I will be reviewing it for you and making a decision about whether it is a fair settlement and whether to take the case myself, based on the fee over and above what they offer. This tends to make insurance companies a little more honest. They will tend to give you a little bit better offer up front because they want to at least avoid lawyers…sometimes. This also maximizes the amount you get for yourself and minimizes what you have to pay a lawyer if you have to fight this out to get more money. Calling first should save you money up and down the line. So, feel free to use my name. Just call me first so I know whose name to be looking out for in case the insurance company calls me.
This practice covers Alabama and Mississippi. If we can help you; if you have any questions; call today, 1-800-748-9673, or e-mail, dennis@dennisharmon.com
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