Workers' Compensation

June 30 2020

Other caveats? Like what?

Some other considerations include whether you were fired and, if so, was it for misconduct; being fired for-cause is not a defense to paying indemnity. Also, did you quit? If so, why? Your quitting might be considered voluntary limitation of income, which is a defense to paying indemnity. If the reason you aren’t working is unrelated to your work comp injury, that may be a defense to paying indemnity as well. A finding of Fraud is not only a defense to paying indemnity, but also to providing medical benefits.

June 30 2020

Does work comp pay me if I’m out of work?

vaaadmin Workers' Compensation 0

Yes, under certain circumstances. You, at least, need to be on work restrictions per the work comp doctor, IME, or EMA; not at maximum medical improvement (“MMI” – no medical care will make you better); and your employer has not given you a written job-offer for a specific job within those restrictions. There are some other caveats, though.

June 30 2020

What if the authorized doctor and an IME have different opinions?

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In this instance, if the judge agrees that the opinions are different, the judge will appoint a tie-breaking doctor as his/her expert, who is called an Expert Medical Advisor (“EMA”). This doctor’s opinion, essentially, becomes the judge’s opinion as the EMA’s opinion is presumed correct. However, this is a rebuttable presumption, meaning you can overcome it; but, in my experience, the chance of that happening is slim-to-none.

June 30 2020

What if I want the IME’s recommendations for treatment?

vaaadmin Workers' Compensation 0

If you want to pursue the IME’s recommendations, we would file a PFB, which will be denied by the insurance company, and then prepare to go to Court to ask the judge to order the insurance company to pay for and provide the IME’s recommendations. The caveat is, if we win, the work comp doctor who had initially released you would be the one to perform the IME’s recommended treatment; not the IME who recommended it.

June 30 2020

What if I choose to settle?

vaaadmin Workers' Compensation 0

Settlement is where you receive a lump-sum of money, tax-free, in your pocket in exchange for closing out your work comp case, meaning no more medical care or lost wages paid for or provided by the insurance company. Another caveat of settling is that you would have to separate from and agree to never work again for the employer where you got hurt. Your case’s worth is based on the value of future lost wages and medical care, and we’d, typically, settle for between 40%-60% of that value. Settling is not mandatory, and no judge could ever force you to settle, unless you’ve already signed settlement documents and there is no valid reason for overriding that agreement.

June 30 2020

What if I choose to get an IME?

vaaadmin Workers' Compensation 0

Per FS 440.13(5), you can get an IME, whose opinions are admissible in Court. The purpose of the IME is to get a medical opinion, which is required to further pursue getting you benefits once your work comp doctor releases you. An IME cannot provide you with treatment; only an evaluation. After your evaluation, if your IME makes recommendations, we can either: (1) pursue those benefits, or (2) settle your case. The choice is yours.

June 30 2020

What if I choose to keep the doctor?

vaaadmin Workers' Compensation 0

Even if your work comp doctor has released you, you may continue to see your doctor for follow-ups, but you have to pay a $10.00 copay every visit per FS 440.13(13)(c). Per FS 440.19(2), you MUST see your work comp doctor at least once per year (but we recommend twice per year) in order to keep your case open, otherwise you will have violated the Statute of Limitations (“SOL”) and you will be forever barred from receiving benefits on your case again.

June 30 2020

What if I don’t like the one-time change doctor?

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At that point, in my opinion, you have a few choices: (1) keep that doctor and get nothing else meaningful from your case; or (2) get an expert (called an Independent Medical Examiner “IME”) to provide an evaluation and make recommendations.

June 30 2020

What if I don’t like the doctor I have?

vaaadmin Workers' Compensation 0

Per FS 440.13(2)(f), you have the right to a one-time change in physician once per case. This physician cannot be affiliated with the first physician and has to be within the same specialty as the first physician. This physician is also chosen by the insurance company unless, in the rare occurrence that the insurance company does not respond to our request within five calendar days of receipt, in which case, the choice is yours.

June 30 2020

Do I get to pick my doctors?

vaaadmin Workers' Compensation 0

Unfortunately, in most cases, you do not. Injured workers lost the right to choose their doctors many years ago. Rather, it’s the insurance company who gets to choose your doctors and the provision of medical care, except that you have the absolute right to choose your pharmacy (for now) per FS 440.13(3)(j). I’d recommend you use a pharmacy that will make life easier for you and help with the stress of not knowing if you will get your meds. Pharmacies