Category: Workers’ Compensation

Can an adjuster just close my file?

Workers' Compensation

This may, or may not come as a shock to the adjuster but the answer is “absolutely not.” While she may think that enough has been done it is up to the treating doctor to say that you don’t need any more medical treatment. Even then, the adjuster must ask the Industrial Commission to sign off on closing your claim. If that has not happened your claim is still open regardless of what the adjuster may be telling you. There are deadlines and technicalities involved in this so it’s wise to give us a call and let us point you in the right direction.

I’m not sure I’m ready but the doctor has released me to return to work.

Workers' Compensation

This may be for a couple of different reasons. First, the doctor may have a standing agreement with your adjuster or employer that he won’t keep workers’ compensation claimants out of work as long as your employer will find something, anything, for you to be doing.

Second, many doctors believe there is a healing power in being active and out of the house. While we think that this may be overstated sometimes we’ve seen plenty of instances where clients were worse off sitting in the house afraid to go out because of the network of private investigators working for the insurance company than they would be if they could be active and stay in shape.

Third, the doctor may honestly not have a good idea what your job actually entails. Part of this is that they live in their own world sometimes, but we have seen a lot of instances where a rehabilitation professional gave the doctor a job description which had been edited – sometimes by the RP, sometimes by the employer – to remove all the heavy lifting from it. Thus the doctor is relying on what he believes to be an accurate statement of your job. Don’t count on your employer or your nurse showing this to you in advance. More than one client has reported having a nurse whip out a job description unannounced and presenting it to the doctor.

What is a trial return to work?

Workers' Compensation

The first time a doctor releases you to return to work after having been out he’ll likely put some restrictions on you. For the reasons we’ve pointed out other places no one can really know if you are fit and capable for the work your employer is going to give you. Whether or not the doctor or the adjuster say so you are legally on a “trial return to work” for nine months. Technically this is true even if the doctor did not give you restrictions – but that trial lasts only 45 days. The idea is a good one: give you an opportunity to see if you can manage the job. If you cannot then the doctor signs off that the trial failed and the adjuster has not turn your checks back on. In practice it’s not quite the way it works. Adjusters and the rehabilitation nurses frequently forget to tell you that it’s a trial and often imply, or outright declare, that you have to do the work. Period.

The other issue is that you have to return to the doctor to be written back out of work. But the doctor’s office likely won’t set you an appointment unless the adjuster authorizes it. And the adjusters, being rather clever, will often fail to make this authorization. We’ve had to get the Industrial Commission order them to do so under threat of being held in contempt if they continue to refuse.

We think the best practice is to ask the doctor to set a return visit at the time that the doctor releases you to return to work. We think it’s fair to be pretty candid with the doctor on this point. You’re going to give it a try and you would like a return visit with him in three weeks or so to report as to how it’s going. In our experience doctors find this to be reasonable. They are much more likely to agree to this than to a request to simply stay out of work longer.

I’m going back to work on light duty. Any suggestions?

Workers' Compensation

First, make sure you have a return appointment with the doctor scheduled. Second, make sure you have the restrictions in writing. Third, preferably before but as soon as possible after returning to work, give your immediate supervisor a copy of your restrictions. We recommend doing this in writing and keeping a copy for yourself. Fourth, be patient with your company. Although some employers are evil most employers are good people. Admittedly, sometimes good people do stupid things. In most situations it’s not perfectly clear what “repetitive motion” means. It probably means different things to reasonable but different people. Likewise in most occupations the weights of the material you are working with isn’t clear. Thus a limitation to 15 pounds lifting could reasonably be a bit vague when put into practice.

What happens if I cannot perform my light duty job?

Workers' Compensation

There are a couple of factors here. First, if your employer is asking you to exceed the restrictions then you should politely state what your restrictions are and clarify which portion of the job you feel you cannot do. We recommend that this be done in writing so that you will always have proof that you did it and that you did it politely and in a professional manner. Second, if the job is just too much then you should report this to the doctor. As always it would be helpful if you could explain what aspects of the job are too much for you and what your symptoms are when this happens. All of this gives you more credibility with doctors. In a situation like this where it’s often a matter of pain, conditioning, etc., having credibility is critical.