When I settle an Alabama workers compensation case with continued medical benefits, I explain to my clients what they may expect in the future. Of course, that future depends on many facts. Are the injuries easily provable or highly disputed? Does the client suffer other health problems that complicate issues? Does the client have access to health coverage through other sources? Does the client have a good authorized physician?
Every situation is different. Each case should be approached with thoughtful advice and planning. Lawyers should help their clients prepare to navigate the work comp system. We do. We help our clients during the case and afterwards when issues arise.
The potential issues following a work comp settlement are too numerous for this short post. So, I will just mention three quick takeaways when you settle your work-related injury case with open medical benefits under Alabama law. If you are in this situation, you probably settled expecting and hoping you would receive continued medical care for your injuries. What immediate things should you know? Here are three:
Insurance Companies (And Their Lobbyists) Are Pushing The Alabama Legislature To Change The Law.
Why am I talking about insurance lobbyists? Insurance companies want to save money! Your medical treatment costs money. Almost every year, insurance companies (through one of their friendly state senators) introduce new legislation to limit medical treatment.
Let’s say you hurt your back on the job. What’s important to you? If you are like most people, getting medical treatment and care you need is one of the most important benefits. If you suffer a serious injury, you may be left unable to work and without regular health insurance. And, Medicare may not accept medical bills for a work-related injury. Without open medical benefits under our work comp system, you might be unable to get the care you need. You are entitled to medical benefits for the rest of your life under Alabama work comp laws. Many of our clients need regular, ongoing medical care after settling their claims. Work comp benefits allow them to receive this care.
Insurance companies want the Alabama Legislature to change the law and limit your benefits. Insurance companies want to cut-off your medical benefits. The recent proposals all place time limits on benefits. Instead of medical benefits for life, these proposals would cut-off benefits after a certain arbitrary number of years. This is horrible and unjust. Remember, the insurance companies collected premiums for years to cover these benefits.
Medical Treatment Still Comes With Big Question Marks.
You settled with open medical benefits. That means you can go to the doctor and the insurance carrier pays? Not always. Work comp medical benefits come with qualifications. Some big qualifications.
First, you must see the company’s authorized doctor. You cannot simply pick your own doctor. Do you trust your authorized treating physician? Many of our local Huntsville and Birmingham specialists are truly dedicated to helping their patients. But, a small few are not patient-friendly.
Second, the insurance company only pays for medical treatment related to your injury. If the insurance company constantly questions the medical necessity of all prescribed treatment or whether it’s even related to your injury, care can be difficult.
This can be a difficult issue in some cases. Think about a back injury. Some workers have no prior back problems prior to their accident. Others have a long history of pre-existing issues. In those cases, it can be very difficult for the physician to provide a medical opinion relating the need for future treatment to the work-related accident and injury.
Third, in many serious injury cases work comp carriers routinely ignore or question prescribed care. The delays caused by these insurance company actions can be difficult for patients with chronic pain. What do I mean when I talk about delays? You go to the doctor for an appointment. The doctor performs an examination and prescribes treatment. The doctor’s office tries to communicate with the insurance company seeking approval for the prescribed treatment. Yet, somehow, the doctor’s office is unable to reach the adjuster. And, the adjuster does not return their calls. Weeks, maybe months, pass. This delays your care while you are hurting. It’s frustrating for you. It’s also frustrating for the doctors and pharmacists trying to obtain insurance company approval.
Insurance companies sometimes ignore treatment requests. In other situations, insurance companies openly question the necessity or nature of prescribed treatment. Assume the doctor prescribes epidural injections for your lower back injury. That’s pretty common treatment. Yet, you’d be surprised at how often work comp insurers conduct peer reviews through friendly insurance-biased doctors to question the need for such treatment so it can be denied. Imagine the frustration when some out-of-state physician (who probably has been disciplined for misconduct in the past) generates an insurance company purchased report simply to say he disagrees with your authorized doctor’s prescribed treatment. Then, the insurance company uses its purchased report to refuse care!
What happens when the insurance company delays or denies needed medical treatment? You have rights. Your lawyer should fight for you. But, it takes time and patience in some cases to get needed benefits. That brings me to my third takeaway — You need a lawyer who will continue to advise you after the settlement.
Your Lawyer Matters! Hire A Lawyer For The Long Haul.
Many lawyers settle work comp cases and then refuse to help their clients over the long-term. These lawyers receive their fee at the time of settlement, close the file, and ignore future issues. That’s wrong. Almost every week, we receive a call from somebody mis-treated by their prior lawyer.
Think carefully when you hire a lawyer for your work comp claim. Hire a lawyer willing to go to trial. Hire a lawyer who will remain available for advice and help after the claim is settled.