Reflex Sympathetic Dystrophy (RSD). Sometimes it is referred to as Chronic (or Complex) Regional Pain Syndrome. Either way, it can be a devastating pain condition for patients. I’ve written a couple articles discussing RSD and the disabling toll it has on people. You can read my prior posts here:
Last summer, I wrote about the mental issues (such as PTSD) faced by our first responders. Our first responders have extremely stressful jobs. They handle people and situations at the very worst moments. First responders see the worst human suffering in normal times. With the COVID-19 pandemic, the stressors faced by first responders have exponentially increased.
In my prior post, I discussed current Alabama workers compensation law related to mental injuries. Current law does not provide compensation for mental-only injuries. Mental injuries are only compensable if they stem from a work-related physical injury. The physical injury requirement is also the law in several other states.
You can read my prior article if you want a greater understanding of current Alabama work comp law. Over the years, many of our severely injured clients have dealt with psychological issues. I’ve seen the depression and anxiety suffered by clients who face chronic pain, serious disability or an inability to work. Some physical injuries such as RSD (reflex sympathetic dystrophy) produce chronic pain so severe, mental health injuries are almost inescapable. When we help an injured client facing severe personal injuries and disabilities, we often have to fight in court to win them the benefits needed. Many insurance companies simply deny every request for mental health treatment. You won’t get the treatment you need without a fight. Where the injury and need for care is clearly documented, that’s shameful.
You suffered a sudden accident at work. You are hurting. You need treatment. Questions, worries and fears race through your mind. Will I heal? Can I keep my job? When can I see the doctor? How can I pay my bills? How does work comp work? I’ve heard all the questions. I’ve heard all the frustrations. I counsel injured workers almost every single day.
Today, I want to discuss one of the most common frustrations — The insurance adjuster will not respond or return your calls. Nothing is more frustrating! If you are hurt and frustrated by an adjuster who will not respond, you are not alone. In both Alabama car accident cases and workers’ compensation claims, this is a very common problem. Adjusters bombard you when they need something or when they are pushing you to settle for a small amount. When you need something, they disappear.
Why do insurance adjusters ignore your calls? Let’s look at four primary stages in a work comp claim when adjusters disappear. What are these four primary stages of a work comp claim? Why are you being ignored? How can you respond?
If you suffer a work-related illness or injury in Alabama, you should be covered by our work comp laws. Should be! Yet, the numerous limitations, hurdles and injustices in our current system leave many employees without proper benefits. One issue where workers’ compensation neglects many injured workers — Mental or Psychological Care. Several practical and legal barriers exist to psychological care.
Are Mental Injuries Covered Under Current Alabama Workers’ Compensation Law?
Let’s start with the issue of coverage. Are psychological injuries covered? The answer is, yes, with a big caveat. Yes, but! To recover for mental or psychological injuries under current law, the worker must have suffered an actual physical injury that proximately caused the psychological injury. I know, that’s a long answer.
Traumatic brain injury (TBI) cases are different than other injuries. TBI victims often go undiagnosed and untreated. Emergency rooms are good at saving lives. However, they often ignore the signs and symptoms of a mild TBI. Later physicians may lack the experience or training to diagnose or treat a mild TBI. TBI victims are left to suffer in silence.
Many TBI victims also look “normal.” No scars. No casts. No assistive devices like wheelchairs. When you couple the often “normal” appearance with the lack of diagnosis, many of these patients are doubted or questioned about their symptoms. Yet, almost one-third of patients with a mild-TBI suffer long-term problems working and living.
Surveillance. Hurt at work? Have an Alabama work comp claim? You should expect surveillance. What should you know about workers’ compensation claims and surveillance? Here are a few thoughts.
A Few Ways Surveillance Can Be Used Against You
- To Show You Are NOT Disabled. Most injured people have good days and bad days. If you’ve ever hurt your back, you know what I mean. Some days you feel practically bedridden. Other days, you feel better. An investigator may conduct days or weeks of surveillance on you. Yet, it will never be seen. Only a few moments will be on video – the few moments when you were at your best. This is all the insurance carrier needs to create doubt at trial. My advice: Be honest from the start about your condition. If you have good and bad days, tell the truth. And, avoid activities that worsen your pain.
Workers’ compensation benefits are intended to help restore injured workers. At least, that’s the original intent. That’s why medical treatment and vocational rehabilitation should be top priorities. Heal and restore whenever possible.
Yet, over the last couple decades, our system has largely devolved into a mess leaving many injured workers without benefits. Instead of help, too many injured workers are simply shuffled through the system. I’ve written numerous articles about the current work comp medical system and how it fails injured workers.
Another area where our current work comp system fails — Vocational Rehabilitation. What does “vocational rehabilitation” even mean in Alabama? The phrase is never fully defined by our workers’ compensation statute. Most lawyers and most courts really don’t understand the meaning of the phrase. Why not? The answer is that our courts have so limited its practical effect to the point vocational rehabilitation is largely non-existent and never legitimately offered.
Hurt on the job? If so, the insurance carrier may look for a reason to deny your claim. One of their favorite reasons (and usually a wrong one) is to claim you had a pre-existing condition. On a weekly basis, we listen to injured workers who were (wrongly) denied benefits by the insurance company. What makes this wrongful denial so bad — Many lawyers advertising for injury cases simply accept the denial and refuse to help their clients. Many times, the insurance company denial is wrong.
How Should We View Workers’ Compensation Benefits In Alabama?
Alabama courts have stated over-and-over again that workers’ compensation benefits are “not limited to those in perfect health.” Of course they are not limited. Working men and women deserve a system that provides medical care and basic benefits following a serious accident. If the system required anyone over the age of 35-40 with a history of heavy labor work to have a perfect back, benefits would be worthless. Nobody would be covered.
In Biestek v. Berryhill, a construction worker applied for Social Security disability benefits. Following a hearing, the Administrative Law Judge (ALJ) denied his benefit application. The ALJ decision denying social security benefits is not unusual. The real question in the case was whether or not Biestek had a fair hearing.
In Social Security hearings, the ALJ will often retain a vocational expert to provide opinion testimony. In Biestek, that vocational expert testified the worker could perform a number of different jobs in the national economy. In other words, Biestek was not vocationally disabled. The vocational expert then testified she reached her opinions based upon individual market surveys in her possession. So, on cross-examination, Biestek’s attorney asked to see the data. That’s fair. That’s a very reasonable request. Should any expert be allowed to give an opinion while refusing to show the underlying data? That’s when the ALJ intervened and refused the lawyer’s request. What we now have is an expert who provided an unsubstantiated and unsupported opinion.
I read an interesting article last week in a work comp blog where the author asks the question: What’s Next for Pain — Pharma? The author then discusses available medications he believes could serve as alternatives to prescription opioids. Opioid abuse is a major issue nationwide.
The article’s author is an executive at a pharmacy benefit manager (PBM) in the work comp industry. I started the article with a little bias and hesitation. If you work for a PBM, your main concern centers on prescriptions — reimbursement and cost. After suing a different PBM several years ago, I developed a healthy degree of skepticism as to whether drug payers are really interested in patients. I don’t say that to judge the author or his company.
I will say this author begins with the right issue. He points out that as opioid prescriptions decline, providers and payers have not embraced other treatment modalities. That is an important issue for injured people suffering chronic pain. We must address and treat hurting people. The author then discusses several alternative medication therapies. I represent many injured workers facing chronic pain. So, the discussion of alternative treatments peaked my interest.