denied workers compensation claim indiana

Doctor Claims Injury is Not Work-Related, What Now?

QuestionWhat if I reported my injury and there is no written report made? I was sent to a doctor who would not even look at my hand because he said it was not due to some immediate accident or trauma. He said that the Indiana Workers’ Compensation law does not cover any injury that is gradual over time due to repetitive motion unless you are a secretary and typing. He told me it was not work related because of this and did not examine the hand. I have requested a second opinion. I also asked for a copy of the injury report and was told there isn’t one. The plant manager is out of town and is doing it over the phone.

Answer: The doctor told you wrong. I would be interested in knowing who your employer is and who the doctor is. Sometimes the doctor works very closely with the employer and their opinions are influenced by the employer.

You absolutely can have a condition that is a result of repetitive use or trauma. I suspect you are talking about carpel tunnel syndrome which is a very common condition in many professions, not just typists. For instance, truck drivers and factory line workers often develop carpel tunnel syndrome as a result of their employment. There can also be issues related to a condition called trigger finger or trigger thumb that can be work related and results from employment activities.

In Indiana, employers must pay the compensation and benefits provided under the Workers’ Compensation Act when the following four elements of a worker’s compensation claim are met. If the employer/carrier denies a worker’s compensation claim and the dispute is heard by the Board, the employee has the burden of proving each of the elements.

  1. personal injury or death;
  2. by accident;
  3. arising out of the employment; and
  4. in the course of employment.

“Injury” and “personal injury” mean only injury by accident arising out of and in the course of employment and do not include a disease in any form except as it results from the injury.

“By accident” means that the injury was unexpected. To occur “by accident,” the injury may be either an “unexpected event” or an “unexpected result.” Under the “unexpected result” theory, the injury to the employee may be the combined injurious effect of repetitive motions.  The definition of “by accident” as both an unexpected event and an unexpected result means that a broad range of injuries is potentially compensable in Indiana.

As to your employer’s refusal or failure to report your injury. Ind. Code §22-3-4-13(a) requires that employers file the Employer’s Report of Injury with the Workers’ Compensation Board if an injury results in the death of an employee or in the employee’s absence from work for more than one (1) day. Failure to comply with reporting provisions may subject the employer/carrier to a $50 civil penalty to be collected by the Board. This report must be filed with the employer’s insurance carrier. Sometimes, employers try to avoid reporting work conditions because they want to avoid increases in their premiums for workers’ compensation insurance because of the reports of injuries or work conditions.

If you have found yourself in this situation, you probably want to utilize the help of a lawyer to fight for what you’re owed. Contact our office at 317.569.9644 today.

Have a question for us? Send an email to rklezmer@klezmermaudlin.com for help.

Have you experienced lack of due diligence by your adjuster or employer?

Under the Indiana Workers’ Compensation Act, employees can receive financial penalties against an insurance company or an employer who acts with a lack of due diligence.  The definition of lack of due diligence is likely what the judge thinks is unreasonably slow.  They are expected to handle claims with persistence, attentiveness and in good trust.

Insurance adjuster’s are oftentimes overworked and not responsive.  Not only do you experience this, but we also deal with unresponsive adjusters on a daily basis.  There are many good adjusters also, but many adjusters have too much work resulting in unreturned emails or unanswered phone calls, and therefore unable to perform effectively.  Such conduct could result in a judge penalizing the insurance company for a lack of due diligence.

In our office’s experience, to obtain an award of financial penalties for lack of due diligence requires the injured worker and/or his attorney to keep documentation of each and every step along the case that the adjuster/employer does not act responsibly and within a reasonable amount of time.  If you feel that your claim involves one for lack of due diligence, please remember that the Workers’ Compensation Act allows the judge to penalize the slow party and award you money for their lack of due diligence.

Don’t Let The Insurance Company DENY YOU Medical Care!

Workers’ comp carriers, more than ever, look for ways to avoid paying expensive treatment.  Whether you’ve been ordered to have an MRI, surgery, a spinal cord stimulator or pain treatment, be aware that the workers’ comp carrier may seek to avoid paying for these necessary treatments.  Tactics used by these carriers may include utilization review, a second medical opinion, a psychological evaluation or simply denying the treatment.

Don’t let the insurance company get away with denying you needed medical care!  Under the law in Indiana, the workers’ comp carrier MUST provide you with all necessary care as deemed medically needed by the attending physician.  If you need assistance, please contact our office.

If you would benefit from legal counsel, our office does not charge for a consultation.  We’re here to offer our experience to make sure you receive what you’re legally entitled.

Did you know that all Indiana Worker’s Compensation attorneys charge the same fees? The fees are set by Indiana law.  Under the Indiana Workers’ Compensation Act, attorney fees are limited to 20% of the first $50,000.00, and 15% of any remaining balance.

Klezmer Maudlin can only charge a percentage of any recovery received and never charge you an up-front fee for our services.  With limited exceptions, we also will collect our out-of-pocket expenses from the recovery and not from you. If you hire us with an offer already given to you, we will typically agree not to charge an attorney fee unless we recover additional money.  For example, if you hire us with an offer already of $5,000.00 and 3 months later we tell you we can only get you $5,000.00, we will typically not charge you.

We will discuss this in more detail at the initial meeting and put our agreement in writing. If you have any questions regarding our attorney’s fee, please contact us at 1-800-809-3776.

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Using Sick, Personal, and Vacation Days During Your Workers’ Compensation Claim

 

The employer cannot force an injured worker to use his or her vacation, personal, or sick days in place of receiving disability benefits in a workers’ compensation case.

Nonetheless, when an injured worker is not receiving workers’ compensation benefits because his or her claim has been denied, it may be necessary for him or her to use this approved time off in order to avoid violating the company’s policy for unexcused absences. Violating such might lead to the injured worker getting fired, and the Workers’ Compensation Act does not protect an injured worker from this happening.

The law also does not require employers to continue to offer vacation, personal, or sick days while the injured worker is off on total or partial disability. However, if you have a collective bargaining agreement, that agreement may require your employer to continue to offer these benefits.

When an Employer or Insurance Carrier Acts in Bad Faith or Lacks Due Diligence

 

The Indiana Worker’s Compensation Act gives the Worker’s Compensation Board the authority to determine if an employer or the employer’s worker’s compensation carrier acted in bad faith or lacked due diligence in handling an injured worker’s claim. These terms simply refer to the responsibility of employers and worker’s compensation insurance carriers to handle claims with persistence, attentiveness, and in good trust.

If an employer or their insurance carrier is found to have acted in bad faith or lacked due diligence, the Board can impose fines which are to be paid to the injured employee between the amount of $500 and $20,000. Additionally, attorney fees may be awarded by the Board in these cases of up to 33 1/3% of the amount awarded to the injured worker.

How do I cover my loss of income if my worker’s compensation claim is denied?

 

If your claim is denied, you will not receive lost wages from worker’s compensation for time off work, even if your personal doctor has ordered you off work, unless you are successful later on in winning your contested claim.

Get an Off Work Slip

In order to prove you are entitled to lost wages, you will need to make sure that you obtain an off work slip for each of the days that your doctor orders you off work as a result of your work injury. This is especially important to do if you treat with different doctors each time you receive treatment particularly at facilities such as a veteran’s hospital or a public hospital.

Use Your Paid Time Off

Further, in order to not jeopardize your job, you should consider using paid vacation time, sick days, or personal days when you need to be off for the work injury, or you can file for short-term/long-term disability benefits if this is offered by your employer. You can also request up to 12 weeks of unpaid time off through The Family and Medical Leave Act (FMLA) if both you and your employer qualify for FMLA. Please note that if you use FMLA and do not return to your job at the end of 12 weeks, you may be fired.

Medical Treatment for a Denied Work Injury Claim

 

Medical treatment will be at your expense if worker’s compensation denies your work injury claim.

Your options are to:

  1. Pay out of your own pocket, OR
  2. File with private health insurance

Keep accurate records of the expenses you accumulate for treatment related to your work injury because this information will be needed if you contest the denial of your claim. If your private health insurance pays for your medical treatment and you end up being awarded worker’s compensation benefits, then your health insurance company should be reimbursed by the worker’s compensation insurance carrier. Make sure this issue is addressed before signing the final settlement agreement. Otherwise, you may be responsible for reimbursing your private health insurance out of your settlement money.

If you do contest the fact that your claim was denied by your employer’s insurance carrier, and you file an Application for Adjustment of Claim (AAC) with the Worker’s Compensation Board, then medical providers who have treated your work injury cannot try to collect payment from you until it is determined who– either you or your employer’s insurance carrier– is responsible to pay. In order for medical providers to be considered for payment when the Board determines who is responsible to pay for your medical treatment, the provider should file an Application for Adjustment of Claim for Provider Fee (Form 18487) with the Board. An Ombudsman can assist with completing this form.

This rule only applies to those who treat you for the work injury. So, if your credit card company is coming after you for not making the required payments, even if the reason  you cannot make these payments is because you are not working now as a result of your work accident, you will not be protected by your worker’s compensation case. Similarly, if you have a collector calling you about a dental bill that is unrelated to your work accident, there is nothing you can do about it through your worker’s compensation case.