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indiana work comp laws

Nurse Case Manager Misconduct

nurse case manager

 

 

Have you been hurt at work and the insurance adjuster assigned a nurse case manager to accompany you to your medical appointments?

We represented a worker who had a nurse case manager attend all doctor’s appointments with him. A nurse case manager is a nurse who is supposed to take a look at a workers’ compensation claim from a broad view, considering both the medical and legal aspects of the case. Some of the duties of a nurse case manager include:

  • Schedule appointments
  • Act as a liaison between the injured worker, medical provider, employer and workers’ comp benefit provider
  • Ensure the doctor keeps the employer/insurance agency informed of recommendations including work restrictions
  • Help facilitate care suggested by the medical provider

Before the nurse case manager’s involvement, the injured worker felt like he had a good relationship with the doctor that was treating him…until the nurse case manager came along.

Once the nurse got involved, the client felt that the doctor treated him differently and that the nurse controlled the medical visits. The doctor would defer to the nurse regarding treatment choices, such as authorizing an MRI and even the PPI.

The Indiana Workers’ Compensation Act does not currently regulate the conduct of nurse case managers. However, if a nurse acts improperly, that can result in sanctions being issued against the insurance company. We have seen nurse case managers that attempt to manipulate the medical care being given to our clients. Instead of helping the injured worker recover from his injuries, the nurse case manager is acting in the best interest of the insurance company to cut off your medical care and benefits.

If you have a situation where a nurse case manager is controlling your medical care, we can help. Call us at (317) 569-9644. Don’t let a nurse case manager impact your medical care, get the treatment and rehabilitation you deserve.

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.

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.

Are federal employees covered by the Indiana Worker’s Compensation Act?

 

No.

Federal employees fall under the federal worker’s compensation system. Not all worker’s compensation attorneys are familiar with the federal worker’s compensation laws, so make sure you ask about this in your initial conversation with an attorney.

Besides federal employees, other common jobs not covered by the Indiana Worker’s Compensation Act include:

  • Railroad employees
  • Certain municipal police and firefighters
  • Volunteers
  • Farm & agricultural workers
  • Casual laborers
  • Real estate professionals
  • Household employees

Temporary Partial Disability (TPD): What Injured Workers Need to Know

 

The law in Indiana provides injured workers with three forms of disability pay: Temporary Total Disability (TTD), Temporary Partial Disability (TPD), and Permanent Total Disability (PTD).

Temporary Partial Disability

Temporary Partial Disability (TPD) is paid when an injured worker is only PARTIALLY unable to work for a TEMPORARY period because of a work-related injury. In other words, the injured worker is either limited in the number of hours he or she can work OR needs to be temporarily re-assigned to a job that earns less than what the worker earned prior to the job accident and the amount he or she earns in this temporary re-assignment is less than sixty-six and two-thirds (66 2/3%) percent of the difference between his or her average weekly wage before and after the injury.

Another way of stating this is if you return to your job with restrictions while still under the care of the worker’s compensation insurance carrier’s doctor, and the earnings you bring home are the same or more than the amount you received when completely off work and earning TTD benefits, then you will NOT be entitled to any additional disability pay. If, however, you are able to return to your place of employment, but what you bring home is less than what you would have earned if you were completely off work for the injury, then you will be paid this difference.

An injured worker can earn a maximum of 300 weeks of TPD pay.

Example:

Barbara is a cook for the local college. One day at work, she dropped a heavy pot on her foot, injuring a couple of her toes bad enough to require surgery. The doctor said she could return to work while her toes and foot healed if she was in a sit down job that allowed her to prop her foot. He also said she should work no more than four hours a day. Before the accident, Brenda worked 8 hours a day.

Barbara’s employer was able to meet her restrictions by having her work the cash register for 4 hours each day. Since she will be able to work while healing, Barbara is only PARTIALLY disabled from her job. Barbara’s toes will heal, so her disability is TEMPORARY.

In the above example, if Barbara’s income from this temporary, cash register job is less than 66 2/3% her average weekly wage before the accident, then she will receive the different in TPD benefits. However, if her income from working 4 hours a day as a cashier is equal to or more than 66 2/3% her average weekly wage before the accident, then she will not receive any TPD pay.

TPD Guidelines

Remember that before you receive any type of disability pay, the following must occur:

  1. Your claim has been accepted by the worker’s compensation insurance carrier.
  2. Their doctor has ordered you off work or put you on restrictions that your employer is unable to meet.
  3. You have been ordered off work for more than 7 days (not necessarily consecutive days).

End of TPD Benefits

You will no longer qualify for disability pay if your job can accommodate the doctor’s restrictions and you income is equal to or more than what you drew in  TPD benefits.

Once you have been released at maximum medical improvement by their doctor, your disability checks will stop even if you are unable to return to the job you held before the work accident. The only exception to this rule is a case involving permanent and total disability.

Depending on your situation, it is likely that you will receive notice from the insurance carrier when your disability pay is about to stop.

 

To learn more about other types of disability pay, like Temporary Total Disability, click here.

Temporary Total Disability (TTD): What Injured Workers Need to Know

 

The law in Indiana provides injured workers with three forms of disability pay: Temporary Total Disability (TTD), Temporary Partial Disability (TPD), and Permanent Total Disability (PTD).

Temporary Total Disability (TTD)

The Guide to Indiana Worker’s Compensation, written by the Worker’s Compensation Board of Indiana, says that TTD is paid when an injured worker is TOTALLY unable to perform his or her regular work for a TEMPORARY period because of a work-related injury. TTD is paid at sixty-six and two-thirds (66 2/3%) percent of the injured worker’s pre-injury average weekly wage (AWW), or the average wages he or she earned for the fifty-two week period prior to the date the injury occurred.

An injured worker can earn a maximum of 500 weeks of TTD pay.

Example: Jim, a construction worker, trips over some tools left out by one of his coworkers and breaks his ankle. Because of his on-the-job injury, Jim cannot perform his regular job duties and the company has no light duty jobs available that meet his injury restrictions. So, Tom is now TOTALLY disabled from his job. However, since a broken ankle will heal, Tom will only TEMPORARILY be disabled from his construction job. Until he is able to return, Tom will receive TTD benefits.

TTD Guidelines

Before you can receive any type of disability pay for your work injury, the following things must happen:

  1. Your claim has been accepted by the worker’s compensation insurance carrier.
  2. The doctor has ordered you off work or put you on restrictions that your employer is unable to meet.
  3. You have been ordered off work for more than 7 days (not necessarily consecutive days.
End of TTD Benefits

You will no longer qualify for disability pay if your job can accommodate the doctor’s restrictions and your income is equal to or more than what you drew in TTD benefits. Once you have been released at maximum medical improvement by their doctor, your disability checks will stop even if you are unable to return to the job you held before the work accident. The only exception to this rule is a case involving permanent and total disability.

Depending on your situation, it is likely that you will receive notice from the insurance carrier when your disability pay is about to stop.