Nurse Case Manager Misconduct
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?
Question: What 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.
- personal injury or death;
- by accident;
- arising out of the employment; and
- 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.
Health joining safety as strategy for reducing workers comp claims?
Preventing workers comp claims has always been about improving workplace safety, but promoting health and wellness among employees is just as important, according to Integrated Benefits Institute President Thomas Parry. (Based in San Francisco, the independent non-for-profit Institute provides the data, research and tools professionals need to make sound decisions in how they invest in the health of their respective workforces.)
In an address to The World at Work 2014 Total Rewards Conference in Dallas, where he spoke about the transformation of health-management strategies, Mr. Parry goes on to say that “more and more workers comp people are recognizing that the underlying health of employees is also becoming a driver of workers compensation claims” and cited obesity as a very good example of an underlying health problem.
Parry closed by saying “What you want to do is prevent claims by having a healthy workforce and a safe workplace.”
If you or someone you know has sustained a work-related injury, call the attorneys at Klezmer Maudlin at 317-569-9644. We can help you navigate the deadlines and the forms, and we can help you get the treatment you need and the settlement you deserve.
We offer free advice and only charge a fee if you need us.
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.
How long does it take to get a worker’s compensation hearing before a Judge?
Every case is different. Most workers’ compensation claims are settled without a hearing. The Workers’ Compensation Board of Indiana requires both parties to make attempts to settle their disputed issues on their own before bringing them in front of a Judge. Going through this process can take some time.
Hearings are scheduled in either the county where the injury occurred, the county where the employer is located, or a county nearby.
Does the Indiana Workers’ Compensation Act protect my job?
Unfortunately, the Indiana Workers’ Compensation Act does not protect or secure an injured worker’s job after a work accident. The Act only bars an employer from firing an employee in retaliation against him or her for filing a workers’ compensation claim.
It is your right to pursue a claim under the Workers’ Compensation Act. However, injured workers sometimes find themselves getting written up or reprimanded for issues that would not have been a big deal in the past, once they do return to the job after a work accident. These issues may serve as a basis for the employer to fire the employee at a later time, or the employer may push the injured worker to feel like he or she should resign.
If you find yourself in a similar situation, you should consult with a qualified Indiana worker’s compensation attorney.
Workers’ Compensation & the Americans with Disabilities Act (ADA)
If you have a condition that significantly reduces or limits your ability to work, you may be considered disabled according to the Americans with Disabilities Act (ADA) and therefore protected by this federal law.
The ADA applies to any employer with 15 or more employees. The Act says that an employer cannot discriminate against workers with disabilities. This includes those who may be a candidate for a position as well as those who already hold a position, such as an injured worker who is left with a disability due to a work accident, but who wants to return to his or her place of employment.
An injured worker whose work abilities have been limited by a work accident will probably be evaluated by a doctor to find out how well he or she can perform the necessary duties of the job. If the worker’s condition limits him or her from performing job tasks that are not critical to the job, then the ADA would require these tasks be reassigned. In a similar manner, if the task that the worker is unable to do are critical to the job, then the ADA requires the employer to consider a reasonable accommodation that would help the worker to still complete this task. This might include special equipment or a device that relieves some of the physical nature of the worker’s job; however, the law does not clearly define this term.
Vocational Rehabilitation for Injured Workers
Vocational rehabilitation may be available to you as an injured worker if you are not able to return to the job you were doing before the work accident. However, the Workers’ Compensation Act does not require the employer to pay for this additional treatment. The Office of Vocational Rehabilitation [(317) 232-1319] can assist you with questions regarding this process.
Workers’ Compensation & the Jones Act
The Jones Act provides benefits to seamen who work on-board a vessel in navigation and who are injured on the job. A seaman is someone who spends a substantial amount of his or her time on-board the vessel. For example, riverboat casino employees may be treated as seamen under the Jones Act. Riverboat casino employees who have been injured on the job and are unsure of their rights should contact an attorney familiar with workers’ compensation and with the Jones Act.
Questions surrounding the Jones Act and whether employees falling under this law are eligible to receive Indiana workers’ compensation benefits have surfaced more recently. Some attorneys believe that employees under the Jones Act are still eligible for workers’ compensation benefits in Indiana. If your employer tells you otherwise, you should consult with an attorney about YOUR RIGHTS to workers’ compensation benefits.
Social Security Disability & Workers’ Compensation
Sometimes, workers sustain a work injury that leaves them unable to return to their former job or a similar job. Since permanent total disability (PTD) benefits are not a guarantee for an injured worker who cannot return to his or her prior job or place of employment, these individuals might be forced to seek benefits elsewhere.
Consequently, social security disability (SSD) benefits may be pursued by the injured individual. This often leads to the question of whether SSD benefits will be reduced if the worker is also receiving TTD benefits from workers’ compensation. To determine if there will be a reduction in SSD benefits, a specific formula needs to be followed. Here is how you can determine whether your workers’ compensation benefits will affect drawing social security pay early due to a work-related disability:
- If the total of your combined monthly workers’ compensation and social security benefits (including what others in your household draw) exceeds 80% of your gross average earnings per month (average current earnings) prior to the disability, then your SSD benefits will be reduced so that you do not exceed this 80% level
- Example: Donna draws $1,000 from SSD per month. Her husband draws $1,500 per month. Donna is also drawing $548 from workers’ compensation each month. Thus, benefits in this household total $3,048. Donna’s gross average earnings per month before she became disabled from a work accident was $3,500. Since 80% of $3,500 equals $2,800, the amount that Donna and her family draws from SSD will have to be reduced by $248 (the difference between $3,048 and $2,800) in order to meet the 80% requirement.
OR
2. If your monthly social security disability pay alone is more than 80% of your gross average earnings per month prior to the disability, then your SSD benefits will be reduced so that the combination of drawing these events along with workers’ compensation benefits does not exceed the amount over 80% that you drew just through SSD income.
- Example: Dennis draws $1,300 from SSD per month, while his son draws $300. In total, Dennis’ household receives $1,600 from SSD each month. This does not account for what Dennis earns from workers’ compensation. Dennis’ gross average earnings per month prior to the disability was $1,800. 80% of $1,800 equals $1,440. In this case, since the SSD benefits are more than the 80% requirement, the $1,600 will serve as the maximum standard of benefits level. Thus, the SSD benefits will be reduced so that the combination of this plus Dennis’ workers’ compensation benefits does not exceed $1,600.
On the other hand, workers’ compensation disability pay will not be part of the earnings that determine what you can get from social security disability when you do become eligible to draw it. In other words, if you had a work accident in 1992 and you received 11 weeks of temporary total disability pay that totaled $2,500, then the Social Security Administration will not recognize the $2,500 as part of your total earnings for 1992. This is because social security taxes are not taken out of workers’ compensation disability income.