New Guidelines for Nurse Case Managers in Indiana
A Nurse Case Manager is a Registered Nurse who is hired by the insurance company to oversee your medical treatment. A good Nurse Case Manager can be very helpful to your recovery, but a poor Nurse Case Manager can interfere with your medical treatment.
The Indiana Workers’ Compensation Board has issued new guidelines for Nurse Case Managers.
The Indiana Worker’s Compensation Board has issued guidelines for the use of Nurse Case Managers (“NCM”) in the administration of compensation claims. A NCM may be involved in a claim to schedule appointments, help facilitate care suggested by the medical provider, and to report back to the employer and/or carrier. However, a NCM should not express opinions, to either the injured worker or the medical provider, regarding an injured worker’s course of medical care or otherwise attempt to influence the process. Additionally, a claims adjuster should not attempt to direct the care provided to an injured worker by the authorized treating doctor.
If you feel a Nurse Case Manager is interfering with your medical treatment in a workers’ compensation case, please call us at 317.569.9644 to discuss your case.
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.
What happens if the workers’ compensation insurance carrier goes bankrupt?
Although workers’ compensation insurance carriers do go bankrupt on occasion, it is not the norm.
In the event your employer’s workers’ compensation carrier does go bankrupt or becomes financially unable to pay the benefits you are entitled to by the Workers’ Compensation Act, then you should contact the Workers’ Compensation Board or the Indiana Insurance Guaranty Association at (317) 636-8204 for further guidance.
Note: the Guaranty Association does not guarantee amounts owed by self-insured or uninsured employers.
What to Expect During a Mediation for Your Workers’ Compensation Claim
The Workers’ Compensation Board requires that attempts be made to settle a workers’ compensation claim before having a formal hearing. Recorded statements, depositions, and interrogatories, are all conducted so parties have a better understanding of the work accident claim and what might realistically be a fair settlement to offer to avoid having to go to court.
Mediations are a last ditch effort to settle a case before it would go to court. In a mediation, the parties hire an outside, neutral person known as a mediator, to sit in on a discussion about the case with the parties. Mediators will offer advice to both sides on how they could resolve the disputed issues. Although mediations have a high success rate, it is a completely voluntary effort, so you cannot be required to accept a settlement offered during this process.
Worker’s Compensation & Child Support
According to the Indiana Worker’s Compensation Act (Ind. Code §31-2-10), a settlement award is subject to any orders pertaining to child support. Up to one-half of the award can be withheld in order to comply with the child support order (Ind. Code §22-3-2-7).
A child support order may also be issued to require the injured worker to pay a portion of any settlement to the court involved in the child support matter.
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.
How can I receive the form that lets me get an Independent Medical Examination (IME)?
If you have not received a form that lets you get an independent medical examination (IME), but you have been released from the worker’s compensation doctor, then you can contact the worker’s compensation insurance carrier and ask about it.
If you find out that you are not eligible for an independent medical examination (IME) through the Board, then you can seek one at your own expense and try to use your doctor’s report as leverage to get your benefits reinstated. Obviously, this would only happen if the doctor’s report is favorable to you.
If you do seek an IME, make sure you select a doctor with an excellent reputation or the Board may discount your doctor’s opinion.
Current Notice from the Indiana Worker’s Compensation Board
Notice: The following is a brief clarification regarding permanent partial impairment (PPI) ratings to the shoulder and hip. Please note that when injuries are specific to either of those body parts, because both are part of the torso, the impairment rating should be made to the body as a whole. This explanation is intended to provide clarity and direction to all involved parties, particularly physicians, who make the actual assessments on which we all rely. Please contact Kathy Haynes for assistance with the calculation of ratings.
Notice: The 2012 Self-Insurance application and guidelines are now available. Please click here for more information and to download these forms.
Notice: Effective May 21, 2012, the Worker’s Compensation Board ofIndiana will require that all filings be made on the most recent State form. These forms are available on our website and notice will be given via e-mail to our newsletter subscribers when a form has been amended. Filings made on outdated forms will be rejected and may subject the filer to penalties related to tardiness.
[via WCB]