Defying the conspicuously silent logic of the hoary adage that “what happens in Vegas, stays in Vegas,” disavowing any apostolic compulsion to confess, we herewith reveal the transparent composition of our recent presentation before the National Workers’ Compensation and Disability Conference and Expo, held in Las Vegas from Nov. 20, 2013, through Nov. 22, 2013, with apologies and atonements to David Letterman, he of the infamous Top Ten, as well as Alan Pierce, Esquire, our tactfully laconic moderator during our Vegas session on Nov. 22, allowing our panel, and our attentive audience, to review and identify the following potential causes as reasons injured workers seek attorney representation in workers’ compensation matters:
1. Claim Denial
- This is the number one reason why injured workers hire attorneys;
- Denials are often, but not always, triggered by claim investigation;
- Multiple factors influence claim denials, including medical evaluations, work restrictions, availability of alternative-duty work, prior claim history, and employer input.
2. Injured Worker Represented In Prior Claim
- The existence of a prior attorney-client relationship, obviously dependent upon prior claim outcome, will usually result in an injured worker retaining attorney for a new claim.
3. Confusing State Forms
- Certain jurisdictions, Pennsylvania being one of them, employ compensation forms that even judges, experienced counsel, and the most highly sophisticated claims adjusters struggle to understand, in terms of their effect on compensability, disability, and related issues;
- Receipt of a state form, accompanied by a form letter, can be confusing to an injured worker unskilled in compensationitis;
- The same form can be the impetus for the Google keystroke, the counterpoint being to use simple, direct, and non-insulting directions for form execution and return.
4. Cessation/Termination of Claim Benefits
- Stopping benefits, absent agreement to the stoppage, generally results in attorney retainage;
- Employer-filed WC litigation seeking to cease/terminate claim benefits drives injured workers to attorneys.
5. Process Overwhelms and Confuses
- Although not rocket science, it is a not uncomplicated process to secure or retain workers’ compensation benefits, particularly when potentially related to other alphabet soup statutes, such as FMLA, ADA, and Unemployment Compensation, as well as private disability coverage.
6. Dissatisfaction with Medical Care
- Cannot get medical treatment authorized;
- Does not like employer-designated health-care practitioner;
- Disagrees with, or will not follow through with, treatment recommendation;
- Cannot get the claims adjuster to answer questions regarding medical compensation benefits.
7. Third-Party Liability
- The existence of third-party liability typically results in the involvement of personal injury attorneys, with referral to workers’ compensation claimant attorneys;
- Potential third-party liability triggers potential subrogation lien interests of the employer/insured.
8. Google It
- In general, the ability to find and retain skilled legal representation, in any kind of practice area, is only a computer keystroke away;
- It is also there on the radio, on the drive to the doctor’s office;
- It is ubiquitous;
- It is splattered all over public transportation;
- It is emboldened by numerous publications and periodicals.
9. Unpaid Medical Bills
- Collection notices for unpaid medical bills drive injured workers crazy, resulting in attorney involvement.
10. I Hate My Job Almost as Much as I Hate My Boss
- It happens!
- This evidences a lack of trust, not to be confused with pure retaliation;
- It is the perception that has festered, infecting claim dispositions.
11. Referrals by Medical Care
- Particularly true with chiropractors, as well as physical therapists, as they tend to be quicker referral sources than other practitioners;
- It is a symbiotic medico-legal universe.
12. Fear of Being Fired
- Are we surprised?
- The fear of being fired, besides producing cold sweats and trepidation, produces psychological crisis, resulting in confrontation.
13. Family Prodding
- It is the nudge while watching TV;
- It is the frustrated “when are you going to do something about this?”;
- It is the stuck at home, no paycheck, no ride to the doctor, no work, and no taking out the trash, no doing house chores, building a base of friction and frustration.
Is there a moral to our story?
Anyone attending the National Workers’ Compensation Disability Conference and Expo heard numerous presenters characterize workers’ compensation systems and procedures as having, at their core, the function of restoring injured workers’ physical and psychological capabilities to return to work to achieve pre-injury status. Several NWCDC panelists underscored the humanitarian policies upon which workers’ compensation statutes and systems are structured, placing great emphasis on the moral obligation of all workers’ compensation stakeholders to employ fairness in the administration of claims. The following tips are suggested for all, in the course of dealing with injured workers:
- Be courteous;
- Be polite;
- Be truthful;
- Be fair;
- Be direct;
- Be responsive;
- Be informed;
- Be civil;
- Avoid argument;
- Avoid making assumptions about claim facts and claim personas;
- Be credible;
- Be yourself;
- Be real.
In short, even in disputed claims, it is critically important to treat others, including the claimant, claimant’s counsel, the employer, any third parties involved in the claims administration process, defense counsel, and the administrative fact finder, as you would want others to treat you.