Is it time for a Denver work injury attorney?
I’ve been injured at work, what now?
The insurance carrier for the employer usually determines what happens in a workers’ compensation claim, but if you have been hurt the place to start is with the employer. You must notify your employer in writing of the injury within 4 days. The employer must provide you with the names of at least two doctors to see for your injury. The choice of doctors is one of the most important things that occur in a claim, and usually the person who is hurt has not had a chance to consult with a Denver work injury attorney experienced in workers compensation when this choice is made. As a result claimants are frequently dissatisfied with the treatment they get from the “insurance” doctor. Click Here to view the Colorado Department of Labor and Employment’s Division of Workers Compensation rules and procedures for filing a worker injury claim.
If they have failed to provide two doctors there are remedies that an attorney can pursue. In addition, a change of doctors can be made but only within the first 90 days after the injury. If you are approaching 90 days it is critical that you talk to an attorney to see if there is an option you can pursue.
The insurance company will have to decide if they are going to admit on the claim, or contest the claim, within 20 days of being notified of the injury. They may provide treatment with a physician and still not admit on the claim. The reason they do this is because they do not want the injured worker, or the attorney for the claimant, picking a doctor for treatment. By offering medical care they can still deny the claim, or consider it “under investigation” and keep control of the choice of physicians. The time to contact a Denver work injury attorney is sooner rather than later.
Even if the claim is admitted there are substantial advantages to having an attorney. The insurance company does not want the claimant to get an attorney. They know that cases involving attorney cost them more than cases where there is no attorney. The reason is simple, attorneys experienced in workers compensation know when the insurance company is not paying the benefits they owe, they know what to ask for, and how to ask for it. An attorney can tell if their doctor is trying to get the claim concluded rather than providing proper care, and they know how to get another physician involved if that becomes necessary.
Live in Denver or Colorado, and at or near MMI, what comes next?
If the authorized treating doctor has said that you are at, or nearing, MMI (maximum medical improvement) then you are at a point in the case where some decisions will have to be made about how to proceed. There are a number of decisions that have to be made at this point in a case. If you are unfamiliar with how the workers compensation system operates these decisions can be fatal to your claim, and, at a very minimum they will substantially affect both the benefits you are to receive and your rights as an injured worker. Remember the insurance company is not interested in you. They are interested in paying the least amount possible in benefits and they will show us this over and over again during the course of any given claim. This is another reason it is so important to contact a Denver work injury attorney as soon as possible.
What is MMI and how does it relate to work injury?
Maximum Medical Improvement generally means that the authorized treating physician has determined that there is no further treatment that can be offered to help you to get any better. This doesn’t mean that you have completely recovered from your injury, though that could be true. You could still have pain, limitations and restrictions, but be at MMI. You could still be in need of treatment, or have medications that are being prescribed, and be at MMI.
What happens when I am at MMI after my work injury?
When someone is placed at MMI then the insurance carrier is no longer obligated to pay temporary total disability (TTD). The doctor must notify the insurance carrier that MMI has been reached and determine if the person has permanent disability (PPD) as that is defined in the Colorado Workers Compensation statutes. The insurance company will not stop TTD until they have the doctors’ report on permanent disability, so there is usually a period of time when you are at MMI but still receiving temporary benefits. They will consider these an over-payment and, if they owe permanent disability, will take it from the amount that they pay for PPD. This happens in nearly every case and is to be expected because of the time lag between MMI and getting the doctors report on permanent disability. Have you reached MMI? Contact a Denver work injury attorney today!
“Joe” is getting temporary disability of 250 a week and is put at MMI by his Dr at his March 15th appointment He is scheduled for a FCE (functional capacities evaluation) for March 30. The therapist does the FCE and reports the findings to the Doctor. Joe sees the Dr on April 5. The Dr. gives him a 7% impairment rating for his back injury. The doctor sends the report to the insurance company indicating 7% impairment and MMI on March 15th. The insurance company does a Final Admission of Liability of April 15th. They agree with the doctors rating of 7% and start paying permanent disability to Joe, but they say they have an overpayment of $1000.00 (the TTD they paid from March 15th to April 15th).
How does the doctor determine the impairment rating?
When you are placed at MMI the doctor has to decide if there is permanent impairment. In many cases they will say there is no permanent impairment and the person will be released to return to work with no restrictions. (0%)
If there is permanent impairment the doctor must use the AMA Guide to Permanent Impairment 3rd Ed. to decide what impairment is appropriate. For the most part the guide will have the doctor, or his therapist, doing range of motion testing to determine impairment. It is important that you give your best effort in this testing because the guide requires the doctor to do each test 3-6 times for validity. If the range is off by more than 5% it is deemed invalid so a person trying to limit their range of motion to get a higher rating usually ends up with an invalid test and no impairment rating for that portion of the test. There is an entire book on permanent impairment so this is not all that goes into it, but this is the most common situation, and there are additional things added in by the doctor after range of motion is done.
In Colorado there is a distinction made between injuries to the extremities (arms, legs) and those to the rest of the body (called whole person). The statutes here require the insurance company to use a different table for payment for extremity injuries and generally this means that arms, shoulders, legs and hips will be paid out separately. This amount changes slightly each year so injuries in prior years would use a different number. This is based on the schedule of disabilities found at CRS 8-43-107. In extremity cases (arms, legs) permanent impairment is not affected by age or how much you were making at the time you got hurt.
Permanent impairment for injuries not covered on the schedule of disabilities (like backs or necks) is based on a formula that takes into account your impairment rating, your age and your average weekly wage (make sure you have told us of any disagreement you have with the AWW, or if you had OT, two jobs, employer provided health insurance or just got a raise prior to your injury). UNDER THIS SYSTEM TWO PEOPLE WITH EXACTLY THE SAME INJURY CAN GET PAID VERY DIFFERENT
IMPORTANT TO KNOW!
Permanent impairment is NOT affected by whether someone can, or cannot, return to the job or profession they had prior to the injury.
Permanent impairment is NOT affected by inability to do the recreational things you could do prior to the injury, your relationship with your spouse, kids or significant other, or your “pain and suffering”. While all of these things are significant and important they are NOT covered under the workers compensation statutes.
What happens after the doctors determines my impairment rating?
The insurance company must decide if they agree or disagree with the rating. If they agree they will file a FINAL ADMISSION OF LIABILITY. Generally they will agree because they got to choose the doctor. The Final Admission will have the doctors report attached and will state what permanent impairment they are admitting for, and whether they are admitting for medical benefits to be provided after the date of MMI. (called maintenance treatment because it is treatment designed to assist the injured worker to MAINTAIN their level of maximum medical improvement).
If the insurance company disagrees with the doctors’ impairment rating they must file a request for an independent doctor chosen by the Division of Workers Compensation (DIME) to do an evaluation and determine impairment. If they are the ones to request the DIME they must continue to pay TTD until the independent doctor issues his report, but if the DIME doctor says he agrees with the original doctors date of maximum medical improvement there will be a significant over-payment that will be deducted from the permanent disability they owe you.
What if we decide that we disagree with the doctor on MMI or impairment?
If the doctor puts you at MMI and we disagree with either the MMI determination or the impairment rating that you were given the ONLY option available to us to ask for the Division of Workers Compensation Independent Medical Exam. The physician is picked by sending the names of three doctors to the work injury attorney for the claimant and to the insurance adjuster or their attorney. Both sides get to eliminate one name so that the doctor that is left is the one to do the exam. (The choice of doctors here is VERY important and should be made by an attorney who specializes in Workers Compensation because only someone who practices in this area will have experience with these physicians and be able to eliminate the physicians most likely aligned with the insurance company).
The DIME doctor cannot be someone who has been involved in your case or working for the same company as a doctor on your case. The insurance company must send all of the medical records from your case to the DIME doctor. Neither party is allowed to talk to the doctor, so the only one that gets to speak to the physician is the injured worker. The cost of the exam is $675.00. IF you qualify as indigent the insurance company can be required to pay for this but that application must be submitted to the Division of Workers Compensation soon after the DIME application goes in.
The DIME doctor can agree or disagree with the authorized treating physicians rating, or can say that someone is “not at MMI” and require the insurance company to provide more treatment. Unfortunately this means going back to the doctor that just said you were at MMI for the treatment. The DIME doctor cannot be a treating physician.
What if I can’t go back to work at all?
There are cases in which an injury prevents a worker from going back to work in any job for which the worker has previous training or skill. In these cases it is very important to know what your rights are and how to challenge the insurance companies Final Admission of Liability. Failure to timely object to the Final Admission means the case will close and they will only be responsible for those benefits that are admitted on that document. If the injured worker can’t go back to work at any job it is unlikely the insurance carrier will admit this and pay these benefits. In this case please talk to a Denver work injury attorney before the 30 days to object has expired.
Social Security Disability and Workers Compensation can be similar in this area. An attorney can describe the differences and make recommendations concerning pursuit of one or both claims.