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The Adjuster Cut Off Your Weekly Check and Your Doctor Won’t Listen to You

If this is your situation, you’re not alone. This is a common scenario that many injured workers find themselves in.

When a worker is injured, it’s the job of the adjuster and insurance doctor to get you back to work as soon as possible. That means they’re not on your side. In fact, both parties are often unprofessional, making it difficult for you to get the benefits you need and deserve.

If you have been injured at work and the insurance adjuster has figured out a way to cut off your weekly check, or your doctor won’t listen to you because they don’t have your best interests at heart, call the Law Office of James M. Hoffmann. We can stop the carrier and employer from harassing you into returning to work before your doctor says that you are ready to return to work. In addition, you need to make certain you have a good doctor working for your interests, not trying to make the insurance company happy so that they can maintain a good relationship with the carrier.

Your Doctor vs the Insurance Doctor

Adjusters always base paying TTD on the opinion of the authorized treating doctor because that doctor is usually very biased toward insurance companies. They will: give you the least amount of time off work, give you the least amount of protective restrictions, or send the injured worker back to work despite complaints.

But, remember that employees are free to treat with their own doctors and decline treatment from the insurance doctor. Yes, the employee has to pay for his/her own doctor. But it is perfectly legal to have the work comp doctor do your lumbar fusion or rotator cuff tear surgery, then decline further treatment with the work comp doctor and do the rest of your treatment with your own doctor. It is also perfectly legal to use your health insurance to pay for a work injury. But, the problem there is that “front desk” personnel at many medical offices do not understand this and will refuse to submit to your bills to your health insurance saying “we need to be approved by the work comp insurer” but this is wrong!

Workers compensation adjusters will “counter” your private doctor’s off work recommendations by getting an independent medical exam (IME) with a doctor they chose. When the insurance company doctor says full duty, and your doctor says to stay off work, and of course they follow the work comp doctor recommendations, then a hardship hearing is needed to resolve the issue.

If Your Employer Gives You a Humiliating or Unsafe Job

Many workers comp doctors play games. For example, after a surgery they will authorize 3 days off work and then light duty. No TTD is paid for those 3 days, and then the employer provides a worthless made up job that is humiliating to the employee.

The work comp statute, CH. 287, mandates no retaliation by an employer, so in a situation where the employer gives the employee a humiliating job, or says “go work at this other place down the street until you are full duty; we will pay you.” However, this other job is unsanitary and unsafe.

If something similar has happened to you, give the employer a letter, and keep copies. In the letter ask why employees who are injured outside of work are not forced to do this; ask where in the employee manual are you required to do this; explain that before the injury you got along great with all the bosses but since the injury none of the bosses will talk to you; explain why the workplace down the street is unsafe and not sanitary.

How to Deal With an Unprofessional Doctor

Another game is where the authorized doctor says “full duty trial” while you are still treating. Even though you know you can’t do your job due to ongoing pain and limitations, you contact your employer who says “sorry, we don’t need you anymore.” So, the workers comp adjuster cuts off your TTD saying “the doctor said full duty.” You are unable to work because of your injury and your employer offers you no work. The work comp doctor didn’t listen to you when you said there is no way I can work.

In this situation, the best plan is within a few days of your doctor visit, drop off a letter at the front desk of the doctor’s office. Date it! Write “please put this letter in my medical records” across the top. Print your name, email, and cell at the bottom. Using short and simple sentences, confirm what you told the doctor, confirm how he refused to answer your questions, and confirm that when you said “I am a laborer for a concrete company. You did a 2 level lumbar fusion. I am 6 weeks out from surgery and still in severe pain”, that the doctor just looked at you and refused to address your concerns. CC your employer and given them a copy of the letter along with a letter demanding a new doctor and explaining you cannot work full duty as you fear further damage to your lower back. Keep copies!

Then, file a complaint against the doctor: https://pr.mo.gov/healingarts-complaint-forms.asp. Your relationship with a work comp doc is supposed to be the same as with your primary care doctor – professional! Being unprofessional, disrespectful, and ignoring your concerns are all grounds for a licensing complaint. These complaints will be the only way we can stop biased and unprofessional doctors.

Insurance Adjusters Want to Cut Off Your TTD Benefits

Insurance adjusters want TTD cut off as soon as possible. Demanding the authorized treating doctor to cut off TTD would get them sanctioned. So instead they start emailing, calling, and writing the doctor (yes, they will harass their own doctors) about “when do you expect MMI.” This is the “hint” that the adjuster wants the employee released to full duty so that TTD can be stopped. You may notice a change in the doctor’s attitude. Maybe you had a nice doctor and then, out of nowhere, he becomes abrupt and says got back to work: my bet is that we’ll find recent letters, emails, or calls to that doctor from either the adjuster or the nurse case manager, asking about MMI or returning you to full duty.

The Letters You Write are Critical

Your letters to the doctors and to your employer are critical in proving what actually was said at a doctor visit. You will be shocked when you finally get your medical records and see that your doctor failed to document your complaints: “patient still sore but getting better”. Your letters are worth their weight in gold at trial: short sentences; keep them simple; keep them short; date them; keep copies; do not mail them:either fax or drop off at front desk even if they refuse.

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Updated: May 16, 2024