Five Biggest Mistakes

The Five Biggest Mistakes that workers make with their
Workers Comp claims are:

Mistake #1 – Not hiring a lawyer at the outset of a Texas Workers’ Compensation Claim.

Too often workers contact us and we have to tell them that they have failed to take proper action, that they have said the wrong thing to unscrupulous claims adjusters, allowed their employer to choose a doctor who is sympathetic to the employer, missed a critical deadline or put their job in jeopardy because they have irritated the employer or adjuster. There’s an old saying that a “Lawyer who represents himself has a fool for a client.” This applies even more so to a non-lawyer who tries to represent himself.

Don’t make the mistake of trying to be your own lawyer. Our lawyers all have college degrees, law degrees, passed a very difficult State of Texas Bar Exam and have years of experience in Workers Compensation practice. On the other hand, if one of our lawyers tried to do your job we would probably look even worse.

Mistake #2 – Missing Workers Comp Deadlines.

Here are some of the Texas Workers Compensation Deadlines that you must recognize and take action or lose some or all of your Workers Comp Benefits. One of the most difficult things about these deadlines is knowing when they start to run and knowing exactly what you must do to comply with the deadlines.

You have 30 days to report an injury to your employer. You have 1 year to report an injury to the Division of Workers’ Compensation. You have 90 days to dispute an Impairment Rating given by your treating doctor. You have 90 days to dispute an Impairment Rating given by a Referral Doctor. You have 90 days to dispute an Impairment Rating given by a Required Medical Examiner. You have 90 days to dispute an Impairment Rating given by a Designated Doctor. You have 10 days to dispute a denial of a request to change your Treating Doctor. You have 10 days to dispute a denial of a request to extend your Statutory Maximum Medical Improvement date based upon spinal surgery. You have 7 days to submit a Supplemental Income Benefits quarterly application before the quarter begins. You have 10 days to respond to the insurance carrier’s request for a Required Medical Examination. 14 days prior to a Benefit Review Conference, you must exchange any documentation that you wish use with the insurance carrier. 15 days after a Benefit Review Conference, you must exchange any documentation that you wish to use at a Contested Case Hearing with the insurance carrier. Once you have received interrogatories from the insurance carrier, you have 5 days to respond. Interrogatories to the insurance carrier are due 20 days prior to a Contested Case Hearing. You have 15 days to submit an appeal of a Decision from a Contested Case Hearing.

You have 15 days to respond to a request for an appeal by the insurance carrier of the Decision from a Contested Case Hearing. After a Benefit Review Conference, you have 20 days to agree or not agree to arbitration. After the Appeals Panel has made a decision on appeal, you have 30 days to request Judicial Review in State District Court. You have 15 days to dispute approved attorney fees. You have 15 working days to dispute the denial of medical treatment for non-network medical providers. You have 30 days to dispute the first written denial of a network provider. You have 45 days to request an Independent Review Organization to appeal denied medical treatment after the second written denial. You have 20 days to dispute the findings of the Independent Review Organization, if it involves concurrent or prospective medical necessity for health services in a non-network claim. You have 30 days to dispute the findings of an Independent Review Organization if it involves a network claim.

Mistake #3 – Improperly Filling Out DWC Forms.

The first DWC form you must complete and file is the Notice of Injury and Claim for Compensation. Common mistakes in completing this form include putting the wrong date of injury, not including every potential body part in the Notice, describing the accident in too much detail or too little detail, being unsure of whether you are reporting an injury or an occupational disease, being unsure of whether the first work day missed can be a partial day or if it has to be a full day, putting the wrong date for when you knew an occupational disease was work related, and leaving the treating doctor information blank or putting the wrong doctor’s information.

While it is extremely important to fill out the Notice of Injury and Claim for Compensation form correctly, there are a number of other DWC forms that, if filled out improperly, can create problems with your claim. When filling out a request for a Designated Doctor, if all of your medical treatment and injured body parts are not listed, a doctor may be selected who is not qualified to examine you or is not aware of the full severity of your injury. If you are submitting a request to Change Treating Doctor’s and the contact information for the doctors is incorrect or if you do not provide a sufficient reason to change doctors, your request can be denied. If you are applying for Supplemental Income Benefits, your application must be filled out correctly and completely. Failing to document your job searches, income earnings, or providing the proper medical documentation can result in a denial of your application by the insurance adjuster. Any improperly completed forms can create problems and/or delays with your claim.

Mistake #4 – Trusting Claims Adjusters

The most important thing for you to know is that the claims adjuster is not your friend even if he or she acts “friendly.” You should know that insurance companies make higher profits when they pay out less on claims. An adjusters job is to avoid paying claims at all, if they must pay a claim their job is to limit their exposure and keep the amount of the claim at a minimum, adjusters typically under calculate the correct amount of your weekly workers comp check when they think you don’t know what you’re doing, adjusters want a “recorded statement” from you so that they can ask you tricky questions that will limit which body parts are included in the claim, try to trick you into saying that your job injury was really a pre-existing condition or any number of other thing that could wipe out your claim or seriously limit what you deserve. Adjusters will try to get you to go to one of their doctors who will do what the insurance company pays him to do, which is, to release you back to work too soon, limit your impairment rating and your IIBS and SIBS benefits and write reports that make you look like a trouble maker. Never go to an insurance doctor unless you have been ordered to go to one by the DWC. You and your attorney should make sure that whomever you choose does not have a reputation of being a “paid gun” by the insurance company or your employer.

Mistake #5 – Failing to Recognize a Third-Party Claim.

A third-party claim is an additional claim that you may have against another person or company that is not your employer. Examples include, being hit by a vehicle owned or operated by a person or company other than your employer, injuries due to defective machines that are manufactured by a company other than your employer, contractor injuries and countless other possibilities. Workers almost never spot a third-party claim and are amazed at what constitutes a third-party claim.

The good news is that any money we recover against a third-party is also used to pay back your workers comp benefits, meaning that your employer will get back some of the money that was paid to you by his workers comp insurance company. If you are afraid of losing your job because an employer may get angry with you over your workers comp claim, you need to allow us to search for a third-party claim. This way you can end up helping your employer instead of being a financial drain to them. While you would think that a workers comp insurance company and an employer would look for third-party claims themselves, that is often not the case. Adjusters, foremen and executives are not lawyers and usually don’t have a clue of all the potential third-party causes of action. Personal injury attorneys know of all these actions and we will be able to tell you conclusively whether one exists or not.