Mistakes to Avoid in a Boston Workers’ Compensation Claim

One of the biggest mistakes to avoid in a Boston workers’ compensation claim is not knowing your rights under the workers’ compensation law. Injury victims might be afraid that, if they resist and do not follow everything the insurer tells them, they could lose their benefits and lose their job. The person trusts that the insurance claims adjuster is telling him or her the complete truth and is not misleading them.

Unfortunately, the insurance companies do not always work in the victim’s best interests. If you have to negotiate with insurance companies because of your injury, you may want to hire an adept workers’ compensation attorney to represent you. A lawyer could work to ensure you receive the full benefits you need.

What is the Pay-Without-Prejudice Period?

To encourage the insurers and self-insurers to err on the side of paying claims, the workers’ compensation statute gives them 180 days or six months to pay without prejudice. It is called the pay-without-prejudice period (PWOP). During the PWOP, the insurer or self-insurer can modify or terminate benefits altogether. The only thing the insurer or self-insurer must do to comply with the law is to give the employee seven days written notice.

PWOP Extensions in Boston

There is a provision within the workers’ compensation statute that the employee and the insurer can agree to extend the pay-without-prejudice period by another six months. Unfortunately, what happens all too frequently is that insurance claims adjusters do not notify the employee that it is completely voluntary. Signing this agreement is one of the biggest mistakes to avoid in a Boston workers’ compensation claim. Extending the PWOP gives the workers’ compensation insurer one whole year to be able to stop the weekly workers’ comp checks with just one week’s notice to the injured worker.

Often, insurers make this request is made as the six-month deadline approaches. For the insurer to retain complete leverage, they ask employees to sign the agreements without any explanation. Employees often do so, trusting that this is something that they should do when, in fact, it is something they should not do because they give the insurer an additional six months to have total control. If they had not signed the agreement, the insurer would have accepted liability.

Discontinuing or Modifying Benefits After the PWOP

Even if an insurance company has accepted liability, they can try to discontinue or modify benefits. However, the insurer must file its own claim with the Department of Industrial Accidents (DIA), seeking permission. Until that claim is presented to a judge at a Conference, the insurer must keep paying the weekly benefits to the employee.

If the insurer terminates benefits during the PWOP, the employee has no income until the weekly workers’ comp benefit checks are reinstated. If he or she is disabled and cannot work and his or her attorney has to file a claim, the employee could be without any income for up to three to four months before the case goes before a judge at a Conference. At that time, the attorney may request the judge to order benefits to be reinstated retroactively and ongoing.

Nurse Case Managers

As part of the claims process, insurance companies often assign nurse case managers to the claim. They try to inject themselves into the employee’s treatment by requiring the employee to call them after each medical appointment and by contacting the employee’s medical providers directly. In some cases, they go to medical appointments and go into the exam room with the employee.

The employee hears the title nurse and thinks nurse case managers are part of their medical team. In fact, nurse case managers are employees of the insurance company. Their focus is on trying to minimize the financial exposure and risk to the insurance company. They may have the doctor return the employee to work before the injured person is able. They could also try to send the employee back to a light-duty job that does not exist in reality, only on paper.

The nurse case manager tries to interfere with the doctors by assuring them that payments will be processed so the doctor is reimbursed for the medical care they give to the injured worker. The big mistake an unrepresented employee makes is believing that the workers’ compensation insurance company’s nurse case manager is part of their medical team and is another medical provider just like the nurse in their doctor’s office.

Contacting a Boston Workers’ Compensation Attorney

If you were injured in a workplace accident, you should consider asking a seasoned attorney to represent you. Insurance companies are often misleading, but an attorney could advise you of the mistakes to avoid in a Boston workers’ compensation claim. Seek the services of an experienced Boston workers’ compensation lawyer today.