What Your Adjustor May Not Tell You

Beware!

What Your Adjuster May Not Tell You...

The Colorado Workers Compensation Act can be described as a jungle of law, rules, and court rulings. It is difficult for the newcomer to understand. What you need to remember as an injured worker is that this is probably the first time you have dealt with complexities of the workers’ compensation law. However, your adjuster has dealt with these issues many times. Be careful that you know the law before you make any decisions or before you agree to anything the adjuster may tell you. Hiring a workers’ compensation lawyer can help ensure that your rights are protected. Here are a few examples.

Your Treating Physician

Under Colorado law, your employer has the right to designate a doctor for you when you report your injury. However, if your employer doesn’t tell you what doctor to go to, you may have the right to may your own choice of doctor. Keep in mind, though, that whether your employer chooses a doctor or you do, once that choice is made, the doctor cannot be changed without the consent of both parties. An insurance adjuster may tell you that they are changing your doctor for a variety of reasons. Unless you agree to the change, you are probably not obligated to change doctors. But remember, if you go that new doctor and he treats you, the law probably views this as you consenting to the change of physicians.

Mileage For Medical Treatment

Reimbursement for your mileage to and from medical treatment is considered a medical benefit. This includes mileage to any treatment prescribed by your doctor. If you are sent to physical therapy, or to a health club, you are entitled to be paid for your mileage. Remember to keep track of the miles to and from medical treatment and submit them to the insurance carrier for payment on a regular basis. It often takes two weeks or more for this mileage to be paid, so try to send in your mileage record regularly. The Eley Law Firm in Denver, Colorado, specializing in workers’ compensation, has mileage forms that you can use.

Fringe Benefits and Your Average Weekly Wage

The wage loss benefits you receive for your time off work are based upon your average weekly wage. For example, if your doctor’s restrictions prevent you from working, you are entitled to receive two-thirds of your average weekly wage in temporary total disability benefits, up to a yearly-adjuster limit. Fringe benefits that you receive as part of your pay package, but which you don’t get when you are off work, can be included in the calculation of your average weekly wage. For example, if your employer-paid insurance is terminated because you are off work, the cost of that insurance should be included in your average weekly wage. The same is true with employer-provided meals and lodging. Make sure that your adjuster knows that you have lost these benefits and what it would cost you to replace them so that you will receive the correct amount of temporary total disability benefits. A workers’ compensation attorney can help you decide which benefits you are entitled to be compensated for. If you have questions on your fringe benefits, please call the Eley Law Firm in Denver, Colorado.

Independent Medical Examinations

After your treating physician has placed you at maximum medical improvement, either you or the insurance company can ask for an independent medical exam, or IME. The issues the second doctor determines are usually the date of maximum medical improvement and the extent of your permanent disability. Both of these issues can greatly affect your benefits. If you can’t agree on a doctor to perform this exam, the Division of Workers’ Compensation will provide a doctor for you. Do not be quick to agree with the claims adjuster about a doctor to perform the IME. There are many doctors that receive a large percentage of their business from insurance companies and employers. If you agree to one of these doctors, you could be very disappointed. Remember, the IME doctor’s opinion can only be overcome in court by “clear and convincing” evidence. This is a difficult burden to meet. You can usually get an opinion regarding a doctor by calling a workers’ compensation attorney such as the Eley Law Firm in Denver, Colorado.

These are just a few examples of the rights you have that might go unprotected. Remember, unlike you, the adjuster has dealt with these things many times. If you have questions regarding these or other issues, contact our firm for a free consultation. Call our Denver, Colorado office at 866.458.6360 or 720.279.9172, e-mail us, or fill out the form on the Contact Us page of this website. We look forward to hearing from you.