If you have been injured on the job and are pursuing workers’ compensation benefits, you are going to be coming into contact with a lot of people who are involved in the process. It can get confusing when you are dealing with all these different folks and, really, all you want to do is just get the care you need and get better.
I’ve put together a brief list of who does what in the processing of a work injury claim to help injured workers better understand the process and identify the people and agencies they may come into contact with during the process. A lot of people tend to just say “workers’ comp” without really understanding the different roles of the persons or agencies they are talking to. I’m hopeful that by helping you have better understanding of who does what, you can avoid some frustration and you will have a better idea of who to go to for your specific needs.
Workers’ Compensation Doctor
The workers’ compensation doctor is the doctor the insurance company sends you to for medical care or the doctor that you see for your workers’ compensation injuries that the insurance company has allowed you to see for your injuries. For ACCEPTED workers’ compensation cases, you must see the insurance company’s doctor for care or get the okay from the insurance company to see a doctor. Usually, this is a doctor that is “handpicked” by the insurance company and this will be your primary doctor for your work-related injuries until he or she releases you or refers you to another physician for additional treatment. Generally, you get a workers’ compensation treating doctor from a panel of three doctors that the workers’ compensation insurance adjuster gives you to choose from. Once you pick that doctor and he treats you, he is then your workers’ compensation treating doctor and neither you nor the insurance adjuster can force a change in doctors. Also, the workers’ compensation doctor is the ONLY person in this entire system who can write a work status note for an injured worker.
The insurance company (or insurance carrier) is the company that your employer pays for workers’ compensation insurance coverage (like you might pay your car insurance), so when an injury is reported, the insurance company can step in and take over management of the claim. If you are receiving benefits, payment for medical care and/or payment for lost wages come from the insurance company. The insurance company is the one in charge of approving medical care and paying you a weekly check, not your employer.
The insurance adjuster is an agent of the insurance company. Their job is to investigate and determine what, based on their information, should or should not be covered under a workers’ compensation claim. Insurance adjusters work for the insurance company and will often contact injured workers and take recorded statements (beware of recorded statements – they can be used against you!). This person will likely be your first point of contact for your claim (unless you have hired an attorney to assist you) and will also be the person who makes the initial determination as to whether your claim is approved or denied and if medical care and/or wages should be paid. The adjuster will also be the person who will determine what (if any) additional treatment requested by your treating doctor will be approved. Most likely, you will go through numerous insurance adjusters.
Nurse Case Manager
The nurse case manager is hired by the insurance company. Their role is to monitor your medical care. They may even be present at your doctor appointments and report back to the insurance adjuster on your progress. The nurse case manager will also give an opinion to the insurance adjuster as to whether or not they agree with the course of treatment your doctor is recommending. In their reports, they also comment on statements made by the injured worker. Many times, the nurse case manager will consult with your doctor and possibly put pressure on him or her to return you back to work before you are medically ready. Remember – the doctor is the ONLY one who can write a work status note for an injured worker.
Virginia Workers’ Compensation Commission
The Virginia Workers’ Compensation Commission (also sometimes referred to as the Commission) is the State agency that oversees the administration of all workers’ compensation benefits. It is similar to General District Court. It is required that the Virginia Workers’ Compensation Commission be notified of all work injuries but many insurance companies fail to notify the Commission properly and it falls upon the injured worker to file a Claim for Benefits form with the Virginia Workers’ Compensation Commission. Injured workers can go to the Virginia Workers’ Compensation Commission for a hearing (if necessary, due to all or a portion of their claim being denied). You must understand that the Virginia Workers’ Compensation Commission is completely separate from the insurance company. The Virginia Workers’ Compensation Commission makes the final determination if a matter is contested or denied. The Virginia Workers’ Compensation Commission decides what benefits that you may be entitled to; however, they can’t order a settlement.
There is a lot more information in my book if you would like additional knowledge. Or, you can always call my office and speak to my trained intake staff that can help you identify your situation more specifically.
The Injured Workers’ Law Firm is a Richmond, Virginia based firm solely focused on serving clients with workers’ compensation claims in Virginia. If you have questions about your benefits or if you would like more information on the Virginia workers’ compensation system, order our book, “The Ultimate Guide to Workers’ Compensation in Virginia,” or call our office today (804) 755-7755.