One of the main complaints in a workers’ compensation case from both the perspective of the injured worker and the insurance company is communication — more specifically, the lack of communication between all the involved individuals and parties.
Who’s involved in a workers’ compensation case?
There are 4 main parties or groups in a workers’ compensation case.
- Claimant. First, there is the injured worker and their representatives. This includes attorneys who represent the injured worker, family members of the injured worker and maybe even friends of the injured worker.
- Employer. The second party in a workers’ compensation claim is the employer. The list of representatives for the employer may include supervisors, safety managers, members of the human resource department and witnesses to the accident.
- Insurer. A third party that is involved in a workers’ compensation case is the insurance company and those who represent the insurance company. These folks include adjusters, attorneys for the insurance carrier, and nurse case managers. What they all have in common is that they are paid to represent the insurance company.
- Medical providers. The fourth group in a workers’ compensation case are the medical providers. Medical providers include doctors, physical therapists, nurse practitioners and medical assistants.
As you can see, there are many different individuals who may be involved in a workers’ compensation case. Ensuring proper communication between all of these parties is essential in achieving the objective of a workers’ compensation claim, which is ensuring that the injured worker receives medical treatment that allows them to return to work.
Why communication is key
It is important that there is constant communication between all of the parties because so much of the workers’ compensation system is built around the injured workers’ treatment with the authorized treating physician. The authorized treating physician determines when an injured worker can return to work, when they are unable to work, or when they can work but with certain restrictions.
There are times when an insurance carrier will hire a nurse case manager in an attempt to coerce a doctor to release an injured back to work before it is medically prudent. Sometimes these nurse case managers will draft correspondence to doctors omitting relevant and important facts about the claim in pursuit of their objective.
Other times, nurse case managers attempt to attend the appointment with the injured worker. Georgia law allows the injured worker to request that the nurse case manager not be present with them when they are seeing the doctor.
New Jersey law aims to improve communication
New Jersey recently proposed a law in an attempt to deal with the communication problem commonly present in workers’ compensation cases. This new law will require the employer or insurance company to notify the injured worker or their representative of the time, date and substance of any communication they have with the authorized treating physician.
We’ll see if this new rule helps to reduce the nefarious actions that commonly take place on behalf of the insurance company with the authorized treating physician. If it does, rest assured that we’ll advocate for similar legislation here in Georgia.
