The Workers’ Compensation Medical “Evaluation”

Want to avoid the following common scenario?

Your employer and their workers’ compensation insurance company immediately retain counsel to fight you. I strongly recommend that every injured employee immediately hire an experienced workers’ compensation attorney who can put an end to the games played by insurance adjustors.

Reporting Your Injury

If you are injured on the job in the state of Missouri, you have 30 days to report the injury to your employer. The employer’s rules cannot shorten this time. They may try to bully you by saying you failed to comply with the employer’s 24 hours reporting rule and, therefore, do not have a claim. However, in fact and law, you have complied with the reporting requirement by either telling your supervisor, filling out a reporting form, or by a note from you to the HR manager. There are multiple ways to report an injury. If the employer ignores your verbal report, then hand deliver a letter to them and be sure to retain a copy.

After several days, an insurance adjustor calls you and requests a recorded statement. You’re told that no treatment will be provided until after an investigation is performed. Missouri workers’ compensation laws do not allow this conduct. Once your injury is reported, the employer/insurer must provide medical care. Do not give a recorded statement. If the adjuster refuses to provide medical care, fax a letter to the adjustor confirming his or her conduct; then give a note to your employer explaining what the adjustor is doing; report the conduct to the MO Div. of Workers’ Compensation Fraud unit in Jefferson City, MO; and seek treatment on your own so that you have medical documentation of a work related injury.

Workers’ Compensation Medical “Evaluation”

You then receive a letter or call from the workers’ compensation insurance adjustor that an “evaluation” has been scheduled with a doctor. You think it’s for medical treatment, however, upon arrival at the doctor’s office you are asked to fill out pages of intake forms which contain numerous questions about how the injury occurred, your past employment history, and questions like “did you report the injury?”. Many questions are ambiguous and never asked by a true treating physician. Many questions only have space for a yes or no answer when the answer is not as simple as yes or no and you need to write an explanation. The body chart is poorly drawn and they want you to mark several different symbols only on the body chart when you would rather just write an explanation. They refuse to let you leave with the Questionnaire and say that the appointment will be cancelled if you don’t complete it before your appointment time. And you think… this is going to be my doctor???

On numerous occasions, clients have told me they had to wait 2 or more hours to finally see the doctor. My recommendation is this: after one hour tell the receptionist you are leaving. Then, give a note to the claims adjustor that you left the doctor’s office after waiting more than an hour past your scheduled time. In your note, request a physician that will be timely, courteous, and professional.

You are surprised when the doctor tells you that he is not authorized to treat you but was only authorized by the work comp adjustor to do an “evaluation.” Frustrated, you explain that your back pain is from your work injury, that your leg is getting number by the day, that you can’t sleep at night, that your supervisor is harassing you because you take unscheduled breaks for back pain and are working slower. You explain that you waited 3 weeks for the appointment and that the claims adjustor said it was for medical treatment. The doctor then won’t answer any of your questions and says that a report will be sent to the adjustor. Weeks later, you are still waiting, still in pain, and your boss is still picking on you.

Workers Compensation Claim