At Kenneth G. Franconero, PLLC, we are often asked by our DBA clients, why it takes so long to obtain medical treatment and wage loss checks.
First and foremost, a claim will start out by establishing a relationship between the claimant and the adjuster. The adjuster does an preliminary investigation of the injury. This involves talking with the employer and confirming than an accident happened on the job. Where facts are controverted, such as when an injury does not develop until weeks after the workplace trauma, the Adjuster may controvert the injury, and then gather additional information from investigators or doctors. Even the best cases will go south, however, when it reaches a point where the adjuster no longer wants to pay out the claim. She may order an “independent” medical examination (“IME”), but that is usually with a doctor that is cherry-picked by the insurance company.
Depending upon what the DBA Adjuster’s doctor says, he may decide to terminate wage loss benefits, concluding that the worker is able to return to work. Also, medical care may be terminated or reduced, if the IME doctor disagrees that the treatment you are getting from your own physician is medically necessary.
Who is Looking Out For Your Best Interests?
In actuality, it often takes longer for an injured worker to recover from her injuries, and that months, and not weeks, are often necessary to gain full functioning and return if possible to her pre-injury employment. However, doctors, even those who accept workers’ compensation cases, are often beholden to health insurance and workers’ compensation pressures to finish up care quickly, and release patients to work – often prematurely. They are often conditioned to treat patients this way, since insurance companies pay their bills, not patients directly.
Our San Diego Defense Base Act law firm at Kenneth G. Franconero, PLLC will often get the case when things have reached this “going south” point. To the worker, often times things feel like they are taking longer than before they hired an attorney. Often, things are indeed going slower. But the slowdown is not the result of attorney involvement. Rather, it is the Adjuster who is slowing things down by denying benefits which should actually be paid. The treating doctor, and not the adjuster or their IME or peer review physicians, should be in charge of the course of medical treatment.
Get Treated, Get Healthy, Get Compensated
At Kenneth G. Franconero, PLLC, there is no pressure for us to get our clients back on your feet sooner than their doctors recommend. Instead, we fight to make sure that your treating doctors’ treatment course is respected and complied with by the Adjuster. The law actually presumes that your doctor’s treatment is compensable, in the absence of substantial evidence to the contrary. See LHWCA §20(a).
Whether benefits are another six weeks of physical therapy, three more months of time off benefits, or authorization for a denied prescription, we make sure our clients’ treatment and wage-loss benefits are fully paid.