Workers’ Compensation – Who’s Your Friend?

If an employer in Virginia regularly employs three or more employees, the Virginia Workers’ Compensation Act requires the employer to maintain workers’ compensation insurance. The workers’ comp insurance companies – not employers – almost invariably exercise total control over the claims of injured workers. These companies DO NOT have the best interests of injured employees at heart. (Indeed, the companies don’t even have a heart!)

There is no credible dispute over the fact that the workers’ comp system is beneficial to injured workers. As with most laws, however, there are unintended consequences. No one questions the validity of a profit-driven enterprise . . . but reason must govern all things. Regrettably, in their quest to increase their profits, workers’ compensation insurance companies often engage in unreasonable behavior. One way they do so is to hire someone to say that white is black, or vice versa.

On March 31, 2009, the New York Times published an article entitled “Exams of Injured Workers Fuel Mutual Mistrust.” The article addresses the so-called “independent” medical examination, in which a physician paid by a workers’ comp insurance company examines an employee seeking workers’ compensation benefits. The extensive article includes these enlightening words:

Dr. Hershel Samuels, an orthopedic surgeon, put his hand on the worker’s back. “Mild spasm bilaterally,” he said softly. He pressed his fingers gingerly against the side of the man’s neck. “The left cervical is tender,” he said, “even to light palpation.”

The worker, a driver for a plumbing company, told the doctor he had fallen, banging up his back, shoulder and ribs. He was seeking expanded workers’ compensation benefits because he no longer felt he could do his job.

Dr. Samuels, an independent medical examiner in the state workers’ compensation system, seemed to agree. As he moved about a scuffed Brooklyn office last April, he called out test results indicative of an injured man. His words were captured on videotape.

Yet the report Dr. Samuels later submitted to the New York State Workers’ Compensation Board cleared the driver for work and told a far different story: no back spasms, no tender neck. In fact, no recent injury at all.

“If you did a truly pure report,” he said later in an interview, “you’d be out on your ears and the insurers wouldn’t pay for it. You have to give them what they want, or you’re in Florida. That’s the game, baby.”

. . . .

[A] New York Times review of case files and medical records and interviews with participants indicate that the exam reports are routinely tilted to benefit insurers by minimizing or dismissing injuries.

“You go in and sit there for a few minutes — and out comes a six-page detailed exam that he never did,” said Dr. Stephen M. Levin, co-director of the occupational and environmental medicine unit at Mount Sinai Medical Center, who has been picked as the interim medical director at the compensation board. “There are some noble things you can do in medicine without treating. This ain’t one of them.”

If you’re injured on the job, please don’t feel comforted if your employer says something along the lines of “You don’t need to file a claim with the workers’ compensation commission, because our workers’ compensation insurer will take good care of you.” That insurer has one motivation – to maximize profits. Accordingly, how do you think it will view your injury?

Our enduring advice is that an injured worker should always seek legal counsel – and fast! HammondTownsend is here to serve you.

The article mentioned above can be found here:

http://www.nytimes.com/2009/04/01/nyregion/01comp.html

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