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How to protect your workers compensation claim when dealing with medical doctors

Medical evidence is usually the key to winning or losing workers' compensation disability benefits. It is therefore important to have a good relationship with the treating doctors, even those chosen by the insurance company.

The most common mistake the injured employee makes upon their first visit to the doctor is not adequately reporting the facts of the accident to the doctor. It is difficult to prove that the visit to the doctor is related to an on-the-job accident when the doctor's notes do not contain any reference to the on-the-job accident. You would be surprised at how often this occurs. It is therefore important to report the facts to the doctor and report them frequently.

You should understand that everything you tell the North Carolina Industrial Commission, the body that will find the facts in case of a dispute, the doctor could very well read. Therefore, it is important not to make any intemperate or unwise statements to the doctor. Many times the doctor does not himself make entries into the medical records. It is important to determine who actually makes the notes and be sure that they are done accurately. It is surprising how frequently inaccurate facts are recorded in doctor's records. Unfortunately, once these inaccurate facts are in the record, it is almost impossible to have them removed. If the doctor does not testify until a year-and-a-half after the injury, the doctor will likely have no independent recollection of his treatment. It is very unlikely that a doctor would admit that any entry in his record is wrong.

It is important to get copies of the medical records frequently and to correct any errors that exist in the records as nearly as possible to the date they were entered. The longer you wait, the more difficult it is to correct the mistake.

You should, of course, be truthful with the doctor so that he or she can treat your injury as effectively as possible.

If possible, try to get the doctor to agree to discuss with you his opinion about return to work restrictions, functional capacity results or anything relating to your ability to return to work before he gives them to the insurance company in writing or otherwise. Many times nurse rehabilitation professionals will unfairly try to influence the doctor's opinions with respect to these issues. You should at least have an opportunity to present your views to the doctor on an equal basis with the nurse. With respect to an honest doctor, there is no reason why your input should not be just as influential to the doctor as that of the nurse hired by the insurance company. The vast majority of doctors are honest and have your best interests at heart. With respect to the very few medical prostitutes, there is little you can do, but it does not hurt to try.

Be sure to specifically request that you be present for any and all conferences between the doctor and any rehabilitation counselor, nurse or vocational counselor. Although the rules specifically prohibit a rehabilitation professional from communicating with the doctor outside your presence, the doctor himself may request such a private meeting. If so, such a private meeting would probably not violate the rules. It is therefore important that you express to the doctor your desire to be present at all meetings with the nurse or vocational counselor. Doctors are generally very careful to observe patient physician privileges. While the privilege does not technically exist with respect to workers' compensation matters, a doctor will very likely be sensitive to your request to be present for these interviews and the request should always be made.

Be sure not to express any negative feelings or attitudes about the rehabilitation counselor or the workers' compensation insurance company to your physician. It will reflect badly upon you. Chances are the doctor is well aware of the practices of workers' compensation insurance companies and nurse rehabilitation counselors and how they operate. You will not be telling them anything they do not already know.

No matter what, do not lose your temper with the doctor. He or she is the one whose opinion is a huge factor in whether you win or lose your case. Even if you end up with one of the few medical prostitutes, do not show your anger.

Some lawyers advocate tape recording all visits to the doctor's office. This is a very ticklish issue. I advise against taking any recording of visits with the treating doctor. It will more than likely antagonize the doctor and ultimately do more harm than good.

With respect to a one-time doctor's examination by one of the non- treating doctors chosen by the insurance company, I advise the injured worker to take a tape recorder with them during the examination and to keep this tape recorder in the record mode during the entire time the worker is in the presence of the doctor. This will show how cursory the examination will likely be and will avoid any disputes at a later time as to what was said to the doctor. However, even with respect to the adverse examining doctor, common sense should be used and the doctor should not be provoked or agitated unless absolutely necessary. At the very least, keep accurate notes about the doctor’s adverse examination especially concerning the time the doctor was actually with you in the examining room, what he or she actually did to examine you, and how much time was spent examining you.

When being examined or treated by your workers’ compensation doctor for on the job injuries, be sure that the doctor does not treat you for any unrelated conditions at that same visit. If the workers’ compensation carrier notices that the record shows that the doctor treated you for anything unrelated to your workers’ compensation injury, they may disallow payment for the visit and require you to pay the entire bill yourself. If you need to see this doctor for something unrelated, be sure to keep the visits separate and distinct from your workers’ compensation treatment.

If the doctor prescribed over the counter medication, request that he give you a prescription for a similar medication that requires a doctor’s prescription. Otherwise, the workers’ compensation carrier may not pay for the nonprescription medication.

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