Part II: Five More Things the Vermont Workers' Comp Adjuster Won’t Tell You
Continuing our two-part post on things the workers' compensation adjuster won't tell an injured worker, our attorneys discuss five more things that adjusters don't share with Vermont workers' compensation claimants.
If you want to go to your own doctor, or you don't want to share your entire medical file with the adjuster, or you don't want to let the nurse case manager into your appointments, you are not alone. Adjusters tell claimants a lot of things, like suggesting they need a referral to see a specialist or insisting on getting a preauthorization request for medical treatment, but one thing they don’t do is tell claimants everything they are entitled to.
Read on to learn more about what you are entitled to while you are on workers' comp.
1. You Don't Need a Referral to See a Specialist
A lot of healthcare specialists require a referral, but the Vermont workers’ compensation system does not. You can self-refer, and your visits will be covered by the insurance company so long as the treatment is reasonable, necessary, and related to the work injury.
2. You Don't Need Preauthorization for Medical Treatment
Vermont also does not require preauthorization for medical treatment that is reasonable, necessary, and related to your work injury. Some medical providers like to have it because they think it will help them get paid, but this is not required by the workers' compensation insurance company—if you have an approved Vermont workers’ compensation claim, your doctor can treat you and bill the insurance company for payment, and the adjuster must pay within 30 days. If your doctor does decide to seek preauthorization, the most important thing they can do is fill out the request correctly. An incorrect request is easy for the insurance company to deny.
3. You Don't Have to Share Your Whole Medical File
The adjuster will want to review the medical records and bills for your injury and treatment. This is very important as it can help to link your injury to your workplace, and therefore you must sign the required authorization (Form 7) if asked. If you don’t, it gives the adjuster a reason to deny your claim. But you don’t have to give up your privacy and provide your entire medical file. You only need to give them access to the records that relate to your work injury.
4. Workers' Comp Must pay Medical Treatment for the Injury for Life
After you reach medical end (the point when you are not expected to improve any further), you’re still entitled to medical treatment for the body part you injured for your lifetime. Your claim stays open, and the adjuster must continue to pay for future medical treatment related to your injury for your lifetime. The exception is if you decide to sign a full and final settlement of your claim. In that situation, your claim is closed, and treatment will not be covered if your injury gets worse over time or if you need ongoing medical treatment or prescription medications. The insurance company’s settlement offer may sound generous until you compare it to the cost of future medical care over a lifetime. For this reason, we recommend that you talk to a lawyer before signing a full and final settlement agreement.
5. You Can Choose Which Doctor Does Your Rating
When you reach medical end result, the adjuster may request an impairment rating in order to decide how much money to pay you as a permanency settlement. They may try to force you to accept a settlement (Form 22) based on a rating from a doctor of their choice, but you don’t have to agree without getting another opinion. In Vermont, you can choose a second doctor to do a medical evaluation for your impairment rating. The adjuster must pay for both sets of evaluations—and they must start paying you the permanency money you are owed, even without an agreement being signed and even if you are going to go see another doctor for a rating. Most treating doctors do not do these ratings or if they do, they do them incorrectly. BFS can help you choose a good doctor who will be accurate and generous in their rating.
6. Bonus Tip: You Can Exclude the Nurse Case Manager from Your Appointments
A nurse case manager (NCM) is a medically trained nurse hired by the insurance company to help you get the treatment you need to recover. Some are helpful, but others intrude and apply pressure rather than showing support. In Vermont, while you can’t choose your NCM, you can choose whether to talk with them and you can say no if they ask to go into your medical appointments or speak with your providers. Denying the NCM access to your appointments does not give the insurance company a valid reason to deny payment for treatment.
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