Who is Who in Your Workers’ Compensation Claim
If you have a Vermont workers’ compensation claim, you know that there are a lot of people involved and it often feels like you are “the little guy”, fighting your battles alone. This guide describes each person’s role and shows clearly who you can look to for help and who does not have your best interests at heart.
Claimant (You): A person who gets hurt at work.
Your Attorney: A legal professional who represents you in your workers’ compensation claim and helps you get all benefits due to you. They force the insurance company to follow the law and pursue justice if it does not. They communicate with the nurse case manager, especially if the claimant chooses not to.
Your Medical Providers: Your own doctor, nurse practitioner, chiropractor, physical therapist, specialist, or any provider who you have a relationship with. They can be a big help in your case.
Employer: The individual or organization that you were employed by when you got hurt.
Workers’ Compensation Insurer: The insurance company contracted with your employer to provide employees with workers’ compensation benefits.
Adjuster: An insurance company employee who investigates your claim and chooses whether your benefits will be paid. He or she can deny claims, underpay benefits or pay late, reject medical treatment requests, not respond on time, or not tell you about all benefits available to you.
Defense Attorney: A legal professional who works with employer and insurance company to fight workers’ compensation claims and minimize the benefits paid.
Company Doctor: A medical provider paid by insurance company to perform medical exams that favor the insurer.
Nurse Case Manager (NCM): A medically trained insurance company employee, supposed to help you recover but often biased towards the insurer. You can’t choose your NCM but you can choose whether to talk to them. BFS can help you manage your NCM to benefit you.
Your team: A good NCM makes your recovery easier. They use their medical knowledge to get you referrals, arrange medical appointments and transportation, and get tests and treatments pre-approved.
Employer’s team: A biased NCM forces contact with you, tries to intrude in your doctor-patient relationship, and hurries you back to work. They apply pressure rather than showing support.
Vocational Rehabilitation (VR) Counselor: A specialist paid by the insurance company to help some claimants return to work. You can choose your VR counselor but take care to choose the right one. BFS knows the best VR counselors in Vermont and can help you choose someone who will be on your side.
Your team: If you can’t return to your pre-injury job, a good VR counselor will help you get a better job and will not be focused on cutting costs for the insurance company.
Employer’s team: If chosen by the insurance company rather than by you and your attorney, chances are the VR counselor will work more for the insurance company than for you.