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How Workers’ Compensation Works

Workers’ Compensation in Missouri

At the Piatchek Law Firm, our attorney Scott G. Taylor handles many different types of workers’ compensation claims, ranging from simple injuries (which will lead to full recovery) to catastrophic workplace injuries (which may result in life-long disability) to death.

While results and financial recovery can differ greatly from case to case, there are certain patterns we observe in many cases. Therefore, we feel it would be helpful to describe what a typical workers’ compensation claim may look like in Missouri. We feel that the following theoretical scenario sounds familiar in many different types of workers’ compensation claims and with many different situations and injuries. If you have been injured on the job, this example shows what might happen during your workers’ compensation case.

Workers’ Compensation Case Study:

How a Common Workplace Injury Might Play Out

Assume you have injured your shoulder (or another body part) at work while lifting a heavy object. Perhaps no one else actually saw the injury happen, because you didn’t drop anything and nothing fell on you. You might have simply felt pain; or perhaps now you feel pain, but you didn’t experience pain before. Or, perhaps you have repeatedly lifted this heavy object over a long period of time, resulting in your current pain.

At some point, you mention your workplace injury to your supervisor. Your supervisor doesn’t take your injury too seriously and tells you to take some ibuprofen and rest. However, after a few days, your work injury is still really hurting, and now you can’t perform your job the way that you could do it before due to the pain.

So, perhaps you go back to your supervisor, who may have previously failed to record your first report of the injury. He now reports it, but since time has passed since the accident occurred, perhaps the company now questions whether something really happened the first time. In fact, perhaps the company wonders if something has happened over the last few days, maybe at home or elsewhere. In any event, your supervisor or HR administrator send you to see a doctor.

First Visit to the Doctor

The doctor has a nurse or assistant see you first. They ask you some odd questions and take down your history. For example, they want to know if you play softball, golf, swim, fish, or like to carry your grandkids around. Why would they ask you these questions when you are there about a workplace injury? Is it possible that this doctor is searching for another cause for your injury, no matter how remote the possibility? Is this doctor working for you or the insurance company?

The nurse or assistant may also ask you how often you perform these out-of-work activities. Eventually, they run a few diagnostic tests, and then the doctor sees you for a short time. He or she performs a few range-of-motion tests and asks you some additional questions. The doctor may or may not excuse you from work for a few days or advise that you be put on light-duty tasks.

Return to Work

After that, you go through some minimal treatment for your workplace injury, and then you go back to work. Perhaps you receive some checks for the time you were off work, if it exceeded three days.

Eventually, an insurance company claims adjuster will call you, although they may be called something else, like a nurse or case manager. They will ask if you have received all the care you need, and maybe even ask if your employer is treating you well. This person tells you they are there to make this process go smoothly. Is this true?

What is the motive of this person? What were the motives of the doctor and nurse you saw? Who is signing these people’s checks? Who do they work for? Do they work for you, or are they working for someone else? Could they even be working against you? Then it dawns on you: all the people you are dealing with are actually working for the insurance company. Remember that the way insurance companies make money is to minimize claims and minimize payouts.

If you end up needing additional care, they will likely send you back to a doctor, who, like everyone else, is on the insurance company payroll and has a vested interest in doing as little as possible to help you.

The doctor, nurse, case manager, and any others working for the insurance company may tell you to simply call if you have any additional questions. However, here is what they don’t tell you:

This entire time, going back to the first day you suffered your injury, you have only had a certain amount of time to file a formal workers’ compensation claim. Your time is now running out! And you may be entitled to much more treatment, financial assistance, and recovery than what you have been getting!

If you have a truly significant workplace injury, the company might even offer you a settlement, but it will be very low. Why? Probably because of the answers you gave to the questions in the doctor’s office – the doctor to which your employer sent you (see above). Your injuries are legitimate; however, there may be other factors outside of work that are also related to your workplace illness or injury, which you mentioned in the doctor’s office.

Insurance Companies Make Money by Minimizing Your Injury and Payout

This is how insurance companies minimize what they will pay you, in addition to many other practices. This is where the advice and representation of an experienced attorney is crucial. At the Piatchek Law Firm, our lawyers know how the system works and how to counter the tactics of your employer and their insurance company.

We know doctors who can give second opinions, and we are familiar with many of the doctors that are used by insurance companies. We can access the histories of the doctors and learn how often they work for insurance companies, and then we can use this knowledge to our advantage. We can make sure the judge knows about the doctor’s history or credentials if necessary.

Contact Us Today

The example above is just one general fact pattern. There are many variations that can occur, because each workers’ compensation claim is different. If you have been injured at work or have otherwise suffered a workplace injury or illness, contact our attorneys today. We can answer your questions, help you avoid common pitfalls, and get you the compensation you deserve. You may contact our firm at 417-882-5858.

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