Joe Worker was performing his usual job as an IBEW electrician when he lifts his tool belt and feels a pop in his shoulder and neck. It’s Friday and almost quit time. Joe grabs a beer after work with his buddies and heads home. After a restless night of sleep, Joe’s arm is painful the next morning. He can barely lift his coffee cup. He is not noticing any symptoms in his neck. Ibuprofen gets Joe through the weekend.
Monday, Joe goes to Rick Supervisor and tells Rick about the pop he felt on Friday. The two fill out a report of injury. The report of injury states that Friday Joe lifted his tool belt felt a pop in his shoulder. Joe is sent to medical. Joe tells Dr. Clinic that he lifted his tool belt and felt a pop in his shoulder. Dr. Clinic takes x-rays of Joe’s shoulder, gives Joe more Ibuprofen and tells him to return to work. Later that day, Joe gets a call from Ida Dontcare, the adjuster at Denial Insurance. She asks Joe a series of questions about his injury. Joe tells Ida that he felt a pop in his shoulder when he lifted his tool belt. Then she asks Joe if he reported the pop in his shoulder to his supervisor right away. Joe confirms that he reported the incident on Monday when he returned to work after the weekend. Ida asks Joe what he did over the weekend. Joe tells Ida that he did not do much, just wrestled with his grandson.
Next thing Joe knows, his workers’ compensation benefits are denied because Ida Dontcare says that he probably hurt his shoulder while wrestling with his grandson.
This scenario is common. It is also a situation that can be remedied, but will take time, effort and probably an attorney. Meanwhile, Joe is hurting and needs medical care. He may be losing time from work. If Joe had reported the pop on Friday, it is more likely that his workers’ compensation benefits would have been paid.
The Missouri Workers’ Compensation law requires that “employees must report all injuries immediately to the employer by advising the employer personally, the employer’s designated individual or the employee’s immediate boss, supervisor or foreman and that the employee may lose the right to receive compensation if the injury or illness is not reported within thirty days…”
Lesson #1: Report injuries right away, no matter how slight they may seem at the time.
Joe hires a lawyer. He continues to work in pain without treatment because his private insurance will not pay for work-related injuries. The lawyer files a claim. With his lawyer, Joe gives his deposition to his employer’s attorney. Following the deposition, Ida Dontcare agrees to send Joe to a doctor. Joe sees Dr. Specialist who orders a MRI of his shoulder. The MRI is negative. Dr. Specialist orders another MRI of Joe’s neck. Ida Dontcare denies authorization for the MRI because Joe never mentioned that his neck was injured. Joe remembers that his neck also popped when he lifted his tool belt. Ida Dontcare denies all testing and treatment for Joe’s neck anyway. Joe needs surgery and is caught again between workers’ compensation and his private insurance.
Unfortunately, this is another common scenario.
Lesson #2: Always include all body parts when reporting an accident, even if one seems to be more symptomatic than another.
Joe has learned two lessons about workers’ compensation the hard way. Insurance companies are often looking for reasons to deny claims. Don’t make it easy on them.
Look for more lessons from Joe Worker in future issues of the 1439 Times.
* *Ann Dalton is a partner at Hammond & Shinners, P.C. where she practices exclusively in the areas of Workers’ Compensation and Social Security Disability, representing claimants in Missouri and Illinois. For questions, Ann can be reached at 314-727-1015 or by email at firstname.lastname@example.org. The firm’s website can be viewed at hammondshinners.com.