If the insurance company denies you an MRI, a test, or any treatment really, what we do is file a petition in the Workers Compensation Court saying that you needed this form of treatment, it was denied or not approved, and we ask for a court order authorizing and approving the treatment or the test or the MRI that you need. And once we get that order, the insurance company now has to pay it because a judge has determined and weighed in on the controversy.

You can, and quite often your primary care provider is the quarterback of your care with respect to your work-related injury. But again, from time to time, if it’s something that requires you to be referred out to a specialist—an orthopedic surgeon, a neurologist, or what have you—then you’re still entitled to have anything that’s reasonable and necessary to treat you for your work injury approved and paid for by the workers compensation insurance company. And if they deny it, we know what to do on your behalf, and we know how quickly we can get it done.

If you find yourself in a situation where your doctor is saying you need surgery or an injection or some type of treatment or diagnostic study and the insurance company denies it, certainly not a fun situation to be in—but the question is, what do you do about it? If that happens and we represent you, what we do in that situation is make sure that the request for the treatment, the referral, or whatever your doctor’s looking to have you undergo is in writing. We ensure we can show it was demanded in writing to the insurance company, and then that the requisite period of time in Rhode Island—21 days—has passed. If the insurance company has either denied it or, quite often, not responded one way or the other, we don’t waste any further time. We file a petition in the Workers Compensation Court saying that your doctor has recommended this treatment and that the insurance company has not approved it in the 21-day period after you requested it in writing. When we do that and go to court for a hearing on this, the judge will look at the evidence and decide whether or not you need the treatment at issue—meaning, is it reasonable and necessary to treat you for your work-related injuries? That is a situation that happens every day, multiple times a day in Rhode Island and, indeed, in the Rhode Island Workers Compensation Court. We’re there every week enforcing our clients’ right to treatment that their doctor says is necessary to relieve them, cure them, or rehabilitate them from the effects of their work-related injury.

You do under the Workers Compensation Act. If you’re injured at work, if you’re entitled to workers compensation benefits, then you’re entitled to choose what doctor treats you and what doctor is trying to get you better. That is typically something you would choose at the beginning of your case, understanding that from time to time, your doctor that you do choose may decide you need to be seeing a different type of doctor or a specialist or may refer you out in some regard, and you are entitled to that as well, as long as we can show that it’s reasonable and necessary. You certainly don’t have to have your doctor picked for you by someone else, and certainly not by the insurance company.

If you’re feeling pressure from the insurance company or anyone to return to work, you should talk to your lawyer and see if it’s reasonable to try and get you back to work at that time or if it’s unreasonable because you’re still not better. The whole point of the workers compensation system is to be there for you during the time that you are unable to work, regardless really of how long that is. And we can talk about different cases in terms of how long you could theoretically stay out on workers comp for. But if you’re—and this does happen from time to time—people who are, and it goes back to the same issue, unrepresented injured workers talking with adjusters about their case, and oftentimes adjusters will make comments or do other things to make the injured worker feel pressure to go back or to feel guilty or bad that they’re not back as quick as the insurance adjuster would like to see them back so that they can close out their claim, so to speak.

So pressure to go back doesn’t really help anyone. There are already incentives built into the workers compensation system to get you back to work in due time, but no one really should be pressuring you unreasonably to get back to work because my experience is most people don’t enjoy being out on workers comp. They’re only making a fraction of what they’re used to, and not working every day has its own toll that it can take. So it doesn’t need to be exacerbated by some insurance adjuster making comments or remarks to press you to go back. And if that’s the case, you may want to consider why you’re talking to the insurance adjuster at all. And unrepresented, it should be your lawyer talking with them about your case—someone who has your interest at heart, as opposed to the insurance adjuster, who is an employee of the insurance company and has their interest certainly at the forefront of her consideration.

Yes, they can. And I don’t mean yes they can in the sense that they can pick what doctor is your treating doctor, the doctor whose job it is—like any doctor you see normally—to get you better. What I mean is: if the insurance company sends you a notice that they want to have you examined by a doctor they’ve chosen, hired, and paid for, you do have to go to that examination.

But they can’t decide who your treating doctor is. You can continue to treat with your doctor. You continue to be entitled to receive medical treatment and care for your injury.

But they—the insurance company—have the right to have you examined from time to time at reasonable intervals by a doctor of their choosing. And it’s important to realize that that doctor’s not your doctor. They have no physician-patient relationship with you. They’re not there to treat you or get you better.

In fact, you can’t sue them for medical malpractice if they give a wrong opinion to the insurance company about your case.

You certainly have rights with respect to who you see as your doctor for your work-related injury. There are specific rights you have to choose your physician in the first instance, and the insurance company can’t dictate that for you. Oftentimes, insurance companies or employers have a policy or a relationship with a certain medical facility where they encourage or tell all their injured workers to go to a specific place—but you don’t have to. Number one, you have the right to your own physician, but again, you need to have someone to enforce those rights and explain that you do have the right to your own doctor. The only exception is that from time to time, the insurance company does have the right to have you examined on a single one-time basis by a doctor of their choosing. They often refer to that as an “independent” medical examination or IME. There’s nothing really independent about it—the insurance company hires and pays this doctor, who is performing the examination for the insurance company, and there are many reasons why that can result in the insurance company doctor perhaps interpreting or finding things that benefit the insurance company more than they benefit you. You do have to go to these so-called independent medical examinations—we call them insurance or defense medical examinations at our firm—but you must comply, and I always tell my clients to be cooperative because you don’t want to go into these examinations with an attitude just because it’s the insurance company hiring them. You also want to talk to your lawyer both before and after your examination by an insurance company doctor because sending you for that type of examination, although it’s their right, can often forecast what’s to come in your case—whether it’s an attempt to stop your benefits, deny a surgery or treatment, or take some other action based on the doctor’s report. Also, when you’re sent to an insurance company doctor, you’re entitled under the Workers’ Compensation Act to a full and complete copy of the report once the insurance company receives it, but often they don’t provide it, especially if you’re not represented, and you may be left wondering what that doctor said. The insurance company can delay that if you’re not represented. There are also other rights involved—such as being entitled to mileage reimbursement for driving to and from these appointments—and again, these are just examples of rights spelled out in writing under the Act that you might not know about, and even if you do, you may not know how to go about enforcing them, getting that report promptly, or preparing properly before and after the examination to protect yourself.

Can they stop your benefits for any reason is a bit of a difficult question to answer, only because in one sense yes—sometimes they just do it, and even though they’re not supposed to, it could be a mistake, or perhaps sometimes it’s intentional. We don’t always know. But if you hired a lawyer and you were put on workers’ compensation benefits the right way and you’re entitled to those weekly benefits, then theoretically they cannot stop them without court intervention or you agreeing to it. You are protected, which means if they do for some reason stop your benefits even though they’re not supposed to, now there are legal ramifications to doing that and your lawyer can enforce your rights. So, for example, if they stop paying you for a certain period of time, you’re not only entitled to what they didn’t pay you—they may be responsible to paying you a penalty on top of it. Unfortunately, sometimes we do see cases where we have no idea why payment was stopped, but we know legally they can’t do that, and we can enforce your rights, go to court and get your payments resumed retroactive to when they stopped, plus penalties, plus attorney’s fees. So, ideally the insurance company pays everything they’re supposed to when they’re supposed to pay it. The reality, of course, as we know, is that doesn’t always happen, and that goes back to why it’s always a good idea to have an attorney waiting in your corner to promptly deal with a situation like that as soon as it occurs.

The insurance adjuster is the single person, typically that’s assigned to your case, your claim, and their job is to make sure you’re getting everything you’re entitled to. And that’s, of course, the ideal. Of course, the insurance adjusters also have in mind that they—their employer, the insurance company—they’re a for-profit business, and that can mean often that if something’s, let’s say, a close call in terms of whether you’re entitled to it or not, there’s a lot of incentive, whether explicit or implicit, for the insurance adjuster to do perhaps what’s in the insurance company’s best interest financially as opposed to yours. So that’s sort of both sides of it. Many of the adjusters do a wonderful job handling claims, but a lot of the times they serve their own master—the insurance company—and that often means you’re not getting what you’re entitled to or you’re not getting it as promptly as you should. And that’s why there should always be not only an insurance adjuster, who’s ultimately an employee of the insurance company and doing what’s in the insurance company’s best interest, but you should also have your person watching over your claim, and that’s your lawyer.

If you feel retaliated against after filing or pursuing workers’ compensation benefits, your first call should be to your workers’ compensation lawyer—and if you don’t have one, you should get one immediately. The next steps depend heavily on what kind of retaliation you’re experiencing. Depending on the situation, your workers’ comp lawyer may be able to address the issue directly or at least help you take the right steps to protect yourself. Fortunately, retaliation isn’t something we see very often, but when it does happen, it’s important to act quickly. Sometimes, the retaliation may fall outside the scope of workers’ compensation law, such as in cases involving discrimination, harassment, or other unfair employment practices. Those issues often fall under employment law, which involves a different legal framework and may require a different kind of attorney. In those cases, your workers’ comp lawyer can still help by referring you to someone who specializes in employment law and can take the right legal action based on your circumstances.