Myth: The Worker has to “eat” lost wages when attending treatment.
FACT: The Worker is eligible for reimbursement from the insurance carrier for mileage to and from treatment visits together with wage loss payments if the Worker misses 4 or more hours for treatments in a single day.
Myth: The Worker must treat with the doctor chosen by the Employer or the Insurer.
FACT: Not only may the Worker treat with whomever he/she chooses, neither the Employer nor the Insurer can direct or mandate treatment without enrolling the Worker in an MCO.
Myth: Once the Worker chooses an Attending Physician, he/she is stuck and cannot change doctors.
FACT: The Worker may change Attending Physicians up to two times without permission from anyone.
Myth: The Worker has no compensation rights if he/she injures an area previously injured or if there is a pre-existing condition.
FACT: The Worker has compensation and benefit rights so long as the new injury is the “Major Contribuing Cause” of the condition and need for care, regardless of past history.
Myth: The Worker must cover the cost and risk in pursuing Workers’ Compensation benefits.
FACT: The cost of pursuing benefits are largely covered by the Insurer; and the Worker is rarely at risk of owing costs. Attorney fees are generally paid directly by the Insurer, or as a percentage of increased benefits secured by the representation.
Myth: The Worker has the task of proving that the major contributing cause of his/her condition is the WC injury and not a pre-existing condition.
FACT: The Insurer has the burden of proving that the pre-existing condition is the major contributing cause of the current injury.
Myth: “I hurt my leg on the job, and all the limping has caused my back to hurt.” Too bad. Workers’ Compensation won’t cover treatment for this back pain.
FACT: Though the Worker bears Burden of Proof, if you have pain in another area as a direct result of the original injury then it is covered by Workers’ Compensation.
Myth: The Worker need not cooperate with the Insurer or the Claims Process.
FACT: A WC claim will be closed if the Worker does not cooperate with the Insurer, the Claims Process or the doctors. Examples: If the Worker fails to attend treatment for 30 days, or fails to attend a closing exam the claim will be closed.