The Workers Compensation Insurance Company Will Try to Manage Your Medical Care and Direct Your Health Care Providers


The Virginia Workers’ Compensation Act prohibits insurance companies from managing your medical treatment and directing your health care providers. Under Virginia workers’ compensation laws, the employer and insurance company’s role in your medical care is limited to providing you a list of doctors from which to choose your workers’ compensation physician. The doctor you choose from the list becomes your authorized treating physician, and the employer and insurance company are responsible for paying for reasonable and necessary medical care given by or at the direction of your treating physician.


Though the law may prohibit insurance companies from meddling in your medical treatment, that doesn’t mean the insurance company won’t try to manage your care. And they have come up with many strategies and tactics to keep their costs low. Unfortunately keeping costs low often has a negative impact on you – the injured worker.


This article discusses common strategies that insurance companies use to interfere in treatment for your workers’ compensation injury. These tactics may have a negative impact not only on your physical and mental recovery following a workplace accident, but also on the workers’ compensation settlement value of your claim. If you think the employer or its insurance carrier are trying to manage your medical treatment, call, text, or email workers’ comp lawyer Corey Pollard for a free strategy session. We help disabled workers across Virginia, including those in Richmond, Chesterfield, Roanoke, Williamsburg, Hampton, Newport News, Fairfax, Prince William County, Norfolk, Chesapeake, and Virginia Beach.






3 Strategies Used by Insurance Companies to Limit the Value of Your Workers Comp Claim


1. Contacting Your Doctor Before Your First Appointment


The claims adjuster or nurse case manager assigned to your case may call or write your treating physician before your first appointment. While we’re ok with the insurance company contacting your physician for the purpose of scheduling appointments or authorizing medical attention, we’re not ok with the other reasons that insurance companies contact treating physicians.


In many cases we have seen the insurance company representative do the following before the injured worker’s first medical appointment:


  • Give an inaccurate description of how the work accident happened to the treating physician
  • Tell the treating physician that the employer thinks that the injured worker is faking the injury or exaggerating about his or her symptoms
  • Provide copies of medical records from prior injuries to the treating physician


Why would the insurance company do this? To gain an advantage in workers compensation litigation. If the doctor questions your credibility then he or she may release you back to work sooner or ignore some of your complaints, which decreases the value of your claim.


2. Asking Your Treating Physician to Not Give Off Duty Work Notes


If your treating physician gives you work restrictions and your employer is unable to accommodate those restrictions, then you may be entitled to temporary total disability or temporary partial disability benefits to replace your wage loss. This increases the value of your claim.


To avoid having to pay you wage loss benefits, the insurance company may ask your treating physician not to give you off work or even light duty notes. Without restrictions from your treating physicians you have a low chance of receiving wage loss benefits from the Virginia Workers Compensation Commission and must continue to work, even if you’re in pain.


Don’t be surprised if the claims adjuster or nurse case manager tells your treating doctor that your employer has a light duty position available, even if you know that’s not true. If the insurer is able to persuade your doctor to give you light duty instead of off duty restrictions, then you must market your residual work capacity to receive wage loss benefits. The insurer knows that it can defend your claim on the basis that you’re not adequately marketing your residual work capacity. This forces you to either accept a low ball settlement offer or to prove your entitlement to benefits at a workers compensation hearing.


3. Suggest Alternative Treatment Methods to Your Treating Physician


In reading this article you may be seeing some themes. The insurance company will do whatever it can to show that you’re not a credible person if you do not recover as quickly as it thinks you should.


Depending on the type of injury you suffered, the insurance company may suggest certain tests to determine whether you are magnifying symptoms. This can be anything from physical tests to asking your treating doctor to refer you to a psychologist to see if you have symptoms of somatoform disorder.


Another common situation where we see insurance companies try to manage and direct medical treatment is when a doctor suggests steroid injections or surgery. The insurer may try to persuade your doctor to send you for more therapy instead of undergoing injections, diagnostic testing, or an operation because therapy is cheaper than these alternative options.


Managing workers compensation cases is an industry worth hundreds of millions of dollars, if not more. The insurance company has many individuals working hard to limit the value of your case.


You don’t have to sit back and let the insurance company run wild. We recommend contacting an experienced workers compensation attorney from the beginning who will be proactive and make sure that the insurance company does not do anything that is prohibited. Contact us today to get a top-rated workers comp attorney in your corner.