Nurse questions why workers' compensation case remains unresolved




Workers comp: What’s the purpose?

A reader submitted a question about her inability to resolve a three-year-old case she filed under her state’s workers’ compensation statute. Nothing seems to be progressing and she believes that those involved are “passing the buck,” so the claim will not be paid.

Workers’ compensation laws basically exist in two forms — state systems and federal systems. The reader’s question deals with her state system. State workers’ compensation laws have been in existence in the U.S. since the late 19th and early 20th centuries.

The purpose of workers’ compensation laws is to provide employees who are injured with financial compensation if the injury “arises out of and during their course of employment”. The “win-win” characteristic of such laws is that the employer cannot be sued for negligence that might have led to the worker’s injury and the employee is able to receive compensation and other benefits without regard to the employee’s fault or conduct leading to the injury.

Although this characteristic protects the employer from being sued and provides workers’ compensation as the only recourse for employees, litigation costs, lengthy litigation and attorney fees are reduced.

Currently all states in the U.S. have some form of workers’ compensation laws, but they vary. However, one fact does not vary: They cover employees.  Independent contractors, domestic workers and agricultural farm laborers, as examples, are not covered.

It’s unclear exactly how those involved in this reader’s claim are meeting their obligations. Is it the employer who is dragging its feet? Is the doctor who is treating the nurse not filing his or her medical reports on time?

It’s a multi-step process

It is unclear why this nurse’s case has not been handled more quickly. Obviously, all procedural and evidentiary requirements of the law must be met and this can take time, but there are “customary” steps that are included in most workers’ compensation systems.

Those steps include notifying your employer of the injury or accident, filing a claim with the state agency administering the state statute, seeking medical treatment as soon as possible, wage verification, claim determination (accept or reject), initiation of paying benefits or contesting your claim by the employer, and an appeal phase should you want to object to the denial of your claim. The time limits within which these steps vary from state to state.

It’s unclear exactly how those involved in this reader’s claim are meeting their obligations. Is it the employer who is dragging its feet? Is the doctor who is treating the nurse not filing his or her medical reports on time? Is the nurse’s workers’ compensation attorney truly representing her as he or she should?

The best solution in a situation like this is to consult with another workers’ compensation attorney and determine if the process is flawed, delayed or going at the right speed for the injury this reader experienced. If there is a problem with the nurse’s representation, she can terminate her legal relationship with the current attorney and retain the attorney with whom she consulted. Doing so will hopefully move her claim forward.

Have you experienced difficulties with a workers’ compensation claim?  If so, how did you resolve them?

EDITOR’S NOTE:

Nancy Brent’s posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.


About the author
Nancy J. Brent, MS, JD, RN

Nancy J. Brent, MS, JD, RN 

Nancy J. Brent, MS, JD, RN, Nurse.com's legal information columnist, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. To ask Nancy a question, email BrentsLaw@nurse.com.

26 responses to “Nurse questions why workers’ compensation case remains unresolved”

  1. If she thinks her case is a mess, try mine. Federal employee for 15 years, established the Union for civilian employees at our base. From that point, I was degraded, started getting written up daily, was fired for so called “incompetence”. Fought back via Union resources, the arbitrator decision was that the termination was clearly due to Union activities and not incompetence and ordered the Agency to return me to my position (2 years later). Returned to work to a very hostile working situation. Began being written up daily, make to work out of a closet, was under constant surveillance even at my home and on my off days. Within 10 months was sent home for “home duty” due to round 2 of incompetence”. Was watched at my home. Terminated again even though 90% of the decision was based on not getting back to patients in a timely manner on days/weeks I was home on leave or doing Union things that I was out of the office for over a week… It goes on and on. The mind boggles.
    I was put on antidepressant medication during round one. Began counseling the day I returned for round two because I finally had insurance again. It goes on and on. Under oath, the EEO and mediator for the base stated that he had a team building session with the chain of command that I would be returning to, and when he returned from the meeting, he informed the head of EEO that “she doesn’t have a chance in hell”.
    I filed a intentional infliction of emotional distress claim to get back my sick leave that I took because I was so depressed at that point that I was having TMS to my brain because after 4 years of abuse and depression, the part of my brain that says ‘be happy’ was no longer functioning correctly.

    It has been a year now and workers comp just denied step one. They had over 200 pages of doctor and councilors notes and about 2000 pages of transcript from round one that clearly state that my depression was due to working conditions. I now have to go to round 2 with workers comp and have filed for disability retirement.

    I know, a long story but here I am 5+ years after this whole thing started and I am nearing the end of my unemployment benefits and still to paranoid and depressed to leave my own property. I have been Dx with Generalized Anxiety Disorder, Major Depressive Disorder and Agoraphobia with Panic Disorder all having to do with the treatment by my employer.

    To that end, I do not think that workers compensation ever has any intention of paying claims. They just prolong it until you give up. This is the way government and state agencies work. There is no third party neutral to keep them in check. If someone has a workers comp case, just hire the attorney to start with because you will eventually have to go to court for fair treatment.

  2. I am a RN retired due to 100% disability rating by my Workers Comp doctor. My case settled, so I am now applying for Social Security. If I can work in a home or at a desk job part time, I would like to apply for Vocational Rehabilitation. I live in California.

  3. I was injured while working in July, 2015. I tried to handle it through my hospital, but that didn’t go as I had expected. My hospital had assigned worker’s comp cases to an insurance company, who told me that they would handle it, even providing me with a IC (industrial commission) case #. After a couple of months, I contacted the IC in my state and they told me that they had no record of any claim being filed. I talked with the IC case worker and she had me file the claim that day with the ICA in my state. 15 days later, my case was denied by the insurance company, and they had not even examined me, not had they been given access to the medical records from my doctors. A month later, I received a notification of an IME (independent medical exam) date. I went to the office, which was 130 miles away, and there were 19 people in the waiting room. The receptionist told me that I would have to re-schedule because they couldn’t see me that day. I immediately called the claims’ adjuster for the insurance company, and as usual, my call went directly to her voice mail. I left a message and also texted her, but never received a response…ever. When I finally did get in touch with her, she lied to me, and said that because I did not go to the appointment, they were going to dismiss the claim. I told her that she was lying, I proved to her that she was lying, i.e. the text and voice mails, and then she told me that the doctor’s office had told her that I was late…another lie. When I continued to confront her with her prevarications, she hung up on me and the next thing I know, I received a letter from the insurance company’s attorney. I then contacted an attorney. My case went before the IC in on June 7th, 2016. The decision that I was injured at work came down on June 30, 2016. I still have not been reimbursed for all my medical expenses that I had out of pocket, nor have I received any remuneration for the lost wages that they are supposed to be paying every 30 days, which right now is a considerable sum, even with my attorney’s fees taken out. I have talked with numerous people and the most common response is that worker’s comp is only good for the companies to which the premiums are being paid, and those companies will stonewall the injured parties until they finally give up trying to collect to what they are entitled.

  4. 3 years?! That appeared to be a weak answer to the question. Surely the nurse indicated what state she was referring to. More money will be required, as the link to The American Association of Nurse Attorneys was included. I would hate to be in her shoes.

  5. My attorney in S. Fl handled everything. I was terminated six months after I submitted my work comp claim. I had to get an attorney who would be assertive and tenacious against a Fortune 500 company. My lawsuit settled after 3 years and I was compensated for retro work comp payments and my judgment award. Couldn’t believe I won against them. My attorney really fought for me. You really have to have good legal representation.

  6. My workers compensation went on for 3 years; it left me bankrupt and I lost everything that I worked for. During that time the employer, short term disability, long term disability, and workers compensation argued over who’s responsibility it was to pay me. After 3 years, hiring my own lawyer (after the union lawyers told me to hire a private lawyer), finally getting a court date the judge that everyone had to pay me for the time that fell under each entity. But in the mean time, I lost everything. The lawyers got a third, and my life was left in shambles. I was broken, humiliated, and embarrassed to a have had to file bankruptcy. Where is the justice? I lost my children’s home, left unable to assist them through college, lost my vehicle, and suffered personal humiliation among family, friends,colleagues, and neighbors as the house was put into foreclosure. I thought I had done everything right; I bought short/long term disability, had a savings account large enough to last for a full year, before it all fell apart. Ten back surgeries later and I am unemployable and disabled. The healthcare system always said in their motto “they care”; they care my rear, they hung me out to dry with the intention to let me go without payment as long as they could. I’m very bitter with our healthcare/disability systems.

  7. I also had a workers comp case . it took years to resolve, I ended up firing attorney and had to keep paying him anyway. I lost everything and had been an RN for 25 years. I am still not working well I try to but can not do the job and end up leaving or not getting called back. I have been trying for Social Security since 2010 and my injury keeps getting worse and worse, now I have full blown carpal tunnel for the mult surgeries to try to fix, spinal stenosis, major depression,was suicidal, herion (opiates) abuse cause dr took me off ALL meds, and pain was and is unbearable. I lost my insurance and was considered a “self pay”. Now 1 year clean, with program I begged to get in. I also have a protruding hernia that is going to pop but I have to try to keep working cause lost 1 home already and about to loose another. So after serving the public for 25 plus years this is what I get from Government!!!

  8. Having spent over 20 years in the Workers’ Compensation field as a Nurse Case Manager and an educator for new nurses to the field of Workers’s Compensation I can tell you this case is not the norm.
    Three years is entirely too long for a case to languish without resolution.
    In order to be more specific I would need to review the entire case.
    Unfortunately when nurses are injured on the job it is very difficult to get them back to their original job, especially when there has been a back injury.

  9. I am a registered nurse who was hurt 1/24/2010- the case is still open, still waiting approval for 2 more surgeries and i am wkng (as i can).
    This is delay, deny and unethical.
    Please advise
    I have had a excellent lawyer from day one- the lawyer is not the problem it is the work comp changes. One has to go through hoops to get any treatment…
    As a registered nurse caring for patients, shouldnt i get the same medical treatment and care i give to my patients?
    Unfortunately- i dont and continue to struggle with work comp. its not humane!

  10. Many states (PA included) have made drastic changes in the system. They make all changes retroactive. There can be a limited amount of time you can remain on W.C. if your “Independent Medical Examiner” fools with the impairment rating or declares Maximum Medical Improvement. You pray for Social Security for survival. W.Comp. declares your treatment innapropriate and suddenly you are paying all of the bills.Legal also.
    Into court, into a Independent Dr who is working for the insurer and makes a judgement in 5 or 6 minutes.It is constant harrassment. And you must pay into this system. System is broken here, it favors the insurer not the claimant.

  11. My work comp case from 1989 was finally taken care of.
    I had to contact my attorney to get anything, meds, injections, mri, It has been a long drawn out process. Private investigators, they would follow my teenage daughters home from the bus stop.
    27 years is a ridiculous amount of time to ‘own’ somebody. I am so happy to be free of them. Even though I am permanently disabled, attitude is everything.
    Don’t give up!

  12. after 45 years working as a BSN, in hospital and the last 30 years in home health, I have discouraged all friends and children not to be a nurse. Due to the wear and tear on my body – turning, lifting and for the last 30 carrying a 20# scale on one side and a 20# bag of supplies on the other as well as delivering boxes of diapers since it saved the company postage, I am now the bionic woman. titanium in neck for 3 vertebrae fused, both shoulders totally replaced and lumbar sacral fusion and discovered I am allergic to titanium – now this should be workmen’s comp but instead after the lumbar fusion and continuing pain, I was fired after working there for 10 years!!! This makes no sense to me. I have already gone through half of my 403B paying for an apartment since I can’t climb 3 flights to my condo”home”. I can’t sell it because it is 30yers old although was in great shape until I rented for 2 years and they both trashed it. I am paying mortgage and apartment rent and have copay for the chiropractor 3 days a week so one day I hope to be able to walk safely without falling!!! DON’T BECOME A NURSE!!! NOW MY GRANDDAUGHTER IS IN NURSING SCHOOL BUT SHE WILL GET LOTS OF GUIDANCE FROM ME.

  13. Gee Whiz,only 3 years. I’m from California and myself and everyone I know who has had a case has waited 4 to 5 years for resolution. All attorneys say the same thing — can’t get a response from the State. Dealing with the State on another matter has met the same stonewall with the State now in breach of contract for the 2nd time. I got hurt once before on the job about 15 years ago and it was resolved within months. Maybe it has to do with who your employer is or was. The system here is beyond broken.

  14. I was an independent contractor working in an Autism school when a student threw a docking charger at my head and caused horrible pain and concussion. His worker lied that he was present watching him; and I did not have Workman’s compensation. I lost 16,000 of my savings staying out recovering my health and would certainly not recommend The Melioria School in Meriden, Connecticut to any RN to do substitute nursing.

  15. A claim that is lingering for 3 years is unlikely to be awaiting an employer or provider report. In my experience, either the claimant is continuing to treat, multiple body parts are involved and/or the court is back-logged. Many times depositions are scheduled and rescheduled for months or magistrate’s dockets are over-booked and rescheduled month to month to month. I agree with you about working with an attorney and determining if they are doing what they can to move the case along.

  16. It did not say if the injured nurse is still working for the employer she filed a claim against. When my claim settled I had to give up my job. So much for being employed at a Magnet Hospital with a the Non-retaliation clause.

  17. My neuro surgeon just released me after spinal fusion surgery with restrictions. Light duty no weight lifting over 15 lbs. Worket comp immediately stop sending me a check. I have not return to work, waiting for the employer to approve the restrictions. Should I still receive a check until I return to work?

  18. I feel that my claim amount do not meet my disability. I was told that I cannot do bedside nursing anymore but my compensation do not meet my disability, nor am I labeled with a disability.
    Maximum use of right hand is 20lbs. I still cannot lift or turn my arm/wrist in ROM movement.
    I do not think that my attorney is very knowledgeable about how to fight or negotiate for my benefit.
    Should I contact another lawyer?

  19. Dear Nancy, I was injured at work 2 years ago. Completed all the paper work and I am still waiting. In SE Michigan, thanks to Republican legislation, very few people are getting workmans comp.being a very good nursing supervisor- I investigated. The examining Doctor is crooked- he fails everybody. When the claim is denied it goes to a judge. This takes over 2 years. by that time most people have returned to work doing something. This doctor is not only screwing the injured workers he is also screwing the companies who are paying for underwriters insurance. He lectures to them about how much has to be paid out. The result is double digit increase in insurance premiums. Because he denies everyone, they are not paying out anything. I tracked the underwriters and the mother of all the companies is located in Bermuda. The investors connected to these companies are the same investors that brought down the housing industry. This doctor lives in a million dollar house with 2 luxury cars. He has never done any neurosurgery yet he claims to be an authority. He graduated from U of M, and has never worked as a neurosurgeon- he is a professional consultant. The whole thing is a sham. And the doctors are crooked. But they have to deal with me because I am now 70 y/o. I had medicare when I got injured so I was taken care of and I have everything documented. .Nurses are really getting screwed. I ruptured a cervical disk at work, working in ICU.

  20. I had inhalation injury at work
    Rn iv team/ entered a unit which had construction ongoing
    Sandblasting carpet off cement floor with no barriers
    The air saturated with particles. The inhalation closed my airway / house sup took me to another unit for emergent care
    I was unable to walk for couple hours /
    Sob rt treatments and 02
    I started steroids rt to at home
    Able to work 1 shift
    I er at branch of the same hospital resp distress/ treatment over night until I could walk bathroom
    Fri night night
    I continued steroids and rt tx
    Tues went allergy clinic
    Everyday during the week for steroid injections and antibiotic injections
    Er on weekends for steroids
    Continued for a month
    All my paperwork completed
    I was unable to talk above whisper and unable to walk but a few feet
    I could not get to employee health for 2-3 weeks to sign papers
    I needed ride to door of hospital and allergy clinic
    They sent me to pulmonoligist dec 7
    Workers comp turned me down / I saw their doc in er and my doc
    I would not be here if I waited on them
    I begged for help
    This was in 2015
    Intermittent work thru 3/1/16
    I was offered 5,000 by my att in 2017
    I was told to take it / that’s all it’s worth
    I lived on savings and paid medical bills with savings
    I hired family to help
    I received no support from workers comp
    One manager on vent and many nurses transferred related to the poor air quality
    The sand blast entered the air system
    Just needed follow osha .
    I’m insulted by my att.

    Oct 30- dec 7

  21. Oct 28 2015 thru march 1, 2016
    First X-ray clear
    Second X-ray
    Chest X-ray showed pulm nodule
    Ct scan showed cracked glass

  22. At the point of negotiation on settlement, I realized my workers comp attorney was not representing my best interest related to a severe back injury at work.
    I found a bigger attorney group in a big city. I fired the first attorney.
    My new attorney won me a settlement approx five times what the first attorney was suggesting

  23. Travel nurse injured 10 months ago. Herniated disc with nerve damage. Receiving full wc benefits weekly. I am ready to settle. Insurance company is ready to settle. Employer is not willing to settle. Instead are trying to send me to transition to work 36hours a week so far bogus. Mediation scheduled in 3 weeks, don’t believe their going to why this is crazy to me

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