I Don’t Understand The Letters I Get From The Insurance Company

Workers’ Compensation Insurance companies re-use the same letters over and over, often to address different situations and to satisfy certain legal requirements. They may send out the same letter in every case; they may send you same letter numerous times. They have developed “boilerplate” letters that are confusing and borderline unintelligible. Often the letters are harmless and irrelevant but they can cause anxiety for an injured worker.  In other circumstances the carrier will not send any Notices, despite required to do so, or send only some of the required Notices.

You must watch out for letters advising you about your right to request a Panel Qualified Medical Evaluator (Panel QME). The rules are complicated and timing of requests are very important.  There is a ten day time limit to make the request. If you do not send in the request, the insurance company will be able to select a QME. Selection of the specialty is very important and you should consult an attorney about this right away.  If you o not make a timely request, the insurance company will make the request in a specialty that is more favorable to them.

You should be provided Notice when Temporary Total Disability (TTD) and Permanent Disability (PD) starts and stops.  Keep in mind that PD Notices are generally estimates of your permanent disability and settlement amount.  The amount of your settlement is not “guaranteed” until the Judge signs an Order or Award finalizing a settlement.  Any PD money received will be deducted from a final settlement.

You should, but often won’t, receive a Notice of Medical Provider Network (MPN).  You are entitled to change your doctor after 30 days from the date of injury, as long as it is within the MPN.  If there is no MPN, you can chose any doctor who is willing to report to the carrier, within the law requirements, and accept fee levels dictated by workers’ compensation law (a reduced rate). If you do not receive a MPN Notice, explaining where to access the network list, you should ask the claims examiner for access to the network.  You can receive this in paper form or online.

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