1.  If the insurance company or your employer does not agree with your doctor, you need a lawyer.


          2.  Don’t take medical advice from your lawyer.


          3.  Don’t take legal advice from your doctor.


          4.  Make sure you give a clear, detailed explanation of your job duties to your doctor, and make sure that the doctor or nurse writes it down.  Do not exaggerate or leave anything out. 


          5.  If the worker’s compensation insurance company denies your claim, stating that it is not work related, and your health insurance company denies the claim because you indicated that it was work related, send the health insurance company the denial letter from worker’s compensation insurance company and call an attorney. 


6.  If the insurance company schedules an independent medical examination (IME) by their doctor, you must go to the appointment.  Be honest with the doctor, but remember the insurance company’s doctor is not your friend, not trying to treat you and is certainly not independent.  The IME doctor is trying to find something that gives the insurance company medical support to deny your claim.  When you get back the report and the IME doctor disagrees with your doctor, see Rule 1. 


7.  Keep all of your paperwork in one place.  This includes any paperwork from the worker’s compensation insurance company, the doctors and hospitals (including bills), and all information you get from the health insurance company, especially the Explanation of Benefits (EOB) forms.


8.  If the health insurance company sends you a notice and/or a questionnaire about whether you were injured at work, respond and fill out the questionnaire.  This is routine.  Make sure you keep a copy of anything you send to the health insurance company or anyone involved in the case.


9.  You can have a worker’s compensation claim even without a specific incident that happens at work.  If years of heavy work have caused your body to wear down to the point where you need significant treatment or surgery, it may be a work-related injury based on overuse.  Ask your doctor.  If your doctor says yes, make a claim and call an attorney when they deny the claim.  (See Rule 1)

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