Who Has A Gripe about Pinnacol Assurance?

A while ago Pinnacol Assurance was involved in a controversy about its extra revenues. The state of Colorado wanted some of that revenue to help with the budget shortfall. Pinnacol said it should be treated as a private entity so it opposed the effort. The state put off a confrontation but is now flexing its muscle to rein in Pinnacol. By the way Pinnacol is the largest insurer of workers compensation claims in Colorado. Its history is long but let me say it is neither fully private nor fully a public company. So now the legislators are hot on the tail of Pinnacol and Pinnacol is on the defense. A state audit is also underway. Clearly when Pinnacol seems to be thriving and the state is not then you can expect questions to be asked and more funds to go to the state and policyholders. Anyway now they are inviting those with cases or stories involving Pinnacol to come forth and tell a legislative committee all about Pinnacol. You can do this by email so for more on this click here. I am not sure that Pinnacol is the problem. What has happened in workers compensation is that benefits have been reduced and insurers have procedural and financial ways permitted by law to defend themselves and thereby increase profits. Example? If you hurt your arm but can still work in a low wage job you'll get at most a few thousand dollars for a permanent problem if the insurer has its way. So what if you lose your trade. Another example? When someone has a permanent problem with very real pain and medical needs many treating doctors designated by the employer will say you need 6 months or a year or two of medications. So permanent problem but temporary pain relief which allows them to limit future medical benefits. Another way is to close the case out as fast as you can so money is saved. All they are doing is using the law to their advantage. The old concept of liberally construing the law to favor claims was changed. It became a game where there is more to gain by contesting and limiting claims. Without a good lawyer the claimant often doesn't have a chance or may not even know he's getting less then what he might receive. But Senator Carroll is trying to get people to talk about Pinnacol and anyone can do so. Perhaps it will help change the workers comp system to level the playing field for all claimants.

Workers Comp Hearings...Rules To Use

When we deal with workers compensation claims we may need to refer to two different sets of rules. Over at the Division of Workers Compensation (DOWC) they have rules for the processing of claims. Those rules can be accessed by clicking here. But also whenever we apply for a hearing or when the other side does there are other rules which also apply. These are provided by the Office of Administrative Courts (OAC). Those rules are cited as OACRP (Office of Administrative Courts Rule Procedure) and you can read them by clicking here. So when an agency says WCRP it is the Division saying workers compensation rule of procedure such and such. When another agency cites OACRP it refers to its rules. While sometimes confusing both sets of rules are available for anyone to read on the internet.

Be Careful What You Post Online

Anyone with a workers compensation or Social Security disability claim would be wise to remember that what you post online may be accessed by others. So your profile on Facebook or elsewhere may come back to haunt you. We all know that many with claims are investigated and even videotaped but what you post online may also be subject to review. Here is an interesting article that makes the point very well. If you post about yourself and all your interests then that can raise a question about the severity of your disability. So a word to the wise...do not imagine you are invisible and won't be checked out. From digital cameras to Facebook or even other postings elsewhere you had best assume they will discover all this. In this digital age your life could be an open book so with any injury or disability I suggest you cease...that means STOP all such postings for the duration of your claim or at least be extremely careful what you post.
Postscript: August 23, 2009 Dollar Tree uses claimant's MySpace to bust his case.

Time Lines or How Fast Does It Go?

We always seem to get this question from most of our workers compensation clients. First, any time frame may still depend on the doctors. Only after you reach maximum medical improvement(MMI) and also obtain an impairment rating do we then try to guess on the time line. It is truly just an educated guess because so much depends on factors not within our control. The other side can take one day or 30 days to decide what to do. We then must review what they have done and determine if the doctors are correct. More often then not we decide to question what your authorized physician concluded on MMI/rating. This process can take several months and involves legal actions and another medical examination. Even then each side has to act again. The other side has to decide to accept or dispute matters and we also have to review and decide how to proceed. Should you not be at MMI then more treatment can take place and we then wait for that to conclude. The point is that it's like a chess game where one move you make means the other side has time to also make a move. So when we say it can take several months just when you think it's all coming to an end it is because of this back and forth legal/medical process. Many people are quite anxious to resolve matters but this process simply takes time. Having said all this I can indicate that once the treating doctor says you are at MMI (and that is really the case) it can easily take 6 months to either settle or go to the hearing in a typical case. I've had cases which settle faster but then I've had cases which took longer. From the very beginning of your case to the end can take just a few months or much much longer even without any appeal. A key point is that most of the time is devoted to your treatment and medical examinations.

Social Security disability-the Listings

The Social Security disability process is quite different from workers compensation. In Colorado if you are hurt on the job it means you may have a claim for workers compensation benefits which may include temporary benefits, medical benefits, a disfigurement award and permanent benefits (which can be partial or total). In Social Security disability your overall health is important so they do not just look at job injuries. Also the benefit is a monthly check which often can go for the rest of your life (the agency does review from time to time). There are no "temporary" benefits while they medically treat you to help you recover as is often done in workers compensation cases. Instead only if you are obtaining monthly checks do you have Medicare benefits and even then it kicks in two years from the start of your monthly checks or when you should have had your checks start (it can be backdated). In any event one of the things the Social Security process can involve is trying to see if you qualify based on what they call "The Listings" which are health problems so severe that you are approved if you meet one of those listings. Otherwise you have to show that your restrictions and other factors make you unemployable in a full time job. Most people do not meet a listing but that does not mean you cannot obtain benefits. You then must show that you can no longer work based on your overall functional abilities and that is a very personalized matter which factors in your age, education, past work and overall functioning. It is more complex then I can say here but that's the essence of it.

Happy July 4th 2009!