Articles Posted in Insurance Company Unfair and Deceptive Practices

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While the overall intention of Governor Baker’s opioid bill appears to be positive for those in Massachusetts dealing with chronic pain and opioid dependency, it contains a section that would be harmful to injured workers who rely on Massachusetts’ workers’ compensation insurance to pay for their prescription medication.  Section 39 of the Governor’s opioid bill would establish drug formularies in all workers’ compensation cases (not just those involving the prescription and use of opioids) and for all medications.  Section 39 of House Bill No. H-4033 states:

SECTION 39. Chapter 152 of the General Laws is hereby amended by inserting after the following section:

             Section 13 ½. The department shall establish a formulary of clinically appropriate medications, including opioids and related medications, and shall promulgate regulations for the administration of this formulary.  In establishing the formulary, the department shall consult with the health care services board and the drug formulary commission established in section 13 of chapter 17 of the General Laws.  The formulary shall be based on well-documented, evidence-based methodology, and the department shall include as part of the formulary a complete list of medications that are approved for payment under this chapter, and any specific payment, prescribing, or dispensing controls associated with the drugs on the list.  The department shall review and update, if necessary, the formulary at least once every 2 years.

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Workers’ Compensation insurers must follow certain procedures in order to lawfully terminate or reduce Massachusetts workers’ compensation benefits.  The procedure for modification or termination varies greatly depending on how long the insurance company has been paying benefits.

THE FIRST 180 DAYS AFTER YOUR DISABILITY BEGINS

If the insurer has began to make payment of weekly benefits to you timely, namely within 14 days of notice, the insurer is allowed to stop payments to the employee without obtaining approval of the Department of Industrial Accidents (“DIA”) or the consent of the employee. However the insurer is required to give the employee seven(7) day written notice of their intent to stop benefits. The insurer’s written notice of termination must state their reasons and advise the employee of his or her rights to file a claim for further benefits.  If you return to work at the same rate of pay you were earning prior to your injury, the insurer may terminate benefits effective the last day you were disabled prior to your return to work.  If your own treating doctor clears you to return to your previous job, the insurer may terminate benefits regardless of whether or not your prior job remains available to you.

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          Injured workers in Massachusetts who are disabled from work and receiving workers’ compensation benefits may receive an unexpected “light duty” job offer from their employer.  The light duty job offer by an employer to an injured worker can often times create a confusing situation for the injured worker because they are unclear what they should so in order to protect their own best interests.  It is not uncommon for an employer to not contact an injured worker for many months, even perhaps years, and then all of a sudden a letter with a light duty job offer appears in the mailbox of an injured worker.

Workers’ Compensation insurers have a financial interest in getting an injured worker back to earning wages.  Quite simply, if the injured worker returns to work, the insurer can either reduce or terminate their payment of weekly workers’ compensation benefits to the injured worker.  This is a tremendous cost savings to the workers compensation insurer and will also reduce the employer’s insurance premiums.  The more money that the injured worker is able to make, the less money the injured worker receives in workers’ compensation benefits, and, if the light duty job pays the same amount of money as the injured worker was receiving before he or she got hurt, they will not be entitled to receive any more weekly workers compensation benefits.  So it is easy to understand why these light duty job offers are made by employers. Continue reading

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Often times, injured workers who are receiving Massachusetts workers’ compensation benefits are mailed a form titled “Form 105 – Agreement to Extend the 180 Day Payment Without Prejudice Period.”  Workers’ compensation insurers may  send this form to an injured worker who has not yet retained an attorney in hopes of getting the unrepresented injured workers to sign the form without fully understanding the ramifications of doing so.  It is usually sent to the injured worker during the 3rd to 5th month of disability following a work injury.

Signing the Agreement to Extend 180 Day Payment Without Prejudice Period form sent to you by the workers’ compensation insurer can have an extremely negative impact on your claim.
Insurance companies will send you this form under the guise that they are doing you a favor and agreeing to pay you for another 180 days, however by signing this form you are giving up legal rights and you may expose yourself to allowing the insurer to legally terminate benefits and put you in the position where you could go many months with no benefits while you fight the insurance company in court.  In order to fully understand why singing this form can have negative consequences for an injured worker, it would be helpful to explain exactly what the 180 Day Payment Without Prejudice Period is.

THE FIRST 180 DAYS AFTER DISABILITY BEGINS

If the insurer has commenced benefits timely, namely within 14 days of notice, the insurer is allowed to stop payments to the employee without obtaining approval of the DIA or the consent of the employee. However the insurer is required to give the employee seven(7) day written notice of their intent to stop benefits. The insurer’s written notice of termination must state their reasons and advise the employee of his or her rights to file a claim for further benefits. Continue reading

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  Perhaps the most common reason why injured workers seek out a workers’ compensation attorney is because their employer’s workers’ compensation insurer is refusing to authorize and pay for medical treatment that their treating physician is recommending.  Massachusetts workers’ compensation benefits provide for 100% payment of any and all medical treatment that is deemed to be reasonable, necessary and causally related to a work injury.  However, it is very common for workers’ compensation insurance companies to  either deny medical treatment or intentionally not respond to your doctor’s requests for medical treatment.  One possible reason for this is because many injured workers give up, try to use their health insurance (so the workers’ comp insurer doesn’t pay) and never get a lawyer to guide them through this difficult process.  Quite simply, although workers compensation insurers have laws and rules that they must follow in administering claims, they will do everything within those laws and rules (and sometimes outside of them) to frustrate injured workers so that they won’t seek medical treatment that they require. Continue reading

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After you have been injured at work and need medical treatment, often times you will be contacted by your employer’s workers compensation insurance company or a nurse who works for the workers’ compensation insurer for the purpose of them trying to steer you to a certain doctor for medical treatment.  If this happens to you, you should be very concerned about the intentions of the workers’ compensation insurance company.  If you are receiving a weekly disability check from workers’ compensation, the workers’ compensation insurer does have a financial incentive to get you treated by a qualified doctor so that you can return to work as soon as possible and they can stop paying you your weekly disability benefits.  However, some workers’ compensation insurance companies try to steer injured workers to certain doctors because they know the reputation of the doctor is such that he is more likely to recommend medical treatment that is less costly to the insurance company, such as ordering conservative medical treatment such as physical therapy or injections instead of surgery.  Workers’ compensation insurance companies also are known to steer injured workers to certain doctors who are known to either not write disability letters for their patients (which are required in order for an injured worker to continue to receive a weekly disability check) or are likely to clear an injured worker to return to work well before that injured worker is actually physically capable of returning to his or her job (thus enabling the workers’ compensation insurer to stop weekly disability payments to the injured worker). Continue reading

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A recent Middlesex Superior Court decision in the case of Anderson v. AIG, which ordered AIG to pay over $7 Million to a lawyer who was struck by a negligently operated bus (which was insured by AIG), exposes the lengths a large, wealthy and powerful insurance company will go to in an attempt to deny full and fair compensation to an injury victim and his family.  In the Anderson case, AIG and its attorneys were found to have fraudulently created a fictitious version of how Mr. Anderson’s accident occurred in order to decrease its payout on the claim and save the massive insurance company a few million dollars.  You may recall that AIG, whose 2013 net income was over $9 Billion dollars (yes, billion), is the same AIG that received an $85 Billion bailout from our taxpayers (which includes Mr. Anderson, the victim of this accident and victim of AIG’s fraud).  Anyone other than plaintiff’s attorneys who routinely represent those harmed by the careless actions of others  in litigation against large, powerful insurance companies like AIG, may be shocked by AIG’s conduct which was exposed to the court in this case. Those of us who routinely handle these cases are not shocked by the findings, but rather relieved that AIG’s fraud was exposed for all to see. Continue reading

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