A reader contacted us and wanted to know if she needed an attorney. The insurance company assigned her a nurse case manager to her claim. That person told her a lawyer isn’t needed. Her co-workers are telling her she’s crazy if she tries to go at this alone and that the nurse case manager is trying to screw her over.
So who is right?
I’d say that they both are, but that’s a bit misleading. The nurse case manager is never going to tell you that you need an attorney. She has a conflict of interest as she works for the insurance company. Their goal is to limit what they have to pay for your care. So she’ll never you say you need a lawyer because if they are breaking the law or taking away benefits you are entitled to, they don’t want you to know that you could do better.
That said, there are certainly times an attorney won’t make much of a difference. This is especially true with minor injuries that heal quickly. It could also be true in cases where there is an amputation, but no job or wage loss. It could even be true in a death case if all the benefits are being paid, but with both amputations and death cases, if there is no dispute, the lawyer fee is limited to $100 so there would be no reason not to get help.
But in general the co-workers are correct. Things don’t always get out of hand in these cases, but if they do and you aren’t already represented, it will greatly delay your ability to get in to court to get a fair hearing.
Most people I talk to that don’t get a lawyer make that decision because they don’t want to pay the 20% fee when the case is ready to settle. The problem is that there’s no guarantee you will even get a settlement offer and when you do, it’s most likely to be a low ball offer. This is especially true since the law on settlements changed in 2011 with the introduction of AMA guidelines being a factor in these cases. Those guidelines have caused many offers to be woefully low.
But the biggest benefit you’ll get from having an attorney, or at least if you have one that really looks out for you, is that you’ll not get taken advantage of along the way. Most people don’t know that the nurse case manager isn’t supposed to talk to your doctor, cancel your appointments or in any way interfere with your treatment. Some people don’t know that they shouldn’t give a recorded statement. Others will end up paying co-pays with their doctors or out of pocket expenses. If you are being sent for an IME you should know what to expect. Once you settle your case, it closes out your medical rights forever for that injury. A good attorney will make sure that your future needs are looked out for. If you settle without taking in to consideration any future Medicare or social security issues, you might end up owing the government a bunch of money.
I could go on and on, but the point is that you don’t know what you don’t know. And that is the biggest benefit for having an attorney. I talk to people every month who want to re-open a case because they’ve realized that they should have had representation. But once the case is done, it’s done forever.
I’d say that they both are, but that’s a bit misleading. The nurse case manager is never going to tell you that you need an attorney. She has a conflict of interest as she works for the insurance company. Their goal is to limit what they have to pay for your care. So she’ll never you say you need a lawyer because if they are breaking the law or taking away benefits you are entitled to, they don’t want you to know that you could do better.
That said, there are certainly times an attorney won’t make much of a difference. This is especially true with minor injuries that heal quickly. It could also be true in cases where there is an amputation, but no job or wage loss. It could even be true in a death case if all the benefits are being paid, but with both amputations and death cases, if there is no dispute, the lawyer fee is limited to $100 so there would be no reason not to get help.
But in general the co-workers are correct. Things don’t always get out of hand in these cases, but if they do and you aren’t already represented, it will greatly delay your ability to get in to court to get a fair hearing.
Most people I talk to that don’t get a lawyer make that decision because they don’t want to pay the 20% fee when the case is ready to settle. The problem is that there’s no guarantee you will even get a settlement offer and when you do, it’s most likely to be a low ball offer. This is especially true since the law on settlements changed in 2011 with the introduction of AMA guidelines being a factor in these cases. Those guidelines have caused many offers to be woefully low.
But the biggest benefit you’ll get from having an attorney, or at least if you have one that really looks out for you, is that you’ll not get taken advantage of along the way. Most people don’t know that the nurse case manager isn’t supposed to talk to your doctor, cancel your appointments or in any way interfere with your treatment. Some people don’t know that they shouldn’t give a recorded statement. Others will end up paying co-pays with their doctors or out of pocket expenses. If you are being sent for an IME you should know what to expect. Once you settle your case, it closes out your medical rights forever for that injury. A good attorney will make sure that your future needs are looked out for. If you settle without taking in to consideration any future Medicare or social security issues, you might end up owing the government a bunch of money.
I could go on and on, but the point is that you don’t know what you don’t know. And that is the biggest benefit for having an attorney. I talk to people every month who want to re-open a case because they’ve realized that they should have had representation. But once the case is done, it’s done forever.
