I recently had a consultation with an injured suburban Chicago worker. Really nice, older guy who has been off work for six months with a back and neck injury.
There is no dispute that he was hurt at work. He’s being paid for his time off work. He’s treating with one of the most reputable orthopedic doctors out there. That doctor has ordered more physical therapy. He has already had more than four months worth. He is getting better, but his doctor does not think he will ever work beyond light duty again.
Every time he has received a physical therapy order, he has sent it over to the insurance company. He has, rightfully so, viewed this as a formality. But he is a rule follower so he has gone along with what they have asked of him.
This time they told him something different. They said that if you want to have more physical therapy, it can only happen if we send a representative (a nurse case manager) to your appointments. He wanted to know if this was allowed because they are permitted access to his work related medical info. He thought it was not allowed and told me, “I think this is a HIPAA violation.”
He is right that it is not allowed, but not because of HIPAA laws. Under Illinois workers’ compensation laws, the insurance company has no right to talk to your doctor or any other medical provider other than to ask for copies of records and bills.
What will happen, if you let them, is they will send these representatives to your appointments. Their goal, beyond gathering info about your case, is to try to steer your medical care in a less costly and often much less effective way.
In other words, someone who is not concerned about your health and is just trying to justify their job is going to try and bother your doctor so much that they do things that will not be in your best interests. It could be ending physical therapy even if it’s helpful. It could be doing a surgery that likely won’t be as effective but is cheaper. It could be returning you to work when you are not ready which ultimately makes your injury worse and sets back your recovery.
The good news is that it is a solvable problem and usually pretty quickly. When you do not have an attorney, the insurance company will try to take advantage of you in any way they can. They are motivated by saving money, not what is best for your health and recovery.
If this is happening to you, we would love to help. Contact us at 312-346-5578 and we will connect you with an experienced lawyer in your area that can help.
