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Case Study - Fighting Insurer Attempts to Stop Checks

Vermont law allows a workers' compensation insurer to stop weekly check payments when the doctor states you're not going to get much better. That's called "medical end" or "maximum medical improvement." The checks stop, even if you haven't returned to work.



However, the insurers too often jump the gun! They don't wait for the treating doctor's opinion. Insurers often find "independent" doctors and hire them. If they can get an opinion, they'll stop your checks.

The key to preventing unfair results is to (1) know what the insurer's doctor must prove, (2) see if the evidence offered by the insurer's doctor is "reasonable support" for its position, and (3) very aggressively and quickly challenge that evidence and request the Department of Labor reject the insurer's position.



In an actual case, the insurer's doctor concluded the injured client was at maximum improvement from nearly every aspect of the work injury. Our client would have lost a weekly disability check if we had not carefully read the insurer's "independent" doctor's report and found several flaws. Part of our objection. later presented in oral argument during a conference with the Department of Labor, was as follows:

"Julie Charonko, Specialist II

Vermont Department of Labor

P. O. Box 488

Montpelier, VT 05601-0488

Dear Ms. Charonko:

Please let this serve as the Employee's OBJECTION to the Form 27 filed by [employer/insurer name withheld]. 



The Form 27 is signed and dated March 10th and seeks to discontinue benefits effective March 22nd . The reasons stated are that the Employee has allegedly reached medical end result. The sole support offered is a report ... [by independent doctor] Dr. Boucher.

The Form 27 arrived at this office on March 16th. I have reviewed it today. I provide the following bases for the Employee's OBJECTION and request that the Form 27 be REJECTED.



Dr. Boucher states in no uncertain terms that [client name withheld] is not at medical end result for all of her work related injuries. The employer/insurer has filed a Form 27, therefore, which fails to be reasonably supported and must be rejected. 



Dr. Boucher states in his report:
"She has not reached MMI for her right hip condition, ... .
" 

(Report at Page 9)

...

For all of these reasons, and most obviously because Dr. Boucher has stated - in black and white - at page 9 of his report that the right hip condition is work-related and that "she has not reached MMI for her right hip condition, ..." the Form 27 must be rejected as not reasonably supported.

Very truly yours,
Charles L. Powell, Esq."

If your work injury involves more than one body part, if your work injury is causing multiple symptoms, or if you have a psychological depression from the work injury, no insurer should be able to stop your weekly checks unless you've reached maximum improvement for all your injuries.