The adjuster is sending you to the doctor... are you safe?

Just because the adjuster is sending you to the doctor doesn't mean you're out of the woods on your case. All it really means is that she is having her hand-picked doctor be the one to create evidence about your accident, injury, and disability.

Even if the adjuster is also paying you weekly checks you need to make sure that she had filed the appropriate Industrial Commission forms. In most cases these will be either a Form 60 or a Form 63.

If the adjuster gives you a Form 63 you should be concerned. This particular form was developed by the Industrial Commission to give the insurance company a chance to back out of the claim. Basically it means that the adjuster can control your case for 90-120 days and then, if she doesn't like the way it is going, deny the claim. A Form 60 provides a bit more safety to you because the adjuster cannot back out of it.

The other thing to be very wary of is the use of either a Form 60 or a Form 63 as a "medical only" acceptance of the claim. What this means is that the adjuster is accepting liability for the need of medical treatment but is not agreeing to pay weekly checks if you go out of work. The problem with this is two-fold. First, on a Form 63 the normal deadlines to admit or deny the claim are suspended. So an adjuster could deny the claim a year or more after she filed the Form 63. Second, even if the authorized treating physician takes you out of work the Industrial Commission is not compelling the adjuster to start weekly checks without a full evidentiary hearing - which can take a year or more to occur. The effect of this is that the adjuster can pick the doctor, authorize a surgery, and if the surgery goes poorly leaving you out of work and unlikely to return to work soon... well all she has to do is deny the claim and leave you without income or the capacity to work. From the adjuster's point of view this is just business as normal because you will undoubtedly have to settle cheap in order to pay your bills.

There are three things which should trigger a call from you to an attorney:

1. Paying benefits or directing medical care without filing an Industrial Commission form.
2. Filing a Form 63 instead of a Form 60.
3. Filing either a Form 60 or Form 63 marked as "medical only."

If any of these happen, you should definitely speak with a lawyer.