Insurance companies play a lot of games to beat injured workers out of the benefits they are owed. In our series on Games Insurance Companies Play, we’ve explained a few of these tricks already. But, there is a current trend that deserves some attention. Adjusters are mailing very important documents to injured workers and failing to copy the injured workers’ lawyer. Why is that a dirty trick?

While a lot of mail that comes from an insurance company is not important, some of it is vitally important. A PLN-03 form is one of the most important documents that exists in our system. A PLN-03 is the form that an adjuster has to send to an injured worker to put them on notice that an impairment rating has been received. It explains how long impairment income benefits will last, but most importantly, receipt of the PLN-03 starts the clock ticking on an injured worker’s deadline to file a dispute of their impairment rating. This deadline is known as the ninety day rule.

The ninety day rule only applies to an impairment rating. It comes from Division of Workers’ Compensation Rule 130.12, and it states that when an injured worker receives their first impairment rating, they only have ninety days to dispute the impairment rating or it becomes final. That means if you miss that ninety day deadline then you get stuck with whatever that doctor gave you. Most of the time, the first impairment rating is done too early in your claim before you ever have the chance to get all of the necessary medical treatment you need to recover from your injury. Too often, it’s from the company doctor and not from the doctor you chose on your own.

So, when the adjuster mails an injured worker the PLN-03 and fails to copy the worker’s lawyer, the deadline starts ticking and the lawyer doesn’t even know about it. Injured workers get used to their lawyer receiving everything they get from the adjuster so they don’t think about sending it on to their lawyer. If that happens, the deadline may pass without any dispute being filed…and just like that you’ve been screwed over.

Once you get an impairment rating, your eligibility for temporary income benefits (lost wages) ends. So when the company doctor gives you an impairment rating for just a sprained ankle, but you actually need surgery and the adjuster pulls this trick – you can’t get paid temporary income benefits while you are out recovering from surgery. It’s a vicious insurance trick. The ninety day rule is the most tragic and unfair rule in the Texas workers’ compensation system. Don’t fall for this trick. Always make sure to send your lawyer a copy of any mail you get from the adjuster. That will help you beat the insurance company at this game they play.