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In this episode of The Verdict, catastrophic injury attorney Clark Speaks talks with workers' compensation lawyer Brian Groesser about why the first 90 days after a workplace injury can make or break your claim.
Groesser breaks down the dangers of thinking “I can handle this myself” and explains how insurance companies use tools like Form 63 and surveillance to investigate—and potentially deny—your case even while paying benefits. We’ll share some of the hidden strategies carriers use so you know what to look out for.
Don’t wait until it’s too late. Hiring a lawyer early can protect your rights, speed up your care, and keep the system from turning against you.
Here’s what we discuss in this episode:
⏳ Why the first 90 days are deceptively risky
📝 The real reason insurers use Form 63
🎙️ How casual recorded statements can be weaponized
🧠 Surveillance, background checks, and ISO reports—explained
⚖️ How a lawyer protects your care, pay, and claim
Workers comp, catastrophic injury, insurance claims, first 90 days, attorney
Learn more about how Speaks Law Firm can help you: https://www.speakslaw.com/
Schedule your FREE case review: https://www.speakslaw.com/our-team/r-clarke-speaks/#contactFormTarget
Find us on YouTube: https://bit.ly/3R40YMP
SPEAKERS
Clarke Speaks 00:00
I'm Clark speaks, the catastrophic injury lawyer. Welcome to the verdict. Welcome back to the verdict. I'm Clark speaks, and this is Brian grocer, Brian. We You talked a few minutes ago about that first 90 days and how critical that is for people. My experience is that there are lots of people who get into that first 90 days and they're thinking, I can change my own oil, I can do my change the vents, I mean, the filters in my in my air conditioner, I might be able to do my brakes. I might there's, I'm an independent person. I'm a smart person. I might do my own taxes. I kind of, I can. I'm an independent person. So I can probably do this myself. Or my wife can take care of some, or my husband, can you take care of some? And you know, what are some of the mistakes that people can make during that first 90 days that are potentially harmful and that can cost them lots of money? Yeah,
Brian Groesser 00:54
there's a lot that can happen. And the reason I say 90 days, there's a mechanism in the comp system in North Carolina, that's called a Form 63 and this is the ability for the insurance carrier to quote unquote accept your claim. And the reason I say quote unquote is they will pay for you to be out of work. If you're out of work, they'll pay you the benefits, and they'll pay for your medical treatment. But this is all during an investigatory time where they may serve discovery, where they may do what's called a medical trace report and run back and look at your medical treatment, not just for this claim, but for treatment that you've done for the past five years. They may run what's called an ISO report, where they go and look at prior claims that you have filed, whether it's a worker's comp claim, whether it's a motor vehicle accident or some personal property, you know, they're mainly looking for bodily damage to your own body, not to your car, but to you. That's what they're looking for in those reports. These 90 days are when they are active. They may be saying, hey, you know, Joe, everything's going well. We're you know, we're authorizing your treatment. Everything else behind the scenes, they are working feverishly to fully investigate your claim and to see is there any reason to deny it, because the law allows for them if they filed that form. 63 even though they're making those payments, allows for them on day. 89 if they want to, to deny your case. And I've seen that happen. I've seen it happen where the employee thought everything was going fine, right? I'm getting paid while I'm out of work, I'm telling the adjuster everything that she wants to know or he wants to know. I'm cooperating every every which way I can, and all of a sudden I got this denial, what the heck happened? And now I'm not getting paid, and now the employer doesn't want me to come back to work like they won't talk to me. What's going on? What was going on is you were telling the adjuster everything they wanted to hear during their investigation phase of your claim. And the only reason that they are investigating your claim is not to see how much value there is to it and how many benefits you're going to get out of it, is to see if they can deny your case. Right? So they are actively working behind the scenes, and they may even do surveillance during that time period, something that is common in a worker's comp case, just to see if they can deny their claim. And you may just be coasting along thinking everything's fine and there are no issues, and everything's being handled and I'm okay when behind the scenes, they're gonna drop a hammer on you on day 89
Clarke Speaks 03:17
what can an experienced workers compensation lawyer do to protect you during that window of time.
Brian Groesser 03:23
One of the things that happens during that time period is you get directed and this is true in most any case, you're not you lose control of the ability to direct care, like, if it's the carrier's paying for treatment, then they're going to direct you to care. They're going to say, you got to go see this doctor. You got to go see this facility. As long as they're paying for the treatment, they have the right to do that. If you have an attorney involved, though, you can make sure, like I was talking about in prior episode, that that treatment is moving forward in a positive direction. Because if a carrier denies, you know, if they've denied that MRI, and haven't denied it, but they've just delayed it, right? The urgent care facility recommended the MRI. Well, it's been two months, and you still haven't had that MRI. That 90 day period is not stopping, right? That 90 day period is still going on, despite the fact that you still haven't had the MRI done, and all of a sudden, now your case is denied because of something that came up, or maybe there's no medical evidence in their mind, not sufficient medical evidence of an of an actual injury. Well, you haven't had your MRI yet 90 days have already expired. You know the having the attorney helps move things along, move it in a proper direction. It's also true, almost every case involves a recorded statement where a adjuster is going to do an interview, just kind of like what you and I are doing right now. And it may seem very casual, but in reality, it's a fishing expedition to see what exactly happened. It was in an accident itself. And they're also going to ask you questions that seem innocuous, like, what do you like to do in your spare time? Oh, I like to hunt. I like to fish. You know, I like to play basketball. Well, guess what those answers are going to be used for later on surveillance. Because if you say you can't use your right arm, and all of a sudden they got you out in a tree shooting at Deer with a shotgun, and you're got your right arm here, and it's cocked back, and it's, you know, taking the blow from the shotgun. They're going to question, What do you mean when you can't use your right arm right and so having an attorney will prepare you for those recorded statements. They can even sit with you, you know, I can sit with you during that recorded statement. It's someone to hold your hand during that process, because the again, the people you are working with are not your friends. They may seem friendly and they may be friendly, but they are not looking out for your best interest. They are looking out for their company's best interest.
Clarke Speaks 05:40
Thank you, Brian. When we come back, we're going to talk to you. I want to ask you specifically about these medical doctors that people see during the course of their workers compensation claim, and who assigns those doctors, the relationships between those doctors and the insurance company, and how that might affect your claim. So join us next time. Thanks for joining us. Don't forget to subscribe and follow us to stay up to date with our weekly episodes. We'll see you next time you.
SPEAKERS
Clarke Speaks 00:00
I'm Clark speaks, the catastrophic injury lawyer. Welcome to the verdict. Welcome back to the verdict. I'm Clark speaks, and this is Brian grocer, Brian. We You talked a few minutes ago about that first 90 days and how critical that is for people. My experience is that there are lots of people who get into that first 90 days and they're thinking, I can change my own oil, I can do my change the vents, I mean, the filters in my in my air conditioner, I might be able to do my brakes. I might there's, I'm an independent person. I'm a smart person. I might do my own taxes. I kind of, I can. I'm an independent person. So I can probably do this myself. Or my wife can take care of some, or my husband, can you take care of some? And you know, what are some of the mistakes that people can make during that first 90 days that are potentially harmful and that can cost them lots of money? Yeah,
Brian Groesser 00:54
there's a lot that can happen. And the reason I say 90 days, there's a mechanism in the comp system in North Carolina, that's called a Form 63 and this is the ability for the insurance carrier to quote unquote accept your claim. And the reason I say quote unquote is they will pay for you to be out of work. If you're out of work, they'll pay you the benefits, and they'll pay for your medical treatment. But this is all during an investigatory time where they may serve discovery, where they may do what's called a medical trace report and run back and look at your medical treatment, not just for this claim, but for treatment that you've done for the past five years. They may run what's called an ISO report, where they go and look at prior claims that you have filed, whether it's a worker's comp claim, whether it's a motor vehicle accident or some personal property, you know, they're mainly looking for bodily damage to your own body, not to your car, but to you. That's what they're looking for in those reports. These 90 days are when they are active. They may be saying, hey, you know, Joe, everything's going well. We're you know, we're authorizing your treatment. Everything else behind the scenes, they are working feverishly to fully investigate your claim and to see is there any reason to deny it, because the law allows for them if they filed that form. 63 even though they're making those payments, allows for them on day. 89 if they want to, to deny your case. And I've seen that happen. I've seen it happen where the employee thought everything was going fine, right? I'm getting paid while I'm out of work, I'm telling the adjuster everything that she wants to know or he wants to know. I'm cooperating every every which way I can, and all of a sudden I got this denial, what the heck happened? And now I'm not getting paid, and now the employer doesn't want me to come back to work like they won't talk to me. What's going on? What was going on is you were telling the adjuster everything they wanted to hear during their investigation phase of your claim. And the only reason that they are investigating your claim is not to see how much value there is to it and how many benefits you're going to get out of it, is to see if they can deny your case. Right? So they are actively working behind the scenes, and they may even do surveillance during that time period, something that is common in a worker's comp case, just to see if they can deny their claim. And you may just be coasting along thinking everything's fine and there are no issues, and everything's being handled and I'm okay when behind the scenes, they're gonna drop a hammer on you on day 89
Clarke Speaks 03:17
what can an experienced workers compensation lawyer do to protect you during that window of time.
Brian Groesser 03:23
One of the things that happens during that time period is you get directed and this is true in most any case, you're not you lose control of the ability to direct care, like, if it's the carrier's paying for treatment, then they're going to direct you to care. They're going to say, you got to go see this doctor. You got to go see this facility. As long as they're paying for the treatment, they have the right to do that. If you have an attorney involved, though, you can make sure, like I was talking about in prior episode, that that treatment is moving forward in a positive direction. Because if a carrier denies, you know, if they've denied that MRI, and haven't denied it, but they've just delayed it, right? The urgent care facility recommended the MRI. Well, it's been two months, and you still haven't had that MRI. That 90 day period is not stopping, right? That 90 day period is still going on, despite the fact that you still haven't had the MRI done, and all of a sudden, now your case is denied because of something that came up, or maybe there's no medical evidence in their mind, not sufficient medical evidence of an of an actual injury. Well, you haven't had your MRI yet 90 days have already expired. You know the having the attorney helps move things along, move it in a proper direction. It's also true, almost every case involves a recorded statement where a adjuster is going to do an interview, just kind of like what you and I are doing right now. And it may seem very casual, but in reality, it's a fishing expedition to see what exactly happened. It was in an accident itself. And they're also going to ask you questions that seem innocuous, like, what do you like to do in your spare time? Oh, I like to hunt. I like to fish. You know, I like to play basketball. Well, guess what those answers are going to be used for later on surveillance. Because if you say you can't use your right arm, and all of a sudden they got you out in a tree shooting at Deer with a shotgun, and you're got your right arm here, and it's cocked back, and it's, you know, taking the blow from the shotgun. They're going to question, What do you mean when you can't use your right arm right and so having an attorney will prepare you for those recorded statements. They can even sit with you, you know, I can sit with you during that recorded statement. It's someone to hold your hand during that process, because the again, the people you are working with are not your friends. They may seem friendly and they may be friendly, but they are not looking out for your best interest. They are looking out for their company's best interest.
Clarke Speaks 05:40
Thank you, Brian. When we come back, we're going to talk to you. I want to ask you specifically about these medical doctors that people see during the course of their workers compensation claim, and who assigns those doctors, the relationships between those doctors and the insurance company, and how that might affect your claim. So join us next time. Thanks for joining us. Don't forget to subscribe and follow us to stay up to date with our weekly episodes. We'll see you next time you.
