What if the IME doctor won't provide a copy of his report?

A recent caller was upset. He had hurt his back while working in Palatine a few months ago and was sent to a Buffalo Grove doctor for an Independent Medical Exam (“IME”). This is a one time exam the insurance company can request to have one of their doctors examine an injured worker. It’s very common and often these doctors say what the insurance company wants to hear.

The caller was mad because he’s done everything the insurance company asked for and now they won’t give him a copy of the report. To make matters worse, he hasn’t received a check for being off work for five weeks. He then called the doctor whose office told him, rather rudely, that they don’t have to give him the report and they won’t.

So he called us wanting to know what to do.

There are some matters you can take care of on your own and some that need an attorney. In this case, he needs to get a formal case filed and then issue a subpoena to the doctor for a copy of the report. This is what a lawyer does. To boot we’d also make the doctor provide a copy of the letter the insurance company wrote to them and their entire file.

On top of this, we’d likely file a 19b trial motion for the missed time and a petition for penalties and fees to punish the delay in sending the check.

For the caller this is an emotional situation and that’s understandable. The insurance company is screwing with his life. But for a lawyer, we take the emotion out of a situation and focus on how to solve a problem. In this case, it’s an easy problem for us to solve. And that should be why you get a lawyer. To solve a problem or prevent one from happening.

We are workers' compensation attorneys who help people with Illinois work injuries anywhere in IL via our statewide network of attorneys. Contact us and we will answer your questions or find the right lawyer for your situation.

9/7/12

Being Honest Will Serve You Well

If you search our site you will see a few posts where we talk about surveillance in Illinois work comp cases. If you have a serious, long term injury, don’t be surprised if a private detective is following you around.  As a lawyer, that doesn’t bother me at all because as long as my clients are honest and listen to their doctors, the video they get on you will likely amount to nothing and won’t affect your case at all.

I was thinking of this the other day when discussing a pain management doctor that many insurance companies use for independent medical examinations (IME).  He gets a lot of business because he is certainly more likely to tell the insurance company what they want to hear than what you want them to hear.   But he also gets a lot of business because he is very thorough.

The most thorough thing that he does is spy on those that visit him.  He or his staff will watch you as you are walking in to his building and will also watch you when you leave.  If you are walking normally in the parking lot, but limping and wincing in his office, his IME report will say that you are full of it and it will hurt your case.

So it all goes back to the point of being honest.  There is no reason to embellish your symptoms for a doctor or anyone else.  Aside from being bad karma, it’s just not smart.  Doctors are trained and experienced at what they do.  So are insurance companies and the lawyers that they hire (along with the lawyer you hire of course/hopefully).  Point is that you can almost never fool them because there isn’t much that they haven’t seen.  You are actually better served by not limping at all, assuming that reflects your true health, than trying to show how hurt you really are.

In fact, most IME doctors perform truth tests of some sort, they just don’t tell you that they are doing it.  Many clients are surprised when they see comments about this in the reports that the IME doctors write.  But you have to remember, they aren’t your doctor, they are the doctor for the insurance company.

It’s human nature to want people to believe you.  But trying to influence them with anything other than the truth, especially in an Illinois workers’ compensation claim, is a terrible idea that could potentially ruin your life.  So if you do just one thing on your case, please just tell it like it is

We are workers' compensation attorneys who help people with Illinois work injuries anywhere in IL via our statewide network of attorneys. Contact us and we will answer your questions or find the right lawyer for your situation.

1/21/12

Winning the Battle of the Medical Opinions

Before you are going to get surgery covered by workers’ compensation insurance, you are often asked to go for an Independent Medical Examination.  This is an evaluation by a physician that the insurance company sends you to, at their expense, to get a medical opinion about the cause and/or treatment for your injury.

Even with the best of intentions by all of the physicians involved, there is still frequently a disagreement about the recommended course of treatment.  If your treating physician recommends surgery, and you want to go through the procedure, you hope for the best that IME physician will agree, but prepare for the possibility that he or she will not.

How can you position yourself the best to win the battle of the “experts” and have your surgery covered?  First, be sure that the expert you are putting out there is qualified and credible.  The insurance company is likely to hire someone who specializes in the particular area your issue involves.  If your doctor does not have much experience in this type of procedure, or is a general physician rather than a specialist, then the recommendation may be given less weight.  Credibility is also key.  The reputations of the doctors can sway the opinion one way or the other.  Honestly, a lot of lawyers and insurance companies screw this part up by sending workers to “hired guns” that are known to say whatever needs to be said, not necessarily the truth.

Second, if your physician has the experience and expertise to give the opinion for surgery, be sure that he or she can back it up.  A recent Illinois workers’ compensation case was lost largely because the treating physician’s surgery recommendation was made without the necessary specifics to support it.  There was no rationale behind the decision, other than to say that if physical therapy did not work then this surgical procedure should be tried.

The IME physician was detailed and convincing in his opinion that surgery was not necessary under the circumstances.  He gave specific medical reasons why he did not think that this was the right procedure.  He also was detailed in his discussion of the worker’s risk factors that would make the surgery much less likely to be successful.   In the end, the insurance company’s physician was far more credible and convincing and surgery was denied.

When you want to get your surgery covered, it can be a frustrating process to have to fight to have your opinion accepted.  But with a good lawyer in your corner, and the right medical evidence and support to back you up, you have a good shot at winning the battle of the medical experts, if your case comes to that.

We are workers' compensation attorneys that help people with Illinois work injuries anywhere in IL via our statewide network of attorneys. Contact us and we will answer your questions or find the right lawyer for your situation.

12/24/11

Prepayment for Independent Medical Evaluation Expenses

Insurance companies are allowed under Illinois workers’ compensation rules, to send injured workers for an Independent Medical Evaluation (IME).  This may happen when you are receiving benefits for your injury and the insurance company wants to have another medical opinion about your injuries, your treatment, and the compensation for your injuries.

Even though you are required to go the IME appointment or risk losing your benefits, you aren’t required to have to pay for it yourself.  Not only are the time and place of the appointment supposed to be reasonable, but the costs associated with the appointments for the IME are required to be given to you in advance.  The notice of the time and place for the IME should include the costs for travel, meals, and lost wages if work will be missed.

A recent Illinois case highlighted the significance of the costs being paid in advance.  A worker got the IME notice, but instead of the money for costs, there was a statement that the travel expenses would be paid at the exam.  This is not what the law requires though.  Payment for travel for the IME should be given along with the notice.  And if the costs are not included, the worker does not have to go to the IME appointment. 

In this case, when the worker did not show up for the appointment, her benefits were terminated.  The insurer’s position was that benefits could be terminated because the employee did not fulfill her obligation to go to the scheduled IME.  But in fact it was the notice for the IME that didn’t stand up, and excused the employee from keeping the appointment.

The failure to prepay the travel expenses made the notice for the IME invalid, so the fact that benefits were cut off because the employee missed the IME date was unreasonable.  This can end up costing the employer more money.  If benefits are not paid in a timely way, and there is no reasonable justification for it, then they can end up owing you more money than just the original benefits you were entitled to.  So where they rely on the workers’ failure to go to the IME to stop benefits, this decision is not reasonable if it is based on their failure to send a proper notice with prepaid costs.

If you have any question about whether you can miss a scheduled appointment, it is better to discuss it with an attorney to be sure you won’t be hurting your case.  But if you are asked to go for an IME, you should not have to risk losing money on a promise to reimburse you later.

We are workers' compensation attorneys that help people with Illinois work injuries anywhere in IL via our statewide network of attorneys. Contact us and we will answer your questions or find the right lawyer for your situation.

Overview of IME's (Independent medical examinations)

When you are on the road to receiving benefits through workers’ compensation insurance for your work-related injury, one step in the process may be to have an Independent Medical Examination (an IME). Such an exam may be requested by your employer in order to get an expert’s opinion regarding your injury—both the nature and cause. In order to receive or continue to receive benefits, it is necessary to participate in this exam, but it is not as daunting as it may seem.

You will not have to bear the expenses of this exam. If your employer requests the IME, the costs of the exam itself and related items will be covered by the company. You should be given enough money to defray the costs of travel to and from the exam. This could be important, because if an appropriate expert is located a distance from you, you will be paid for a convenient method of travel.   You should also be given money to help cover the costs of meals during the trip. Further, your employer should reimburse you for your lost wages in attending the IME.

 

Even though you will not be paying for the exam, it still must be scheduled at a time and place that is reasonable and convenient for you. Appropriate notice of the exam should be given to you as well, so the disruption to your life is minimized.

 

Though the physician performing the IME may be a treating physician, you are not obligated to receive treatment from him or her. The purpose of the visit is to gather information which is independent of your treating physician’s regarding your injury. The IME will likely consist of answering questions, reviewing your medical records and history, and having further medical tests. Through this process, the IME physician may look for information regarding the initial cause of the injury, and whether it was related to your employment. The physician may also make a determination as to the current state of your injury and the prognosis for future recovery. 

 

The insurance company may use the results of the IME to derive the amount of benefits to be paid and the amount of any settlement offer. You will be entitled to receive a timely report, however, of the findings of the IME, just as your employer will.

 

If you are sent a notice for an IME, it is best to speak with your workers’ compensation attorney. Compliance with the IME may seem arduous, but it is both legally necessary, and can help speed up the progress of your claim, so you can continue on the road to receiving benefits for your injury.  If you blow off this exam your benefits will be suspended.

 

Most of the doctors who perform these exams are honest, but some are for lack of a better term, whores.  Your job is to be honest, don't exaggerate your problem and answer questions.  It is your lawyer's job to prepare you for this exam and you should never go to one, if possible, without at least knowing what to expect.

We are workers' compensation attorneys that help people with Illinois work injuries anywhere in IL via our statewide network of attorneys.  Contact us and we will answer your questions or find the right lawyer for your situation.

IME reports. What weight do independent medical examinations have in court?

A reader asks:

My doctor says I need back surgery and it is related to my job injury.  I went to an "Independent" medical examination and not only did this hack say that I didn't have an accident, but he also says I can work full duty and need no further treatment.  How can he say I didn't have an accident when I was working with hundreds of pounds of raw materials?  My doctor is a respected orthopedic surgeon.  Will the insurance company get away with this because their doctor is a crook?

The situation described is not un-common.  Your employer or their insurance company has a right to send you to a doctor of their choosing.  If they disagree with your doctor then we go to trial.  That's one way we earn our money.

We can't guarantee who the Arbitrator is going to agree with, but all things being equal, treating surgeons who have seen you multiple times are given much more credibility than a one time visit doctor who maybe spent 10 minutes with you.  The Arbitrators know who the hired guns are and who gives an honest opinion.  If you testify credibly about how you got hurt and there are no other problems in your case like surveillance or intervening injuries, things will probably go fine.

If they get an IME we just have to go through the process.  It can be frustrating to hear that, but that is why you get a good attorney in the first place.

We are workers' compensation attorneys that help people with Illinois work injuries anywhere in IL via our statewide network of attorneys.  Contact us and we will answer your questions or find the right lawyer for your situation.

Do I have to see the company doctor?

A mechanic called us because he is mad about what has happened to some co-workers.  Long story short is that whenever they have gotten injured, the employer makes them go to the company doctor before they go to a hospital or doctor of their choosing.  In more than one instance these co-workers have been told that they are fine only to later find out that they have broken bones, herniated discs, ACL tears and other serious injuries.  The caller said that the co-workers were told that if they didn't go to the company clinic first (never mind that these particular docs appear to be negligent or hired guns) that they would not be able to receive any benefits.

So do you have to see the company doctor if you are hurt at work in Illinois?

While the employer or the insurance company has a right to make you see a doctor of their choosing for a one time examination with possible follow ups depending on the exam or the stage of the case.  But you absolutely do not jeopardize your rights to benefits by seeing a doctor of your own choosing first.  In fact, in some cases it's the smart thing to do. 

For example if you break your arm and it needs to be set right away, do you wait a day so the company doc can look at it?  Hell no!  Doing that could make an injury ten times worse.

We operate by two rules: 1. Always be honest.  2. There is nothing more important that your health.  So don't let your employer stress you out.  The law is on your side.

We are workers' compensation attorneys that help people with Illinois work injuries anywhere in IL via our statewide network of attorneys.  Contact us and we will answer your questions or find the right lawyer for your situation.

Illinois workers' compensation- IME doctors against the treating physician

This question came in from a reader:

My question is can Work Comp make you see their Doctor and go by his orders on stating you can return to work light duty when my own Doctor who performed my shoulder surgery stated I am not to return to work.

That's a good question and a scenario that pops up a lot.  If the insurance company has a doctor that says you are fine, they can rely on that opinion to deny you benefits.  In other words, can they do it, yes, but you do have options.

Option 1 is to try to go back to work and see what happens.  If you give it a go and it doesn't work then all of the sudden the opinion of the company doctor isn't very credible as long as you are credible when testifying.  Of course we can understand why you wouldn't want to do that because nothing is more important than your health so why should you risk it?

Option 2 is to go to trial and pit your doc against theirs.  Injured workers win most of these battles.  But nothing is guaranteed and even if you win you might be without money for quite some time which is really like losing in the end.

Option 3 is to see if the company will work with you.  Often the insurance company tells you one thing, but the employer is a good guy that says something else.  So if your boss wants to listen to your doctor then you might be ok.

Not one option is right for everyone.  You have to decide what is best for you.

We are workers' compensation attorneys that help people with Illinois work injuries anywhere in IL via our statewide network of attorneys.  Contact us and we will answer your questions or find the right lawyer for your situation.

Illinois workers' compensation- company doctors

It's not uncommon if you get hurt on the job in Illinois for your company to send you to one of their doctors.  This could be for a one time independent medical examination or it could be a company clinic.   There are two important things to know about this.

1. You don't have to receive treatment with their doctor on an ongoing basis, but you can.  You are allowed two choices of physicians in an Illinois work comp case and since they are sending you to that doctor that is not considered one of your choices.

2. If their doctor says your injury is work related, you need surgery, etc., the opinion of that doctor is held against the company.  It's not a slam dunk that a Judge would agree with that opinion, but that is usually the case unless one of your choices says something different.  We often see a company doctor go against the company and then the insurance carrier tries to send you to another doctor to fight that opinion.  Technically they can do this, but it is seen as "doctor shopping" and would work against them at trial.  In fact while we don't guarantee a result, we have never lost a case where the company doctor was in the corner of our clients.

If your company wants to send you to a doctor of their choosing you should go, be honest and after it's over write down what happened.  A lot of our clients report that an independent medical examination took less than five minutes and that the doctor hardly asked any questions and didn't perform much of an exam.  These same doctors are the first to say whatever the company wants them to say.

Again, we can't guarantee a result, but we find that when our clients testify as to what really happened at these quick exams as compared with their doctor who spent more time with them, things usually work out for the best.

 We are workers' compensation attorneys that help people with Illinois work injuries anywhere in IL via our statewide network of attorneys.  Contact Us and we will answer your questions or find the right lawyer for your situation.

 

Illinois workers' compensation medical bills

A new client came to us after having had one surgery for his knee from a work injury.  After months of therapy it wasn't getting better and his doctor suggested that he have an additional surgery based on a review of a MRI.

As is their right, the insurance company sent this worker to an independent medical examination (IME) with a doctor of their choosing.   Quite often these are hired guns, but many of these doctors are honest as was this one.  In fact the doctor in his report said that he agreed 100% that the worker needed a new surgery and that it was related to the work injury.

Seems pretty obvious that the insurance company should pay for this surgery and the worker can get better, right?  Well apparently the insurance adjuster felt that he should do more therapy first so even though two orthopedic surgeons agreed surgery was needed, the adjuster put her medical "expertise" above them.

Should he just sit there and get screwed?  NO!!!  Not only can we get the surgery ordered by an Illinois Workers' Compensation Commission Arbitrator, but we can find out how much the surgery costs and the insurance company should have to pay a 50% penalty to our client.  In other words, if the surgery is going to cost $50,000, they should pay this guy $25,000 because their behavior is so unreasonable.

If you are hurt and the evidence is on your side the system will protect you.  You just have to proceed forward.

 We are workers' compensation attorneys that help people with Illinois work injuries anywhere in IL via our statewide network of attorneys.  Contact Us and we will answer your questions or find the right lawyer for your situation.

 

 

FCE, IME, MMI, ???

We are happy to answer any questions that people have about Illinois injury cases.  Three questions we get asked a lot are what are the abbreviations FCE, IME and MMI?

FCE- Stands for functional capacity evaluation.  Basically it's a test that has you perform a series of activities throughout the day to determine if you need any physical restrictions before returning to your job or what capacity you can work in.  It's an objective test that measures not just ability, but also effort.  If you are found to have used a bad effort it can hurt your case.

IME- Stands for independent medical examination.  This is the insurance company's right to send you to a doctor of their choosing to see if you are really hurt, what your diagnosis is, whether or not your problem is work related, what treatment is needed or anything else that they want to ask.  It's usually a one time visit.  Many of these doctors are hired guns or almost always favor the employer.  Some are truly independent.

MMI- This means maximum medical improvement or as good as you are going to get medically speaking.  We don't consider settling a case until a client is at MMI because once you settle you can not get any more medical treatment at your employer's expense.  Sometimes you are at MMI, but still need ongoing physical therapy or a yearly exam.  Your doctor determines when MMI has taken place.

If you have questions about any of these terms just let us know.

 

We are workers' compensation attorneys that help people with Illinois work injuries anywhere in IL via our statewide network of attorneys.  Contact us and we will answer your questions or find the right lawyer for your situation.