If you regularly read my blog you know that I don’t give medical advice. I might tell you about similar cases I’ve seen in the past, but I don’t try and diagnose anyone or especially tell them what type of treatment they should have. The farthest I’ll usually go is to tell someone who has a back injury with pain shooting down their legs that it sounds like they have a herniated disc and that they should see an orthopedic doctor to make sure. I’m OK with that for two reasons. First, it’s pretty much similar to telling someone who is sneezing that it sounds like they have a cold. In other words it’s an obvious statement that is usually right 99% of the time. Second, if you delay too long in seeing the right type of doctor you can cause yourself some serious, long term damage.
A recent caller to our office suffered what sounds like a serious shoulder injury. She has seen an orthopedic doctor and been going to physical therapy. An MRI has been recommended but hasn’t taken place. In fact it was denied by the insurance adjuster. When the worker called to find out why it was denied, the adjuster was very rude and said, “Look kid, I’ve been doing this for 20 years and I’ve seen a lot of shoulder injuries. I’ve seen your medical records” She then screamed, “You should be better by now!”
Uhm, yeah, right.
This would be laughable if the adjuster wasn’t messing with the health of the injured worker. She may have handled thousands of claims over the years, but the arrogance by a non medical doctor to tell our client that she should be all better by now is stunning.
I don’t believe in this case that the adjuster was trying to do anything other than pull a fast one and get the case closed. But I’ve seen other times when adjusters really believe that they can draw medical conclusions based on reading the records or just their “gut feeling.” For most of them, their knowledge is limited to what they’ve seen on the job and some training seminars that discuss various injuries.
Whatever the reason or the motive -which in my experience is most often bitter people who don’t like seeing anyone have a claim – this type of activity violates the Illinois Workers’ Compensation Act and is not a valid reason for denying medical care.
It almost sounds like it’s nuts that this could happen, but sadly it happens all of the time in one way or another. Selfishly it keeps lawyers like me in business. But I’d gladly go out of business if it meant that people were being treated fairly and the law was being followed.