How the Wrong Doctor Can Derail Your Workers’ Compensation Claim
Choose your physician very carefully when you have been injured on the job and seek workers’ compensation benefits.
The right physician will stand up to your employer and insurance company if they try to deny you your rightful benefits. The wrong physician will cost you dearly.
We recently represented a 37-year-old steelworker, who was moving pieces of heavy steel when he felt a pain in his left arm. He was initially diagnosed with tennis elbow. But we suspected his injury was more severe. At our urging, he found a qualified orthopedic surgeon to provide him with a second opinion. Well, guess what? Our client had actually suffered a torn biceps tendon. We obtained a settlement on his behalf in excess of $607,000.
What if our client had accepted the original diagnosis? What if he hadn’t secured the right physician? He would have been without a job and without a safety net to help him.
A Litmus Test for the Right Physician: the IME
You want a physician who does more than provide qualified advice. You want a physician who will fight for you. Case in point: when you undergo the process of getting an independent medical examination (IME).
As we blogged recently, if you have filed a workers’ compensation claim because of a work-related injury or illness, at some point in the process the workers’ compensation insurance company might require you to be examined by a physician of its choice. This process is referred to as an IME.
As the name implies, an IME consists of a second opinion delivered by a physician. The insurance company might require one for any number of reasons. As to how independent the opinion will be is another story. But by way of example, your employer’s insurer might disagree with your physician’s diagnosis about the nature of your work-related injury or illness. Or, more typically, the appointment will be arranged to obtain an opinion as to whether your condition and/or need for treatment is related to your accident or injury or whether the treatment you have been prescribed is reasonable and necessary.
Make no mistake: when your insurance company requires an IME, they have an agenda: to stop or curtail your benefits or limit your medical care. And you better believe they are going to choose a physician who is on their side, not yours. If the IME doctor says you do not need treatment or you are not entitled to benefits, the insurance company will latch on to that report and use it to argue that your case is over or that the value of your case has been significantly reduced. If you have the right treating physician in your corner, the case is far from over. Here’s what you should do when you receive an IME report that you disagree with:
1) Act Quickly
Immediately schedule an appointment with your own physician whose diagnosis probably prompted the need for the IME in the first place. Time is of the essence.
2) Bring the Evidence
Bring the IME report to your physician. Your doctor needs to see the actual IME report, not your interpretation of the report. The IME report also gives your physician the information they need to write a formal disagreement. Here is where a physician can make such a crucial difference. A physician can pick apart a poorly done IME report and give you a fighting chance to overturn its findings.
The key is for your physician to fight for you with conviction. Sure, your attorney can schedule a deposition that requires the physician to comment formally. But it’s far better for your physician to proactively follow up on your own behalf. That kind of action sends a message to your employer and insurance company: you are all in for a long-haul fight.
Now, what happens if your physician actually agrees with the IME? Well, my friend, it’s time for you to have a heart to heart with your attorney. When your physician actually agrees with the IME, you probably just received a wake-up call that your case may not be what you think it is or what you would like it to be.
Can you go find another physician if your own actually agrees with the IME? Sure, you can do that. But, even if you see another physician, you are in a tough position because right off the bat, you have two physicians – yours and the insurance company’s – who have sided against you. It’s going to be nearly impossible for a physician to debunk two similar opinions.
Two Essential ingredients of the Right Physician
To sum it up, when you choose a physician, make sure you select someone who:
- Is credible and experienced treating the specific injury you’ve suffered. This person may or may not be your family physician. Don’t choose who is convenient.
- Will fight for you. Find out how much experience they have with the workers’ compensation process and how much time they are willing to spend to help you.
It’s better to get help than go it alone. You have enough stress running through the energy-sapping workers’ compensation gauntlet.
So how about it: is your physician in your corner?
Call Capron & Avgerinos
Call Capron & Avgerinos now at 800-535-4542 if you need help with a workers’ compensation case in Illinois or Iowa. As your Illinois and Iowa Injury Network, we are ready to assist you over the phone or in person. We perform our cases on a contingent fee basis, which means we are not paid unless you recover compensation for your claim. Call Capron & Avgerinos at 800-535-4542. Let us show how we can deliver results for you.