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  1. #1
    amirajormond is offline Junior Member
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    how can one dispute an IME??? please help!

    What is the name of your state? Colorado

    I'll try to make this as short as possible...
    Bad auto accident, have been getting treatment for 2 years. All doctors/therapists agree that I am still making "slow steady progress" and that I am nowhere near MMI.

    Insurance adjuster lady ordered 2 IMEs, the neurologist I ended up with is one of those who apparently makes her living on IMEs (wish I had been able to weed her out) and has determined that I am at MMI and need no further treatment, and do not even need pain medication. I was floored.

    The chiropractor IME recommended additional physical therapy, chiropractic, massage therapy, pain meds as needed and when done with physical therapy, a gym membership and pool membership to continue treatment on my own when I am ready.

    By the way, the chiropractor told me that he only does one or two IMEs per year. Hence the difference in opinions, the non-scab recommends more treatment, while the scab aka:"I suck as a doctor and the only way I can earn a living is to suck up to the insurance companies and say their customers don't need more treatment when they do" says I am fine and shouldn't need to see another doctor as long as I live.

    What is the likelihood, if I decide to get an IME at my expense, that I can get a fair decision this time? If they use the same method of generating a list of 5 docs, and I strike two names, insurance strikes two names, I go to the one left... is there a way to find out if a doctor is one of these insurance scabs beforehand?

    How much will this cost me? I have heard $200-$1000. This is for a basic neurological exam, not the 8 hour neuro-psyche testing. What other options do I have?

    The insurance lady wouldn't even give me the phone number of the state insurance commision so that I could get the process started. She said if I was going to dispute the original IME findings, she wasn't going to help me.

    Has anyone had any experience with this stuff, or have any advice that is helpful? Thanks in advance...
  2. #2
    shell007 Guest
    So you have an attorney? If not...get one!

    The physicians who perform the IME's for the insurance co.'s defense are usually already on their side and have "business relationships".

    I don't know that getting an independent IME is going to do you any good without representation. All it is going to do is turn into is a case of "he said/she said".
  3. #3
    amirajormond is offline Junior Member
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    not yet

    Quote Originally Posted by shellandty
    So you have an attorney? If not...get one!

    The physicians who perform the IME's for the insurance co.'s defense are usually already on their side and have "business relationships".

    I don't know that getting an independent IME is going to do you any good without representation. All it is going to do is turn into is a case of "he said/she said".
    No, I don't have a lawyer yet. I haven't needed one as the insurance co has been fair up until this. In their letter to me the last line states that if I disagree with the findings I can get an IME at my own expense... I guess no one gets their own IME as is usually won't help as you say. So far everyone I have been able to talk to has said they don't even know how to set it up, etc, they haven't heard of anyone wanting the expense or trouble.

    But if I don't get my own IME, aren't I cut off from treatment now?

    I will be getting a lawyer... wow, I have never had to get one before so that is another ordeal I suppose
  4. #4
    rmet4nzkx is offline Senior Member
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    If the Neurologist is a qualified IME then their report is going to have more weight than the Ciropractor IME. Get an attorney.
    It is impossible to answer your questions without a copy of your medical record including but not limited to the raw data from the Neuropsychological exams which are different than the Neurologist, just to make that distinction clear. After two years you should have acheived about the maximum recovery possible so they will be looking at milingering or learned behaviors. If the insurance is a HMO there may be an appeals process, that information should be available to you through your case manager or patient assistance.
    Can you give any facts re your accident and injuries? Did you have a head injury?
  5. #5
    amirajormond is offline Junior Member
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    I have not had a neuropsyche evaluation nor IME for one.

    yes, I have a head injury. I was unconsious and hospitalized for 5 days, and then missed two months of work following the accident, and per the neurologist should have missed more. Trouble was my job said they would let me go if I didn't come back after 60 days.

    Sitting at the desk job worsened my back, neck and shoulders. Job kept saying they would accomodate the necessary chair/desk/ whatever, but after 9 months of hearing they were going to get me a better situation with respect to the desk/chair I ended up leaving the job as I had increased my Rx pain med so much it was making me sick.

    I wasn't able to start physical therapy immediately after accident, as neurologist felt it was useless until I had finished vestibular, cognitive and vision therapy first. Neuro felt that PT on top of all that was too much, and the other stuff needed to be addressed first. Guess PT doesn't work if your vestibular system is so off you can't stand up without holding onto the wall, right? Vestibular and vision therapy were pretty slow going (at least in my case) as they had to keep the pace pretty slow to avoid my symptoms worsening.

    After "completing" vestibular and vision therapy (neuro said these might need to be readdressed later) I started PT in November. I have gotten a copy of my file from all my treating docs and they all say the same thing... "patient is making continued slow, steady progress."

    I am nowhere near the level of functioning before my accident. I have consistent pain that prevents me from 95% of what I should be able to do. Pain interrupts my sleep, and interferes with every area of my life. I have pain sitting, laying, walking, standing, moving... almost always. I also have constant headaches I would say are now 60% of the time.

    I didn't want to have to get a lawyer as long as I was able to get treatment and the insurance would pay for it as they should. I am very upset that I am now being treated like some conartist, when the truth is I was in a serious accident, I have serious injuries that with treatment would be able to get better.
    Last edited by amirajormond; 03-02-2006 at 12:32 PM.
  6. #6
    amirajormond is offline Junior Member
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    info

    accident was head on collision, the other driver was at fault. Apparently he fell asleep while driving (I don't know how this was determined, if he stated it or what...?) and veered into oncoming traffic and hit me. I was going 15 mph approx, had just turned onto the street from a stop sign. He was going so fast it seemed like he came out of nowhere, I had no time to stop or swerve. And my car was old, no airbags.
    Last edited by amirajormond; 03-02-2006 at 12:32 PM.
  7. #7
    shell007 Guest
    You needed a lawyer YESTERDAY!!

    The insurance company is NOT on your side. As you seem to be quite an honest person, the insurance company really doesn't care. They are there to make money NOT pay it out. They will try and save/make a dollar wherever they can.

    Motor Vehicle Accidents
    In Colorado, one can file suit to recover damages for injuries sustained in a motor vehicle accident up to three years after the accident occurred.
    Last edited by shell007; 03-02-2006 at 12:32 PM.
  8. #8
    rmet4nzkx is offline Senior Member
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    Please consult a PI attorney re the accident and an Employment attorney re the employment issues and ADA violations. Were you eligible for FMLA? Did you officially ask for ADA accommodations or were you competent to do that? What Rx were you taking? Who's fault was the accident? If it was your fault, was there alcohol or any impairment involved? What physical injuries did you incurr in addition to the head injury? Do you have a history of any other head injuries?
    How long were you empolyed by your employer?
    Have you applied for SS disability benefits?

    You need a Neuropsychlogical evaluation?
    Have you sought services through the department of rehab? Other services for brain injured patients? Please contact the center for independent living near you they can assist you in acessing services but you still need an attorney.
  9. #9
    amirajormond is offline Junior Member
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    When I told my neurologist that I was due back at work or lose my job neuro said it would be better to give up the job, but it wasn't practical financially. Neuro wrote script to my employer that they needed to make the necessary accomodations with desk/chair, etc or allow me to work from home as I had the ability to work at a computer that we had placed on a high counter and I could sit on a barstool type chair. My employer refused that, even though they had several other people doing my exact job from their homes for convenience sake.

    Employer said I didn't qualify for FMLA, only a personal leave of absence with max of 60 days.

    Employer promised to make the necessary arrangements. I did not ask for ADA, as I didn't know it would have applied to me. I took them at their word that they would come through for me, and was let down. This is the first accident I have ever been in, and it has been overwhelming.

    I was originally taking daypro and Vicoden. Neuro switched me to Percocet after Vicoden started to upset my stomach and cause vomiting.

    You are all right, I know now that I should have got a lawyer sooner, but when the insurance was cooperating, I thought I wouldn't need one.

    Loaded question... any advice about looking for and hiring a lawyer? Could the same lawyer address both the issues with the accident and work? I had never thought of getting representation against my former employer.
    Last edited by amirajormond; 03-02-2006 at 01:13 PM.
  10. #10
    amirajormond is offline Junior Member
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    Thank you :)

    By the way, you guys are really helpful and I appreciate your assistance more than you know. Thank you
  11. #11
    rmet4nzkx is offline Senior Member
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    Most good attorneys specialize, so get a PI attorney first and they will refer for the employment issues if needed, although that may be a part of your damages, your loss of employment. You may also want to contact the eeoc re complaints or right to sue letter.
  12. #12
    amirajormond is offline Junior Member
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    Quote Originally Posted by rmet4nzkx
    Did you officially ask for ADA accommodations or were you competent to do that? What physical injuries did you incurr in addition to the head injury? Do you have a history of any other head injuries?
    How long were you empolyed by your employer?
    Have you applied for SS disability benefits?

    Have you sought services through the department of rehab? Other services for brain injured patients? Please contact the center for independent living near you they can assist you in acessing services but you still need an attorney.
    I didn't know to ask for ADA accomodations. I have a closed head injury that had resulted in a CSF leak. The CSF leak ended up "self-resolving" (I didn't require surgery), other than head injury related things (attention span, memory (long and short term are affected), cognition, mood swings, vision problems, hearing loss, comprehension, personality changes, etc all the lovely things that go along with a head injury), I have neck, back , shoulder, SI, knee and ankle problems. I broke my arm in two places and broke my wrist, dislocated my shoulder, and broke 3 ribs. My headaches are from TMJ and neck injuries they tell me.

    I have not applied for SS disability benefits as I didn't know about them in relation to my situation. Also I haven't heard of the deptartment of rehab. And don't know of services for brain injured patients, other than going to my neurologist and the docs they have referred me to.
  13. #13
    shell007 Guest
    You are all right, I know now that I should have got a lawyer sooner, but when the insurance was cooperating, I thought I wouldn't need one.

    Loaded question... any advice about looking for and hiring a lawyer? Could the same lawyer address both the issues with the accident and work? I had never thought of getting representation against my former employer
    Yes...the insurance co seems soooo nice and cooperative until it's time to pay up. Don't fall for it.

    Look in your local yellow pages for a personal injury attorney. They will usually offer a free consultation to review the specifics of the case, and then IF you decide to go with them, it will, more than likely, be on a contingent basis. Meaning...no fees up front, and they will take about 33% or so of your settlement. I've also heard to stay away from the ones with the BIG COLORFUL FULL-PAGE ADS.

    As for using the SAME attorney to pursue both portions of your case, I'm not sure. Maybe rmet will come back and advise further.

    Good luck and get well!!
  14. #14
    amirajormond is offline Junior Member
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    Quote Originally Posted by rmet4nzkx
    Most good attorneys specialize, so get a PI attorney first and they will refer for the employment issues if needed, although that may be a part of your damages, your loss of employment. You may also want to contact the eeoc re complaints or right to sue letter.
    Would you suggest getting names of lawyers from my treating docs as they would probably be unbiased and may have heard word of mouth from other patients that have had good experiences?

    I am afraid of just looking in the phone book and just plain freaked out by the ones on tv.
  15. #15
    rmet4nzkx is offline Senior Member
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    Not sure where you are in CO but here are some links to resources and one attorney resouce, give them a call and discuss your case and needed referals. Don't apply for SSDI until you have other assistance with either an attorney or CIL otherwise you will be denied. You also have Statute of limitaitons so you need to get busy soon.

    Brain Injury Association of Colorado -
    A resource directory for family members and survivors of TBI. Including links, chat room, glossary and provider directory.
    [url]http://www.biacolorado.org/[/url]

    Google Groups : Colorado Brain Injury Support
    Description: Colorado Brain Injury Support is an on-line support group for all people in Colorado with brain injury, their families and caregivers. ...
    [url]http://groups-beta.google.com/group/Colorado-Brain-Injury-Support[/url]

    Personal Injury Attorney Denver Colorado Brain Damage Spinal Cord ...
    [url]http://www.fkwlaw.com/PracticeAreas/CatastrophicInjuries.asp[/url]

    Brain Injury Association of Colorado
    The Colorado Traumatic Brain Injury Trust Fund Program ... The Brain Injury Association of Colorado (BIAC) is a non-profit, statewide organization dedicated ...
    [url]http://www.cdhs.state.co.us/ohr/tbi/braininjuryassociationofcolorado.htm[/url]

    The Colorado Traumatic Brain Injury Trust Fund Program HOMEPAGE
    Program Overview Client Services Research Application ...
    [url]http://www.cdhs.state.co.us/ohr/tbi/newtbi.html[/url]


    Colorado State Resources
    Brain Injury Association of Colorado 4200 W. Conejos Place, Suite 524 ... To find out the contact information for centers for independent living (CILs) in ...
    [url]http://www.nichcy.org/stateshe/co.htm[/url]

    Colorado Independent Living Centers. (For a PDF Version of this information, click here.) Atlantis. 201 South Cherokee. Denver, CO 80223 ...
    [url]http://www.cdhs.state.co.us/deafcommission/infocenter/CO_IL_Directory.htm[/url]

    Voc Rehab Home
    Welcome to the home page developed by the Division Of Vocational Rehabilitation, Colorado Department Of Human Services ! We look forward to this opportunity ...
    [url]http://www.cdhs.state.co.us/ods/dvr/ods_dvr1.html[/url]

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