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I dissagree with the IME report, now what?

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Slater02

Junior Member
What is the name of your state? Live In New jersey, work in NYC.
Hi, I was injurered on an off site work trip at the beginning of the year.
I was told by my HR head that I had to file the injury under workers comp.
I knew it would be painful process and riddled with paperwork and hastles, but I had to listen to her as she mentioned that she could not keep this quiet.

After 9 months of doctors (I went to my ortho and then a second opinion-both telling me I need surgery and they were at the end of the line as far as solutions. I was then scheduled for surgery and the paperwork started for approval of this from the workers comp people. I was then informed it was canceled and I needed to go to an IME. When I got to this "doctors office", I was in line with about 20 people that all had accidents and looked to be suing or looking for some sort of compensation. All I want is to get fixed.

After this "doctor" exmained me (for about a minute) and asked me a lot of questions that I was sure he had answers to about my condition (he was sent the MRI results yet he seemed to have no knowledge of info) he raised my arms to check my shoulder injury and it hurt and I said it did, and then sent me on my way. He also gave me a parting shot and asked..this was a team builder trip right, I said yes, he said "looks like this didnt help the team did it" and was very rude and I felt out of line.

In any case, I finally received the report which says that this injury is a pre exisitng degenertive one, possibly aggrivated by the fall. That he feels no surgery is needed, no muscle tenderness or other problem is there and they want to send me back to P/T for 8 sessions and then another IME.

This is preposterous and the report is completely biased by someone with no knowledge of my pain or what it is doing to me.

What are my alternatives. I called my surgon and they tried to reach the insurance company with no luck. Should I call the workers comp people? How can I dissagree with this joker who is seemingly on the side of the company? How can I fight this and thie results of this. It has been 9 months and the only way I can get better is with surgery they refuse to allow. Would I be able to use my regular insurance to get this done or would they refuse it since it was already under workers comp. I just want to get my shoulder right and not sure how to proceed. Do I need a lawyer to refuke these IME findings that are not true.

Please help!
Slater
 


Beth3

Senior Member
Your next step is to file for a hearing with your State's Worker's Compensation Division. You will find this much easier if you have the assistance of a WC attorney.
 

HomeGuru

Senior Member
Slater02 said:
What is the name of your state? Live In New jersey, work in NYC.

Do I need a lawyer to refuke these IME findings that are not true.

Please help!
Slater

**A: yes, hire a WC/PI attorney who will get another medical opinion to refute the IME findings.
 

e3mrk

Member
Ohio.
You need to get another doctor to examin you.
The ones that workers comp. send you to are questionable to say the least.
No you dont need a attorney. but if you want to win your case I would strongly advise speaking with one.
 
First of all, YES, you need to consult with an attorney at this point. Unfortunately, this is a sad reality for many injured employees.

This might help you understand the process a little bit.

Workers compensation insurance is just like any other insurance company, the more claims that are filed, or the more expensive the claims, the higher the premiums are for the employer. Naturally, once your claim seems to start increasing in $, any insurance company/employer is going to review it to see how they can avoid paying claims or save money. Hence, the IME. Now, the IME doctor is not impartial, he certainly has some agreement with your employer or insurance company. His goal is not to deny you care, but to determine if there are other reasonable medical alternatives that he feels the original MD has not considered. Now you have two conflicting opinions, which is why you need an attorney. First you may want to gain approval from the workers comp carrier for an additional opinion, a new doctor (again), but an attorney more versed in your case may steer you another way--

Second--If your priority is to get your surgery done and paid for--Obtain IN WRITING a denial from the workers comp insurance carrier that this will not be covered under workers comp. "not deemed work related".
Then call your health insurance company, explain the details, give them a copy of the WC denial letter, and see if they will approve and pay for the surgery. There's no guarantee, but it is possible they will pick it up. Of course, understand that insurance companies can ALWAYS deny your claim, regardless of approval, or attemp to recoup funds later.

I know this is not very reassuring, but hopefully it helps you understand the process a bit.--Good Luck--and definitely, consult with an attorney!
 

JustDream

Member
Contact the Department of Labor Workers Comp at 800-580-6665. Explain your situation and ask what your rights are. This is an advocate with the NY state wc system. They are there to help injured workers and it does not cost you anything. If you do not get resolution from them, then contact an attorney.
 

tjr5150

Member
have to go with justdream on this one..
Call your deparment of labor and talk to a workman's comp department.. They should be able to direct you to the right form on their website.. It would be a IME application, you can fill it out on your computer or print it off and fill it out that way..Either way you need to fax it or send it certified mail..Then it is a waiting period they can take up to thirty days before they say yes/no...The good news is when you file the IME papers you can choose 3 doctors that you would like to use..Choosse theses doc's well, you will find a list on your department of labor site, they must be class2 or 3.. you subment theses forms to the state and your insurance.. then you ned to decide, you/ins what doctor you would like to use if you can't decide then insurance chooses 3 names and if you still can't decide the state decides..
 

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