Workers Comp Adjuster Tactic

[by0b]

California
I'm not represented and I've been receiving TD benefits for a year for a knee injury. I had a surgery a few months back for a torn meniscus. Because of my limp from not having a cane or brace for 8 months, my new doctor after providing both cane and leg brace stated in his initial exam that I have developed an abnormal gait that has led to severe back, toe and shoulder pain as being compensable to the knee injury. The doctor requested mri's on knee, back and shoulder to see what's going on. That was 2 months ago with no reply from the adjuster. A few weeks ago, the adjuster asked if I was interested in a C&R settlement. I told them I would if the amount was reasonable. Friday I received a call from a nurse case worker for the insurance company requesting to be present and observe at my next doctors appointment. She says she here to help me.
I assume the insurance company wants to see and evaluate me to determine a value to offer me. I am a little concerned that they have not replied to my doctors request for authorization regarding the MRI's. Would it hurt to let someone observe my next doctors meeting?
What do the experts think?

 

[adjusterjack]

Friday I received a call from a nurse case worker for the insurance company requesting to be present and observe at my next doctors appointment. She says she here to help me.

She's paid by the insurance company to verify your injury and condition. Whether that helps you or not is anybody's guess.

California
I am a little concerned that they have not replied to my doctors request for authorization regarding the MRI's.

That's probably on the back burner until the nurse verifies the need for it.

California
Would it hurt to let someone observe my next doctors meeting?

You really don't have any choice. The insurance company is entitled to verify your injury and condition and if you refuse the nurse's presence the insurance company is likely to send you to a doctor of its own choice which is certainly not going to bode well for you.

 

[by0b]

She's paid by the insurance company to verify your injury and condition. Whether that helps you or not is anybody's guess.



That's probably on the back burner until the nurse verifies the need for it.



You really don't have any choice. The insurance company is entitled to verify your injury and condition and if you refuse the nurse's presence the insurance company is likely to send you to a doctor of its own choice which is certainly not going to bode well for you.

I'm already seeing their doctors. That's their verification. It's not as bad as I hear. He's really good. The fact being I do have a choice. They could have replied to the RFA from the doctor with a denial and a QME would decide. The insurance adjuster has no legal right to evaluate me outside his doctor. That's why they have doctors.
Any attorney's out there.
Would you allow an observer for the insurance company's to sit in on your clients monthly progress exam.

 

[adjusterjack]

Any attorney's out there.

Plenty.

You are free to look one up and hire him.

Would you allow an observer for the insurance company's to sit in on your clients monthly progress exam.

You appear to be claiming additional conditions other that those originally claimed.

If this is the insurance company doctor that you see for your monthly progress (and you didn't say that earlier) then I agree that the presence of the nurse is suspect.

But if it's your own doctor and you refuse, your claim on the additional conditions may be put on hold until you comply.

 

[Nellibelle]

California
I'm not represented and I've been receiving TD benefits for a year for a knee injury. I had a surgery a few months back for a torn meniscus. Because of my limp from not having a cane or brace for 8 months, my new doctor after providing both cane and leg brace stated in his initial exam that I have developed an abnormal gait that has led to severe back, toe and shoulder pain as being compensable to the knee injury. The doctor requested mri's on knee, back and shoulder to see what's going on. That was 2 months ago with no reply from the adjuster. A few weeks ago, the adjuster asked if I was interested in a C&R settlement. I told them I would if the amount was reasonable. Friday I received a call from a nurse case worker for the insurance company requesting to be present and observe at my next doctors appointment. She says she here to help me.
I assume the insurance company wants to see and evaluate me to determine a value to offer me. I am a little concerned that they have not replied to my doctors request for authorization regarding the MRI's. Would it hurt to let someone observe my next doctors meeting?
What do the experts think?

IMO, it wouldn't hurt to allow the IC (Insurance Carrier) to provide a representative to observe what is said during your doctor's visit. It could very well be (as you said) that they are trying to determine what type of Compromise and Release settlement they are going to offer you (if any).

I would think very hard about agreeing to a Compromise and Release since it will release your employer's IC from any further liability concerning your work-related injury. This means you will NOT be eligible for "Future Medical" that can provide subsequent operations and/or treatment concerning your knee injury.

 

[by0b]

IMO, it wouldn't hurt to allow the IC (Insurance Carrier) to provide a representative to observe what is said during your doctor's visit. It could very well be (as you said) that they are trying to determine what type of Compromise and Release settlement they are going to offer you (if any).

I would think very hard about agreeing to a Compromise and Release since it will release your employer's IC from any further liability concerning your work-related injury. This means you will NOT be eligible for "Future Medical" that can provide subsequent operations and/or treatment concerning your knee injury.

Thanks, all of you have been helpful