October 18, 2019

Bogus Independent Medical Exam Requested by Insurance Company Puts Benefits at Risk

bad faith workers compensationI received this question from one of my blog readers.  The situation this person describes is, unfortunately, quite common:

I was injured at work over 7 months ago. I went to iworks and then went to my doc, Both docs have me on restrictions and 2 months ago the company had me go see another doc of there choice , with no records or anything he seen me for maybe 15 mins and sent a report saying i can go back to work.. So now my work informs me that even though Iworks and my back specialist says restrictions that I have to return to work back on the floor and ignore the restrictions. Iworks even says no patient transfers but my work says they don't care about Iworks i have to go back to my CNA job. So now what do i do?

Here are my thoughts:  I am assuming by what you have written that you do not have a lawyer.  It may be that the insurance company accepted your claim and paid temporary total disabiltiy benefits initially, which might have made you think that you did not need legal help.  Setting aside the question of whether anyone with a serious injury should proceed without counsel, I think that the insurance company's decision to send you to one of their doctors should have been a red flag.

Insurance companies send you to so-called "independent medical examinations" so they can get evidence which they can use to cut  you off.   Obviously, the IME doctor's 15 minute exam without review of other records was not intended to do anything but cut you off, and while not every IME is this bogus, many are.

An experienced lawyer would most likely have recognized the IME doctor as a bought and paid for shill for the insurance company and would have argued for a more fair medical provider.  At the same time, your lawyer would seek documentation from your treating physicians that their restrictions are valid.  As soon as the return to work notice was issued your lawyer would have requested a hearing and, if you are in Georgia, could have used the claimant's IME to gather additional evidence to support your claim of disability.

At this point you have returned to work and if you cannot perform the duties and you have to leave, you may be cut off.  You should not delay in seeking legal assistance now – your attorney will have to decide whether to request a hearing, ask for mediation or even attempt to settle.

Do Not Forget – Workers Compensation is Adversarial

I printed this letter to document for my blog readers that even a legitmate claimant with restrictions from a treating physician can find her claim maniuplated by a bogus IME.  The insurance company took advantage of the fact that this lady was not represented and they used their superior knowledge of the system to cut her off.

Do not let this happen to you.  Workers compensation in Georgia is a complex administrative law legal system and you will be at a distinct disadvantage if you try to grapple with seasoned insurance adjusters or defense counsel.  Even if everything seems to be proceeding appropriately, there is no reason not to make contact with a claimant's lawyer to learn more and to prepare for the evantuality that you will need legal counsel.

If you'd like to talk to me about your case, call my office at 770-351-0801 or email me.

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Jodi Ginsberg

Attorney Jodi Ginsberg represents employees who are injured on the job and who need medical care and missed wage benefits available under Georgia's workers' compensation laws.

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