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Advice on Independent Medical Examinations

Worker’s compensation insurance carriers hire doctors from a list of doctors who advertise themselves to perform medical evaluations for insurance companies. IMEs are usually used in Worker’s Compensation Claims after your doctor recommends surgery. IME doctors will typically indicate your injury was not caused by your work injury, you recovered more quickly than your treating doctor thinks, or that your extent of permanency is less than the disability assigned by your doctor. 


This tactic is often used to avoid the expense of surgical fees forcing health insurance or State plans to pay your medical bills so that the Worker’s Compensation Carrier can reap the benefits of reduction of your medical (replace with “bills”) obtained by your health insurance company. This is a deceitful tactic which is too often used regardless of the merits of your claim. The more significant affect upon you is the loss of weekly worker’s compensation benefits, decrease permanency payments and denial of medical coverage for your injuries.


Here are my Top 10 recommendations for you when preparing for your Adverse Medical Examination:


  1. The first recommendation is to seek an attorney who is willing to prepare you for an “IME” free of charge. While careful preparation for an “IME” can help preserve your benefits, the doctors who perform the “IME” are paid handsomely for their reports and want to have the recurring business which occurs when they save the insurance company money. The Kmiec Law Offices are willing to prepare you for an “IME” at no charge. We have tools such as videos specifically created for you to prepare for an “IME” and will personally discuss with you the best way to increase your chances of preserving you benefits.

  2. Injury Description: Please try your best to describe how you were injured consistently with previous descriptions of your injury. You may wish to obtain a copy of your injury report which was provided to your employer and initial reports of the injury to your medical providers. Please keep in mind that all your doctors need to know how your injury occurred, including aggravation of a pre-existing condition or the specifics of how your repeated work tasks culminated in your injury.

  3. IME doctors are trained to look for signs of exaggeration of pain. The worst thing you can do during an IME is to try to convince the IME doctor that you are significantly injured. More than likely, the doctor has already decided whether your claim can be denied on their review of your medical records. You will likely be asked to rate your level of pain during the IME with 0 being no pain and 10 being the worst pain you can imagine. I have seen unprepared clients say their pain level is a 20 out of a scale of 1-10. Such a statement will automatically cause an IME doctor to accuse you of exaggerating your symptoms. While disgusting, I tell my clients that the worse pain I can imagine is having my arm being cut off by a chain saw, perhaps due to too many horror movies watched when I was a young boy. The point being that even though your pain is very severe, it is likely not to the degree of a chain saw cutting off your arm. In fact, pain levels of 8-10, should infrequently be used to describe the pain except at the time of the injury or within days following a surgery. Exceptions exit for injured workers who develop pain syndromes such as Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS).

  4. False positive test results: IME doctors are trained to perform examination which are designed to have you say something hurts when the test is designed to not cause increased symptoms. Pushing down on the top of the head, rolling you from your back to your side, or having a ratcheting movement during a range of motion test are just a few examples. There are many tests which are designed to determine whether an injured worker is exaggerating or faking their injuries. However, even injured individuals who have no intent of exaggerating their injuries may succumb to these tests as IME doctors may do them abruptly making you think that you need to tell the doctor that the test caused increased symptoms at the risk of the doctor not finding that you are injured. This is a mistake. You need to be well in tune with your body and only report increased symptoms when you actually feel increased symptoms.

  5. False negative test results: IME doctors will attempt to get a non-response from you to further their conclusion that you are exaggerating your symptoms. The IME doctors frequently evaluate the injured body part and find a location which is quite painful. Then after doing so, the IME doctor will say they are evaluating a different body part and while evaluating the other non-painful area, the IME doctor will reach over and touch the area of your body that was extremely painful. I have reviewed hundreds of IME reports which indicate the when the patients knew the IME doctor was evaluating the injured body party, they lightly touched the skin and the patient nearly jumped off the table in pain, but when misdirecting the patient by evaluating a different body part and touched the previously painful area, the patient did not react at all. The IME doctor then concludes that the patient is obviously exaggerating their symptoms. With injured workers who have sciatica, I have learned that IME doctors will do a leg lift test which will frequently cause pain to shoot down the leg, but while doing the test, the doctor will misdirect the patient by pushing on a toe and ask if that hurts. As the doctor is misdirecting the patient to the toe, patients will frequently respond that it does not hurt and then the doctor will note a negative leg lift test. Therefore, if an IME doctor does anything which causes you increased symptoms, whether or not you believe the doctor is evaluating that area, you should let the IME doctor know it.

  6. Pain levels: The IME doctor will likely ask you about your pain levels on a bad day, a good day and on an average day. Keeping in mind the advise on very high pain levels above, you should consider your pain levels and try to keep them consistent with your reports to your doctors. Once again, you should try to keep these pain levels below an 8 unless you suffer from a pain syndrome such as RSD (Reflex Sympathetic Dystrophy) or Complex Regional Pain Syndrome (CRPS).

  7. Activities: the IME doctor may ask you which activities you can no longer perform and which ones cause increased symptoms. You should discuss these activities with your family and write a list so you can keep them in mind when you meet with the IME doctor. Please keep in mind the huge difference between activities that you can absolutely not perform and those that you can perform but dearly pay for after that activity. The Worker’s Compensation carrier may have hired private investigators who have taken videos of you. As cameras are very small, they can go anywhere and you would never know it. I had a client who went on a ride at Great America behind his son and his son’s friend and the private investigator sat immediately next to my client and took a video of him throughout the ride without my client knowing it until the time of the hearing. As surveillance is consider attorney work product of the defense attorney, I never am aware of the same until the time of the hearing. The point being, please recognize those activities you absolutely cannot perform and those which cause increased symptoms before you walk into the IME evaluation.

  8. Paperwork and Records: Many notices of an IME appointment will instruct you to being records, You have no obligation to bring such documents. The Worker’s Compensation Carrier should have provided all records, MRI scans, x-rays, etc., to the IME doctor. If the IME doctor does not have such records at the time of writing their report, it will typically decrease the credibility of the IME doctor’s report resulting in a better opportunity of wining your claim. While there have been occasions that I have advised clients to bring MRI DVDs because the injury is blatantly depicted, it is rare and you should discuss the same with an attorney before you do so. The reason is that most people start developing degeneration in there joints after age 35. Many IME doctors will rely on findings of degeneration to conclude that the symptoms are due to pre-existing condition instead of your work injury. If the doctor requests you to complete a health questionnaire, it is usually required to complete those types of forms. However, do not sign authorization for anyone to obtain additional records or submit to any testing such as x-rays, MRIs or blood draws.

  9. Pre-Existing Conditions & Other Accidents or Injuries: Just because you may have a pre-existing condition does not eliminate your worker’s compensation claim. The Worker’s Compensation Carrier is entitled to get your medical records without signed authorizations and will likely find records of a pre-existing condition. If such records exist, you need to come clean with the pre-existing condition so that your doctor can determine if your work injury aggravated the pre-existing condition beyond normal progression. Trying to cover up a pre-existing condition will adversely affect your ability to win your claim. If you had a pre-existing condition, the IME doctor will likely have any available records related to a pre-existing condition and will use it against you if you attempt to cover it up. 

    The IME doctor will likely ask you whether you have been involved in another injury accident such as motor vehicle accidents, other worker’s compensation injuries and trips and falls. As with pre-existing conditions, if you got medical treatment, it is likely that the doctor will ask you about such injuries. The best policy is to be honest about other accidents or injuries. If you are honest about such accidents or injuries, it is easier to minimize the effect of the same on your claim as compared to the IME doctor noting a dishonest response to such questions. 

  10. Recording the IME Evaluation or Having Another Person Present: You may record the examination as long as you are not obstructing the examination by recording it. You are also allowed to have one observer present with you who could be your spouse, partner, family member, friend or acquaintance.



KMIEC LAW OFFICES, S.C.

YOUR PERSONAL INJURY & WORKER’S COMP ATTORNEYS

(414)649-9790; (262)650-6800

Text Us

www.kmieclaw.com

info@kmieclaw.com

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As dog bites and dog attack injuries can be complicated, you should hire an experienced dog bite attorney where you or a family member is injured or killed by a dog attack. With postal carriers and delivery drivers making more home deliveries, dog bite claims are frequently complicated by worker’s compensation laws which require reimbursement to the worker’s compensation carrier of a certain amount of your dog bite recovery. Also, worker’s compensation laws allow benefits equal to one-year of your wages for permanent scars and disfigurement under certain circumstances. If you are injured by a dog bite or dog attack while working, you should hire an attorney experienced in dog bites and worker’s compensation claims to navigate both areas of the law to maximize your recovery.
31 Jan, 2023
Worker’s Comp Injuries: There are four ways that an injury can be caused by work which would entitle you to worker’s compensation benefits. As your doctor is the one who needs to provide an opinion on the cause between your work and the injury, you must provide your doctor with adequate and accurate background information as to the mechanism of injury. Understanding the type of injuries that are considered work injuries may assist you in explaining to your doctor the manner in which your injury is related to your job. 1. Direct Injury: A direct injury at work will involve a specific incident such as a slip and fall, a car or truck accident, striking of a body part, lifting a heavy objects, or an over-exertion injury. Even if there is a pre-existing condition, this should not prevent a claim especially if there is a breakage involved, i.e.: broken bone, torn meniscus, torn rotator cuff and/or herniated, bulged or protruded spinal disc. 2. An Aggravation of an Underlying Condition: A lot of claims are denied by the worker’s compensation carrier because an IME doctor provides an opinion that there is a pre-existing condition. However, the law provides that an aggravation of a condition beyond its normal progression is an injury which is covered and payable under the worker’s compensation laws. You need to tell your doctor how the condition got worse if it bothered you before the injury because many of these “pre-existing conditions” are dormant such that they only appear by x-ray or MRI scan. After the age of 35, most people start to develop degeneration or arthritis of their back, neck, knees and shoulders. However, many times it is not painful until an incident at work or repetitive work duties cause it to become painful. Also, a pre-existing condition which is painful may get worse because of work and lead to an inability to work and/or the need for surgery. In these circumstances, the injury should be compensable under worker’s compensation laws; however, you need to discuss this with your doctor so that your doctor can provide an accurate description of how the work caused your injury. 3. An Appreciable Period of Workplace Exposure: Many people work at jobs which require them to lift, bend, twist, turn or hold a certain position over and over again throughout their work days. Other times, workers have multiple injuries and/or micro-traumas where they sustain multiple injuries over time to a part of their body eventually resulting in their body giving out. In these situations, the injury is compensable as a work injury. When you are injured because of repeated activity on the job or micro-traumas, you need to discuss these with your doctor and the reason you believe it is work related. Again, you need to arm your doctor with true and accurate information as to the work you perform, day in and day out, as well as any traumas you have sustained in the past due to work in order that your doctor’s opinions are based upon true information which can be proven at a hearing. 4. A Weakened Condition Causing an Off-Work Place Injury: Many people sustain injuries at work, receive treatment and are then released back to work. The injuries can cause degeneration in the injured joint (knee, shoulder, elbow, back or neck) which over time results in an injury when you are doing an activity away from work. The law provides that the weakened condition caused by a work injury only need to play “some role” in the off-work place injury for the injury to be compensable. People who have knee replacement or shoulder replacements many years after a work injury may not realize that they are entitled to large benefits. Moreover, your doctor will not likely draw a connection between the work and the resulting injury unless you tell him or her of the prior work injuries. Again, you need to be fully accurate and truthful in this regard; otherwise, your doctor’s opinion will not be deemed credible when a judge makes a ruling on your claim. Any combination of the above mechanisms of injury may cause an injury. For example, a construction worker may notice the onset of back pain while performing the normal duties of the job. The worker has likely lifted numerous heavy materials on a daily basis for years. Therefore, there is a work exposure situation, but that worker may also have degeneration in the back unrelated to his work duties. Thus, a claim can be made that the injury was the result of the worker’s workplace exposure of lifting all day long for years which aggravated an underlying, pre-existing condition. The result is that the claim is compensable. The same holds true for a direct injury which aggravates a pre-existing condition. Worker’s Compensation Benefits: When you sustain a work-related injury, you are entitled to benefits which fall into specific categories. Worker’s compensation is not a general liability insurance policy. It is meant to provide you with some replacement for your wages until you can get back to work. As a wage replacement system, worker’s compensation does not pay for pain and suffering as it is not a personal injury claim. The following is a list of some of the more common benefits to which injured workers are entitled. 1. Temporary Total Disability (TTD): During the period of time you are treating for your injury and unable to work, you are entitled to temporary total disability benefits (two thirds of your average gross weekly wage at the time of your injury, including regularly worked overtime) up to a cap which depends upon the year of your injury. You are entitled to receive temporary total disability until your doctor indicates that you have reached maximum medical improvement which is when your condition will most likely not get better or worse. 2. Temporary Partial Disability (TPD): During your healing period, your physician may release you to return to light duty work, or full duty but for limited hours. During this time, you will be entitled to temporary partial disability if you earn less than your pre-injury average weekly wage. For example, if you lose 30% of your average weekly wage, you will be entitled to 30% of your temporary disability worker’s compensation benefits in addition to the wages you are earning until you reach a healing plateau or return to full duty work. 3. Permanent Partial Disability (PPD): When your doctor has determined that you have reached maximum medical improvement, your doctor may decide that you sustained a permanent injury. In most claims where surgery is required, a permanency rating will be provided by your doctor. According to the worker’s compensation department, your doctor is to consider issues such as whether you had surgery, any reduced range of motion in your affected joint(s), your ability to return to work, whether there are restrictions as well as your continued pain and weakness. You need to discuss on-going symptoms with your doctor so that your doctor can determine the degree of permanent injury. 4. Loss of Earning Capacity (LOEC): This type of benefit is only available when there is an injury to the head, neck, back, or torso (i.e.: it does not apply when the injuries are only related to the arms, legs, hips or shoulders). However, people with leg and foot injuries frequently develop back problems because of an altered gate; and in those situations, you may be entitled to a loss of earning capacity claim. You need to advise your doctor of the development of back pain when this occurs. If you do have an injury to you head, neck, back or torso and if the permanent restrictions assessed by your doctor prevent you from returning to your former job or your employer has terminated you, you are likely to be entitled to a loss of earning capacity. This is typically the largest claim available in worker’s compensation. A vocational counselor will likely need to be retained to determine the amount of your loss of earning capacity. To be entitled to this benefit, the employee cannot have voluntarily quit their job and therefore, even if the employer is harassing you, you should continue to perform your job until advised by your legal counsel otherwise. 5. Rehabilitation: If your injuries to any part of your body prevent you from returning to work at 85% of your previous wage or your job is terminated for any reason, you are entitled to be retrained. Rehabilitation programs can include obtaining a college degree, which means that you are entitled to payment of 2/3rd of your salary while attending school, tuition, books, mileage and meals. The Department of Vocational Rehabilitation (DVR) will typically assist in setting up the retraining program. 6. Disfigurement: If your injuries result in visible scars, amputation, clawed fingers or even a limp, you could be entitled to benefits which can be as high as one year of your pre-injury salary. In order to be entitled to the same, your employment with your employer must have either been terminated or you are earning less than 85% of your pre-injury wage. 7. Failure to Rehire: After a work injury, an employer cannot terminate an employee for any reason. The reason for termination must be for a legitimate business reason. If the judge finds that the employee was terminated for a non-legitimate business reason, the employee is entitled to be reimbursed for up to a year of lost wages. 8. Secondary Injury Claims: Claims against the Secondary Injury Fund may be made where an injured worker has a worker’s compensation claim where benefits for Permanent Partial Disability (PPD) is 200 weeks or more, and the employee had a significant pre-existing condition whether work related or not. If an employee has a pre-existing permanent condition such as a hip/knee/shoulder replacement or congenital condition including blindness in one eye, which would arise to a level of 200 weeks of PPD benefits had it been work related, the Secondary Injury Fund is available to pay up to an additional 200 weeks of PPD benefits. 9. Healthcare Coverage: Claims for most healthcare expenses are covered by worker’s compensation with the exception of Acupuncture as long as the treatment is rendered by physicians licensed in Wisconsin. If you need treatment outside of Wisconsin, you should get a referral from your Wisconsin licensed doctor to the out of state physician. Medical payments are to be paid to your choice of two physicians and any provider to which those physicians refer you and any providers who are within the same healthcare clinic. You need to be careful that you do not exceed the choice of two physicians as medical bills coverage may be denied to providers beyond the choice of 2 providers. 10. Death Benefits: Death benefits are payable to dependents when an employee dies from a work injury, or when an employee who is permanently and totally disable dies from any cause, or when an injured worker with permanent disability dies before all permanency benefits have been paid to the deceased worker. The amount of the death benefits for a death related to work is up to four times the employee’s annual earnings subject to the maximum wage cap and paid out over an approximate 6 year period of time. The amount of the death benefits may be increased or decreased where children under 12 years of age are dependents or where the employee has been receiving permanency payments for a lengthy period of time. Also, burial expenses are also available. Where the death is not related to the work injury, the death benefit is the balance of the amount owed on the permanency benefits. Please contact our office if you have any question as to your worker’s compensation rights and/or entitlements. We provide free consults and we do not charge you a fee unless we win your case. KMIEC LAW OFFICES, S.C. YOUR PERSONAL INJURY & WORKER’S COMP ATTORNEYS (414)649-9790 ; (262)650-6800 Text Us www.kmieclaw.com info@kmieclaw.com
31 Jan, 2023
1. REPORT YOUR INJURY CLAIM: When you suffer an injury, you need to report it to a person in authority and insist that a report be made. If you have a car accident, it should be reported to the police by calling 911. Do not let the other party talk you out of reporting the accident. If you have an injury in a store or similar location, you should inform the manager or owner of the property and insistent that a report be made of the incident. If possible, you should get a copy of the report; however, most managers and owners will not provide a copy to you. Your attorney will be able to obtain such a report. 2. TAKE PICTURES: Document with pictures the cause of the accident, the resulting damages and injuries. If you are involved in a car accident, take many pictures of all vehicles involved and the scene of the accident from several angles. If you slipped or tripped, take photographs of the cause of your slip or trip. If there is a rise or crack in a walkway, place an item next to the hazard so that the height of the rise can be estimated at a later date based on the size of that item in the picture. Also, take photographs of your injuries and recovery from those injuries. Bruises, bumps, swelling and scars fade with time so it is important that you capture such evidence while it is visible. If you need hospitalization, you should have a person take photographs of you in the hospital bed. If you need a cast, sling, crutches, etc., have a person take pictures and video of you while using such medical devices. 3. USE YOUR MEDICAL INSURANCE: If you have medical insurance, you should use it. The use of medical insurance usually results in you obtaining a larger recovery because you get paid for the billed amount of the medical treatment. While many insurance companies get reductions on medical bills, your recovery is based on the reasonable cost of the treatment as opposed to the reduced bill sent to your insurance company. 4. WHAT TO DO IF YOU DO NOT HAVE HEALTH INSURANCE: It is important that you get some treatment close in time to the accident that caused your injury. Kmiec Law Offices has built a strong reputation in the legal community such that we have been able to build relationships with many doctors who will provide treatment, including surgery, without billing our clients until the case is resolved. As the doctors will not bill for their treatment until you obtain the recovery from your claim, you may obtain the necessary treatment which will allow you to recover from your injuries despite a lack of insurance coverage. 5. BE VERY CAREFUL OF WHO YOU TALK TO: Kmiec Law Offices advises their clients to not talk to anyone outside of your family or doctor about your case and injuries. You may inform people such as your employer that you were involved in an accident, but do not describe the incident in detail until you speak with an attorney. DO NOT talk to insurance adjusters and/or investigators without first notifying your attorney. DO NOT give a written or recorded statement to any insurance company until you speak to your attorney. If an insurance company contacts you, tell them that you have an attorney involved in the case and that they should contact us. Do not give out any other information. Get the name of the individual who contacts you, the name of the company that he or she represents, their telephone number and claim number. You will want to provide such information to your attorney. 6. WHAT YOU SHOULD TELL YOUR DOCTORS: You need to tell all your doctors every injury you sustained and how the injuries occurred. Unless you tell the doctor that the neck pain, for example, that you are suffering arose out of a car accident, the doctor will have no way to determine the cause of your neck pain. Also, if an accident caused a condition to get worse, you should tell the doctor how much worse it got. Also, if one of your injuries gets somewhat better than another one of your injuries, you should continue to describe all the injuries from which you suffer with your doctors and not concentrate on only the worst one. We frequently need doctors to provide reports and if you do not tell your doctors about all your injuries and the cause of those injuries, a doctor may not be able to provide us an opinion as to what injuries were caused by the accident. 7. WHAT SHOULD YOU TELL YOUR EMPLOYER: You may be entitled to wage losses if you miss work due to injuries from an accident. If you need to miss work, you should obtain work excuses from your doctor. It is not advisable to discuss in detail how an accident which is not work related with your employer. However, you need to tell your employer, usually the HR department, that the time you are missing from work is due to the accident, injuries and/or medical treatment. Your employer should track the amount of time you miss from work due to the accident. If you take sick or vacation time to recover from your injuries, you are still entitled to be compensated for that time off of work as you should not have needed to use up those benefits due to an accident. Therefore, tell your employer that you are using sick or vacation days due to the injuries from the accident. Kmiec Law offices will contact your employer when we determine the value of your case as we will need wage loss verification from them. 8. CONTACT AN EXPERIENCED ATTORNEY: Attorneys with the Kmiec Law Offices have been representing injured individuals since 1959. The longevity of our firm is due to the quality of its attorneys and staff. The general information provided in this article is not intended to replace the advice of your attorney. Please contact Kmiec Law Offices for advice from an experienced personal injury attorney.
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