One of the most difficult aspects of bringing a workers’ compensation claim for a WEAR and TEAR injury or a repetitive stress injury is establishing that your injury is the result of work you did on the job and not another activity you participated in or hobby you have.
Frequently, insurance companies that are looking to avoid paying out for a workers’ compensation claim will attempt to pin the blame for a WEAR and TEAR injury on something other than your job. For example, if you have a chronic knee injury, the insurance company may argue that it is a result of your love of skiing and not because of your physically demanding job.
In order to support these types of claims, insurance companies will frequently utilize independent medical examinations (commonly known as IMEs) to bolster their claims. For this reason, any worker pursuing a repetitive stress injury should be aware of the possibility of a separate medical evaluation.
How Do Independent Medical Examinations Work in Cape May Court House
Typically, when a worker files a workers’ compensation claim for an injury that occurred on the job, he or she will provide medical documentation to support this claim. This may include notes from medical appointments, copies of bills, and whatever other documentation that might support the claim.
In cases where it is not clear that work led to an immediate injury (such as in the case of a repetitive stress injury), the worker’s medical providers may also suggest and document why they believe the injury was the result of workplace conditions or caused by some sort of activity on the job.
In order to refute these types of claims, insurance companies will often resort to their own medical examinations. Because they cannot simply argue that a worker’s medical experts are lying, they will instead try to undertake their own medical examination in the hopes of providing an alternative, non-work-related explanation for the injury.
What Happens during an Independent Medical Exam?
Independent medical exams are conducted by doctors who are hired by the insurance companies. While they are supposed to be objective in their evaluation of a worker’s medical conditions, this is not always the case. Sometimes when examiners have an established relationship of referrals from insurance companies, they tend to find for the insurer when conducting their evaluations.
At an independent medical examination, the doctor will likely conduct an interview with you in addition to reviewing your actual injuries. In most cases, the doctor will have previously reviewed your medical records, and will have a sense of what the insurance company wants to know about your injuries.
The doctor will likely start off by asking you about your basic medical history and then the history of the injury that is the basis for your claim. The doctor may also ask about your lifestyle, other activities you have been involved in, and whether you have experienced similar injuries in the past.
You should be aware that, unlike with other physician-patient relationships, there is no privilege between you and your independent medical examiner. Anything you say can be recorded and will likely be given over to the insurance company in your case. Thus, while you should answer questions directly, you should also be careful about supplying too much information.
After the interview is completed, the doctor may, if necessary, evaluate your injury. This depends on the time when the medical examination occurs, and whether the injury is one that can be easily visually evaluated.
After the IME is over, the doctor will write up a report that will likely address your injury, the cause of your injury, and whether the doctor agrees with the conclusions of your personal physicians. In the case of WEAR and TEAR injuries, the report will likely address the examiners thoughts on what caused the injury and whether it resulted from work or something else.
If the doctor concludes that your repetitive stress injury was not caused by work, this medical report and its conclusions will be used against you in your workers’ compensation case.
New Jersey Attorneys Helping You Handle Medical Exams
If you are involved in a contentious workers’ compensation claim or believe that your employer or insurance company will fight back against your claim, there is a very good chance that you will be asked to complete a medical exam at some point during the court process.
Medical exams do not have to be scary, but they do require preparation so that you know what to expect and how to avoid common issues that can trip up workers. At Petro Cohen Petro Matarazzo, our WEAR and TEAR workers’ compensation attorneys will work with you to prepare for a medical exam and make sure you are comfortable going in.
In addition to helping clients face and overcome these specific issues, our New Jersey workers’ comp lawyers help injured employees through every step of the process.
How We Can Help You
We earn our reputation by helping our clients overcome a limitless number of challenges time and time again. Specifically, many injured employees are thrown curveballs by their employers and workers’ comp insurance companies that are confusing, perplexing, and unfair, such as an IME report that contradicts what your medical provider believes is the cause of your WEAR and TEAR injury.
Some of the most common issues we successfully handle for our clients include the following:
- The insurance company’s initial denial (rejection) of a workers’ comp claim based on a number of different reasons:
- Failure of employee to notify employer in a timely manner
- Failure of employee to seek medical treatment for a work-related injury in a timely manner
- Determination that the injury was suffered outside the scope of employment
- Determination that the injury was not suffered at a place of employment (this may include a determination that the injury was pre-existing)
- Determination that the incident leading to injury is exempt from workers’ comp insurance coverage (e.g., self-inflicted injury, injury caused as a result of horseplay, injury caused because of impairment due to alcohol or drugs)
- The insurance company’s decision to not pay (or discontinue payment of) medical expenses based on the following reasons:
- Determination that the medical treatment is or was provided by an unauthorized physician
- Determination that the type and/or duration of treatment is or was not authorized
- Determination that the medical treatment is unnecessary and/or unreasonable
- Determination that the medical treatment is unrelated to work-related injury
- Determination that the medical treatment has exceeded a reasonable duration
- The insurance company’s decision regarding temporary, permanent, partial, and/or total disability:
- Each of these classifications of disability determine the amount and duration of weekly benefits that an injured employee may receive, and insurance companies may improperly classify a disability in order to pay less benefits.
- The insurance company’s failure to correctly calculate an injured employee’s average weekly wages:
- An employee’s average weekly wages prior to the work-related injury is critical in determining the amount of weekly benefits to be paid to an injured employee. Failure to correctly calculate this number may result in lower weekly check amounts.
- An insurance company’s low-ball settlement offer:
- In order to resolve an outstanding claim as quickly as possible (for as little money as possible), the insurance company may offer a low-ball amount to settle the claim. In workers’ comp cases, any settlement reached is referred to as a “lump sum settlement.”
- Unlawful termination of employment because of a work injury:
- Employers are not required to hold an employee’s position open in every single workers’ comp situation; in many cases, they must hold the job open.
- There are strict rules and regulations that govern an employer’s duty in this regard; in many cases, employers unlawfully and/or improperly terminate an injured employee’s employment.
- Moreover, injured employees may be able to return to work with certain restrictions, but employers do not want to deal with the hassle. In these cases, employers fail to provide legally required, necessary accommodations, or they may simply unlawfully terminate employees due to the restrictions.
For more information or a free consultation with a worker’s comp attorney at Petro Cohen Petro Matarazzo, contact us online or at (888) 675-7607.