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| Workers' Comp Medical Issues FAQ |
What is an "Independent Medical Exam" (IME)?
What if I, or my doctor, don't agree with the findings of the IME? Can I fight it or replace the decision with one from my doctor?
How is the doctor I'm told to go to chosen? Can't I pick my own?
Can I refuse treatment if I think it will hurt me more?
The insurance company is delaying approval of the treatment I need. Isn't this bad-faith? Don't they have to provide timely care?
The nurse caseworker wants to attend my doctor appointments with me. Should I let her?
What is a "functional capacity exam" and how are the results from this test used?
What does the rating I was given mean? It seems wrong. Can I appeal it?
If I've not completely recovered from my injury, should I return to work?
Does my employer have to honor the restrictions my doctor has placed on my ability to work?
I'm going to need treatment for a long time. Can I keep the medical portion of my claim open?
What is "Temporary Total Disability" (TTD)?
What is "Permanent Partial Disability" (PPD)?
How long will I be receiving TTD payments?
Q: What is an "Independent Medical Exam" ("IME")?
A: The insurance company hires doctors to perform medical exams on injured employees, called "independent medical exams." The doctor examines the employee and then reports his results to the insurance carrier.
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Q: What if I, or my doctor, don't agree with the findings of the IME? Can I fight it or replace the decision with one from my doctor?
A: The insurance carrier is entitled to believe the findings of the IME doctor that it hired in the same manner that the injured employee is entitled to believe the findings of his treating doctor. This is one of areas of significant litigation, with each side adopting different doctors' opinions as correct. Often a claim results in a trial before the Industrial Commission, which is how you fight an adverse IME.
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Q: How is the doctor I'm told to go to chosen? Can't I pick my own?
A: The workers' comp carrier can pick the IME doctor it chooses to use. You can pick your treating physician.
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Q: Can I refuse treatment if I think it will hurt me more?
A: You can refuse treatment. However, the insurance carrier may argue that you're impeding your healing and may suspend benefits. You should have a discussion with your doctor regarding the proposed treatment.
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Q: The insurance company is delaying approval of the treatment I need. Isn't this bad-faith? Don't they have to provide timely care?
A: The carrier is responsible for reasonable and necessary medical care. This is another area of frequent litigation. If they have an IME doctor who says that proposed treatment by your treating doctor isn't necessary, they may deny payment. These cases often end up at trial, with the Industrial Commission deciding which course of medical treatment is needed. These types of cases depend heavily on the medical evidence presented by both sides.
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Q: The nurse caseworker wants to attend my doctor appointments with me. Should I let her?
A: The nurse case worker is hired by the workers' comp carrier. Arranging for the doctor to meet with the nurse case manager after the appointment with the employee is a better approach. The nurse case manager would then have to provide you with a copy of any reports that are forwarded to the carrier. Since the nurse caseworker is hired by the carrier, you should be cautious.
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Q: What is a "functional capacity exam" ("FCE") and how are the results from this test used?
A: The FCE is a test that is supposed to be an objective evaluation of the employees' ability to perform certain activities, such as lifting, bending, kneeling, squatting, gripping and walking. The results of the FCE are interpreted to determine what type of work the injured employee can return to.
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Q: What does the rating I was given mean? It seems wrong. Can I appeal it?
A: The FCE rating is supposed to be objective. If it seems wrong to you, bring a copy of the report to your doctor and go over the results with him. It is often thought of as a fair assessment of the injured employees condition, since it's supposed to be an objective test not subject to interpretation.
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Q: If I've not completely recovered from my injury, should I return to work?
A: If your employer has light duty and your doctor allows you to return to work within restrictions, then you should probably return to light duty work. Generally, you will then be back on regular salary.
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Q: Does my employer have to honor the restrictions my doctor has placed on my ability to work?
A: The employer will adopt the restrictions of either your treating doctor or those of the insurance company IME doctor. This is often an area of litigation when there is a difference of opinion between the doctors. The restrictions should be clear and applying to your specific job.
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Q: I'm going to need treatment for a long time. Can I keep the medical portion of my claim open?
A: Generally, the workers' comp carrier will not provide for open medical claims. In certain cases with appropriate medical proof, medical benefits can be negotiated into the settlement. This is the exception rather than the rule. You usually need an attorney to obtain these benefits.
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Q: What is "Temporary Total Disability" ("TTD")?
A: TTD is that payment made to the injured employee when he or she is medically authorized not to work. It is paid weekly or every two weeks, at a percentage of the average weekly wage.
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Q: What is "Permanent Partial Disability" ("PPD")?
A: PPD is the lasting disability that the injured employee sustained as a result of the work injury.
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Q: How long will I be receiving TTD payments?
A: TTD payments will continue as long as the employee is medically authorized off work or the employer has no work within the employees' restrictions.
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Marc Stookal is a partner with the law firm of Nilson, Stookal, Gleason & Caputo, Ltd. in Chicago, IL. |
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