Independent Medical Exam Can Be a Red Flag

Episode 19: Louisville attorney Scott Scheynost discusses a red flag situation for injured workers.  This occurs with the insurance adjuster decides to send you to an independent medical exam for your workers’ compensation claim.  This indicates things are about to get complicated for you.

What is an Independent Medical Exam?

These are also referred to as IMEs.  An independent medical exam can be anything but “independent.” The insurance adjuster usually has 2 reasons to push to get you to an IME.  The first is to avoid additional treatment so they can close your claim as soon as possible.  This is done to save the company expenses related to your Kentucky workers’ comp benefits.

If the doctor performing the independent medical exam determines you’ve reached maximum medical improvement, it signals an end to your Temporary Total Disability benefits (TTD).

Scott explains the other reason the adjuster wants to get you to an IME is to try to get a low impairment rating assigned to your claim.  The lower the impairment rating, the fewer benefits you’ll receive, going forward.  The impairments are extremely subjective.  The insurance companies know which doctors are more likely to assign ratings that tend to benefit the employer, not the injured employee.

The Red Flag

Remember, the insurance adjuster’s objective is to limit the cost of the claim, not ensure that you receive the best medical treatment.  Many injured workers fail to realize this important fact.

If the insurance company is proceeding with an IME, you need to be ready to fight for any additional benefits.  If you haven’t done so already, you may want to consult with an experienced, Louisville workers’ compensation attorney.

How a Workers’ Comp Attorney Can Help

The gloves are now off.  At this point in the life of your claim, you may have to litigate to get the treatments, testing and medications you need. 

Scott explains that it may take several months for the doctor to see you.  This delays the resolution of your claim.  It may also cause you to go without necessary medical treatment, during the waiting period.

Scott discusses that roughly half of the claims he handles for injured workers involve situations where the IME is scheduled before the injured individual has actually reached maximum medical improvement (MMI). 

The injured worker is at a disadvantage if he/she can’t get additional medical treatment.  Because MMI has been reached, the TTD benefits will cease.  Now, the worker is caught in a difficult financial situation.  He/she may simply have to accept the offer from the insurance company.  If an attorney is there to help, the outcome might be significantly different.

Does It Reduce Attorney Fees if I Wait?

Waiting to hire a Kentucky workers’ compensation attorney does not reduce the attorney fees.  Scott explains that in KY, the fee a workers’ comp attorney can charge is capped, by law.  It will be no more than 20% or $18,000.  Obviously, not every case has that much in fees; these are the maximums.

Given the maximum fees, it doesn’t cost you more to hire an attorney earlier in your case, rather than waiting.  Your attorney should be helping to get you the care and treatment you need to sooner, rather than later.

What Is a Contingency Fee?

Louisville workers’ compensation attorney Scott Scheynost works on a contingency fee basis.  This means there is no cost to have him review your situation.  He only gets paid, at the end of the case, if he wins you case.  His fees and other case expenses are deducted from your settlement. 

What Can a Workers’ Compensation Attorney Do?

Once you’ve spoken with your attorney, he/she will usually request medical records to begin building your claim and substantiating the severity various injuries.  Your attorney can request approval of specific treatments or testing. 

Ideally, your treating doctor will provide information supporting your need for additional treatment or tests.  Although, it may take time to get the report from a doctor who is busy treating other patients.  The Administrative Law Judge handling your case will often consider medical reports from your doctor in deciding whether to approve your requests.

Alternatively, as your attorney, Scott could send you to another doctor for an examination, but this may not be as valuable as something your treating doctor might provide.  These exams can be expensive, but Scott will cover the cost and it will be deducted from your settlement, at the end of your case.

The Utilization Review is part of the process, when there is a dispute about the necessity of certain treatment or medical exams. 

That Was It?

Scott advises his clients to write down details about what happened during your independent medical exam.  Some doctors only spend a few minutes with a patient before writing their report.  It can be confusing how a 2-3 minute exam can result in such a detailed report, that might be more favorable to the insurance company than to the injured worker.  Take note of how long the doctor actually spend speaking with you and performing your examination.  This might be valuable to you, once your hearing is actually scheduled.  It could be a year or more.  Trying to rely on your memory isn’t as reliable as notes written immediately following your exam.

Medical Fee Disputes (MFDs)

If you want to get specific treatments or tests, after your IME, your attorney will need to file a medical fee dispute.  The insurance company may work to limit or deny this.  This will then be litigated in front of a judge.  It can take significant time to reach a final decision regarding the MFD.  However, if the judge decides in your favor, workers’ comp will cover the costs related to the treatment.

You may decide to use your own health insurance to avoid the delay, while you still pursue the medical fee dispute.  Again, if you win the dispute, your health insurance will be reimbursed.

This is another reason not to delay your decision to get an attorney involved to represent you in your Kentucky workers’ compensation claim.

Representing Clients Across Kentucky

The internet has made it easier to represent clients well beyond the Dixie Highway area, where Scott grew up and continues to practice.  He is able to represent clients from across Kentucky because much of the work can be handled online, including requesting medical records, client meetings, depositions and hearings.

Can Scott Help Me if I Don’t Live in Kentucky?

The answer is maybe.  It’s a free call to speak with Scott to discuss your specific situation.  If he can determine that your company has a presence in Kentucky or maybe you lived here at the time of your injury but have moved out of state, Scott may be able to represent you.  If you live out of state, but were injured in Kentucky while traveling here for business purposes, you may also have a Kentucky workers’ compensation claim.

Words to Consider

Scott advises you to remember, once you’ve been injured, your company may begin treating you differently.  The insurance adjuster handling your case isn’t there to be your friend.  He/she is trying to contain the costs of your claim.  You need to have someone protecting your interests and working on your behalf.

If you suddenly get a notice that you’ve been scheduled for an independent medical exam (IME), the insurance company is trying to limit the financial exposure.  Interestingly, Scott often sees this move, once the worker has been off work for 6 months.  It’s fairly common for the insurance adjuster to try to get the claim closed out.  This is not usually in your best interest.  You should speak with an experienced, Kentucky workers’ compensation attorney.

It Cost You Nothing to Speak with Scott

Contact Scott Scheynost at (502) 937-5287.  This podcast is meant to provide information and is not legal advice.  Scott’s principal office is located at 7619 Dixie Highway, Louisville, KY 40258.  Co-host Jim Ray is a non-attorney spokesperson.  This is an advertisement.