Tag Archives: IME

Why does your workers’ compensation insurer want a second opinion and what can you do about it?

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Injured workers are often sent for second opinions by insurance companies or claims administrators. The main questions that arise when this happens besides the obvious, “WTF is the b.s?,” are and 1) Why are they sending me to this random doctor or physical therapist? and 2 ) Do I need to go to the examination?

Why you are being sent for a second opinion or FCE by your employer? Cost savings

Your employer is likely sending you to a provider of their choice to minimize their workers’ compensation costs.

Usually employer or insurers ask for second opinions, often called independent medical examinations, or IMEs for short, at critical junctures in a claim. These inflection points include a need for a surgery and or having a doctor place you at maximum medical improvement (MMI) Sometimes employers and insurers have some computer program tell them when your case should be done and schedule medical appointments with that purpose. Functional Capacity Evaluations or, FCEs, are used to determine permanent work restrictions.

The one thing in common all of these situations have is that they involve fairly serious injuries that involve surgery, a long recovery, the need for future medical care and permanent restrictions. All of the above outcomes could lead to a lot of costs to your employer and or their workers compensation insurer.

But costs to your employer or their workers’ compensation insurer are necessary benefits for you. So what do you do when you are faced with an IME or employer-scheduled FCE?

You (probably) need to go. But you should also call a lawyer.

Why you probably need to go this “second opinion” appointment

Under Neb. Rev. Stat. 48-134, employers have the right to have you examined at their expense. In workers compensation vernacular this is called an independent medical examination or IME for short. (These examinations aren’t technically IMEs, but everyone in workers’ compensation in Nebraska uses the term for these examinations. )

Not going to the examination is grounds to have benefits ended. Informally, blowing off an IME is a good way to get off on a bad foot with the Judge deciding your case. However you, or more likely, a lawyer may have some luck trying an examination quashed if it is unreasonable. I think this is difficult burden. I filed a motion to quash a medical examination I thought was excessive about five years. The Judge disagreed pretty strenuously.

Why you probably need to go to an FCE scheduled by your employer

Personally, I think you need would need to go to a, functional capacity evaluation (FCE) set-up by the company. An FCE is a test done by a physical therapist to measure work restrictions. While an FCE isn’t technically covered under Nebraska’s medical examination statutes, the Nebraska Workers Compensation Court has adopted the Rules of Civil Discovery. The Rules of Civil Discovery allow for functional capacity evaluations.

But, like IMEs, an employee, can object to an FCE if they think it’s unreasonable. But again, you would want a lawyer to have a chance to successfully quash an FCE. However, getting an FCE quashed is often a difficult task even for an experienced and knowledgeable workers’ compensation lawyer.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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2015 Mileage Rates Rise to 57.5 Cents per Mile

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Injured workers should be reimbursed for mileage and travel expenses that are related to the medical process in workers’ compensation claims, as I wrote about last year on the blog. It continues to be essential to keep track of detailed receipts, as it definitely helps with submitting those expenses to get reimbursed in a timely manner.

The 2015 mileage reimbursement rate has risen to 57.5 cents per mile, according to the IRS. This “adjustment takes into account all the costs associated with owning a car, including insurance and repairs,” according to this article in Forbes. That also means the rate has increased, even though gas costs have recently gone down.

Generally speaking, the federal rate changes annually. However, when gas prices went soaring in 2008, a mid-year increase went into effect.

As a reminder from a blog post that firm partner Todd Bennett wrote in 2011, injured workers can be reimbursed for activities such as “travel to seek medical treatment, pick up medications, or while participating in a vocational rehabilitation plan.”

The best way to do this is to work with your attorney and legal assistant to keep track of all mileage. This can include appointments for Independent Medical Exams (IME), too. Then your attorney can help you get reimbursed.

It is often essential to save receipts and keep a record for yourself of your doctor’s visits and other reimbursable trips, including physical therapy and trips to pick up medication. Providing that log to your attorney and saving receipts incurred from specific doctor visits and other reimbursable trips creates a “narrative” that makes it easier to justify those expenses.

Because money is always tight for injured workers, contact an experienced workers’ compensation attorney if you have questions about a specific situation.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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What’s an IME (Independent Medical Examination)?

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My employer just set me up for a “second opinion” or IME with another doctor. What is that?

An IME is an abbreviation for an independent medical examination. The purpose of an IME is seeking a second opinion from a non-treating doctor for your work injury in order to obtain an opinion on pretty much anything regarding your workers’ compensation injury: medical causation, diagnosis, treatment, restrictions, impairment, etc. The IME doctor, however, does not actually provide any treatment him/herself. The IME doctor merely dictates a report with his/her evaluation, opinions, and recommendations.

An IME can be requested by the plaintiff or defendant in a workers’ compensation claim. Although “independent” is in the name, oftentimes these exams are not independent at all. In fact, there are three different types of IMEs in Nebraska, and not all would be considered “independent.”

  1. An IME may be requested by plaintiff. In this scenario, the injured worker can choose his/her own doctor with the cost paid by that worker or that worker’s lawyer; 
  2. An IME may be requested by both parties. If there is a medical dispute, the parties can agree to an IME doctor, or have the court appoint an IME doctor, the cost of which is borne by the employer or insurance company; and
  3. An IME may be requested by defendant. The employer or insurance company may choose its own doctor much like the worker can choose a doctor. The cost of this IME is borne by the employer.

Injured workers must be cautious of both #2 and #3 above. In #2, the IME opinion may be binding on both parties at trial if the doctor was agreed to by the parties. Without proper knowledge of the doctor involved, the injured worker may not know that a particular doctor is employer-friendly and is not likely to provide the worker with a favorable opinion.

Under #3, the injured worker must also be cautious. The worker cannot outright refuse to attend an IME, so the worker needs to be on his/her toes with the doctor, because the doctors hired by the insurance companies will go to great lengths to please the insurance companies that pay them big bucks for these IMEs (to the detriment of the worker). Sometimes that can mean denying further treatment for an injury or stating that a worker is “malingering” – or faking – an injury just because a worker didn’t look like he was hurt when he was getting out of his car in the parking lot. In other words, be warned that the doctor is always watching you during these IMEs.

Other advice that I give my clients before going to an IME is to be honest about all prior injuries, because the IME doctor will probably know more about your medical history than you. Be professional at the appointment and non-confrontational. Finally, bring a friend or family member with you to the IME. This can keep the IME doctor more honest hopefully, and can give the worker an additional “witness” about the examination when it comes time for trial.

Probably the best advice for anyone being sent to an IME is to contact a lawyer immediately. Chances are very good that your claim will be denied once you have been sent to an IME, and the sooner you contact a lawyer at that point, the better.

 

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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Mileage Reimbursement Set at 56 Cents per Mile for 2014

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Getting reimbursed for mileage and travel expenses is often part of the medical process in a workers’ compensation claim. However, it’s essential to keep detailed receipts and have a plan for submitting those expenses in a timely manner.

The federal government has set the 2014 mileage reimbursement rate to 56 cents per mile. This rate was effective Jan. 1, 2014. This is a decrease from 56.5 cents per mile last year, but the price of gasoline is also slightly cheaper.

Generally speaking, the federal rate changes annually. However, when gas prices went soaring in 2008, a mid-year increase went into effect.

As a reminder from a blog post that firm partner Todd Bennett wrote in 2011, injured workers can be reimbursed for activities such as “travel to seek medical treatment, pick up medications, or while participating in a vocational rehabilitation plan.”

The best way to do this is to work with your attorney and legal assistant to keep track of all mileage. This can include appointments for Independent Medical Exams (IME), too. Then your attorney can help you get reimbursed. 

It is often essential to save receipts and keep a record for yourself of your doctor’s visits and other reimbursable trips, including physical therapy and trips to pick up medication. Providing that log to your attorney and saving receipts incurred from specific doctor visits and other reimbursable trips creates a “narrative” that makes it easier to justify those expenses.

Because money is always tight for injured workers, contact an experienced workers’ compensation attorney if you have questions about a specific situation.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Workers' Compensation and tagged , , , .