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Work comp, just one big problem in long run.

CMatthewCCMatthew Posts: 49
edited 06/11/2012 - 8:35 AM in Health Insurance Issues
I had my back injury on June 5, 2008. I saw the ER 3 times in two months waiting for work comp to get rolling. I actually laid in bed because I could not move for the first few months waiting on approvals from the WC. My DR was not happy with the delay which in turn hurt me a little more from the laying around not being able to do anything. Anyway a year and a few months later, I receive a call from my case worker stating they want to get an opinion from a DR they are familiar with in my area. So with that I called my lawyer to let him know and he said it is probably an IME. I told him I didn't think so because it ws never said. So I told my DR that I would be seeing a new DR and I wouldn't be seeing him anymore. He said good luck and right after that I received a letter in the mail stating that it was an IME. I called my rep. and she said it was and that I can only go to my pain clinic and my DR up until I see ther DR. So I did that but made an appt. with a new DR to get a new set of eyes on my back. This is after my appt. with there DR because I learned that he doesn't treat me he just gives a report. So I make that appt. and get a call from my rep. stating that they will not cover that appointment until after they get the report from there DR stating what steps they should take next. My whole point is it is not fair that everything depends on this one DR's report. So between the 2 surgeons, 3 neuroligist, 1 phys. ther. DR, and pain clinic DR. I have to wait for there ALMIGHTY DR report to come back before I can receive anymore treatment. Then I get a call after all this from my QRC and she says she talked to my rep earlier last week and she said I can continuwe at my pain clinic till the end of the month, which my QRC says that isn't what she said earlier to her or me. They can't make up ther mind and go back on ther words. No wonder so many people complain and you need to get a lawyer for this whole mess. Sorry so long it's as short as I could make it.


  • Ime stands for Independent medical exam. It is not independent when they submit the information they want in, and hire the doc, and pay the doc. If you are not given a chance to select the doctor, it is clearly not a independent doctor. The idea of the doctor is so that no one has a interest in the outcome. However, work comp has a interest in this outcome. If this doesn't work out to give you some help with your situation. Your Attorney can hire one as well. I'm not sure if you have had this appointment or not. If you haven't had it then please make sure all your medical files including all doctors notes and films are there. Work comp will tell you they are taking care of it. In my experience some key pieces of information get left out, that are imperative to your getting treatment. Your attorney should be being advised in writing to all of these facts. If work comp refuses you treatment get it in writing. You can then take to whatever doctor you like and get medical help and still say it is work comp. They may not pay for it now, but will later if it was medically necessary. Good luck and keep us posted.
  • Thank you Tamtam on this advice, it is good to know. I have had the IME just last week on the 18th. Hopefully this report gets back to everyone soon. The advice on my lawyer and I having an IME ourselves is great news as well. The only problem I have with going to appts. that wc denies as of now is the fact that I dont have regular ins. I was injured on my job before I qualified for it. And with two kids and a wife that runs a daycare and wc doesn't pay muuch it is tough to pay for my visits and meds upfront. I will keep you and everyone else updated thanks again.
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