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Ok workcomp is getting really ridiculous

Emj1988EEmj1988 Posts: 45
edited 06/11/2012 - 8:48 AM in Health Insurance Issues
I have been injured since june '09 and workerscomp has denied everything since Feb of this year because an IME lied in his report and said I was ok (what the heck!!). In May I had to set up payment plans for all the clinics I have been to because of the denials. I have to pay $700 a month because of are laws that permit IMEs to be utilized by insurance companies and lie. I am 21 yrs old and Ill probably have to start selling all my belongings soon to pay all my monthly bills. If it wasn't for my parents taking me in I would be done for. How can our laws let this go!!! I will be going for a hearing in Jan but that may be too long to wait for me.

Is there anyway around this????
> According to my atty there isn't but I still find that hard to believe.

7mm Retrolisthesis l5-s1
7mm disk bulge l5-s1
disk bulge l4-l5
facet and disk degeneration at both levels

mid back and severe neck pain 4 months after my injury


  • Didn't you get a copy of their report along with notification that future visits would not be paid for? I know that for both WC and no-fault I received a stack of forms telling me the results of each IME.

    If you continued to go to doctors after being notified that's your responsibility.

    What is the lie that you think they told? If it's something obvious then you can probably get it changed quickly.
  • I got no notification that future visits would not be paid for. My only notification was when they started to deny my claims. I still needed to see the pain doc though for my meds.

    Ok where he lied was in many areas. I bent forward for flexion about 15 degrees which is when I had nasty pain. He said on the report that I have full range of lumbar motion. He also said that I can go back to work with no restrictions which is weird because 2 orthos have gave me a ton of restrictions.... I also Have tingling down my right leg really bad once in a while I told him this after he asked me that and he said "anybody can have tingling down their legs" why would you both to ask that question if you follow up with a comment like that....

    -if you do your research you will find that IMEs overall, when hired by the insurance company will lie to save them money and make you suffer as much as you can. This is why this whole process is a joke. Maybe in New York you State laws are better??? At least you can video tape your IME I cant do that in my state. NY times did a report on IMEs on Youtube. From what they reported on is what I have pretty much been through..
  • What does "bad once in a while" mean?

    What does "a nasty pain" mean?

    I mean, my right leg falls asleep occasionally, but that isn't because I have back problems. Every night when I lay down to go to bed, my left foot starts tingling very badly if I'm not in just the right position. That is because I have back problems.

    One I report to my doctor, the other I don't.

    I doubt that the person who did the evaluation lied on purpose. I wonder how well you're describing your symptoms.

    Are you still doing your physical therapy exercises in an effort to some day go back to work? What is your long-term plan for your life?
  • The IME's know who "butter their bread", the ins. co.
    Most are honest, but in every walk of life there are a few dishonest one's out there.

    It does not surprise me, what Emj1988 is saying.
    I had the displeasure of dealing with a dishonest one before. But i also had a lawyer who knows these tricks and took it to court and won for me.
    Only thing is you cant fight them alone, you need a lawyer on your side.
  • I doubt that the person who did the evaluation lied on purpose.
    Believe me, they come very close to lieing, and they are trained to do that.

    I recently had an IME with very similar results. Limitations that would be in my favor are either barely mentioned or completely left out of the 20 page report this so called "independent" doctor wrote. Serious symptoms are not mentioned, others are twisted and turned to cast doubt. That is the job of these IMEs. They are performed by the opposing side (in my case workers comp) who is trying to get out of the liability of continuing to pay for our care. In the end, after noting parts of the neurological exam that cannot be denied, they still came to the conclusion I can return to a full time 8 hour a day job with no restrictions or special accommodations needed. What??? Nothing can be further from the truth. If there is anything that is not normal (and we all know how complex and varied spine issues can be), they state that the symptom is suspicious and a sign of symptom magnification. The IME doctors who did my report aren't even spine specialists. They are painfully brutal, attack our character, and come up with a report in favor of the insurance company who is paying for the report. I don't know how these guys sleep at night. I was blown away by my report. It doesn't matter that I have solid documentation of my problems and doctors on my side stating the exact opposite. These IME doctors will find something to run with, even if there is nothing there. They twist everything we say, and look at every piece of your medical history all the way back to birth. If your injury is serious and disabling, they will try to pin it on some psychological issue from your past.

    EMJ, don't let it throw you. If you don't have an attorney, go get one. Let your attorney build a case that will blow that report out of the water. Try not to take that report personally. The abuse they put us through is unforgivable, but if we let it get to us, we are giving them the power to hurt us even more.

    I don't know what to tell you about the medical bills. I think ultimately it is your responsibility if they deny payment. But save all your invoices and receipts. Maybe your attorney can get it all back in the end. I'm sorry so many of us are going through this. A few bad apples make it difficult for the rest of us.

    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • I had both an independent medical exam AND a functional capacity evaluation; in both cases, the so-called professionals lied through their teeth, and I made sure I let that be known.

    I took each of their reports, highlighted the inaccuracies and sent them to my insurance company clarifying exactly what DID happen. There are many, many people who have had this happen, and you're right, blazer...these independents definitely know who butters their bread. I also filed a complaint through the College of Occupational Therapists to make them aware of what I went through, and the woman who did my evaluation was not a happy camper when she found out. I am very passionate about this topic because I was forced through a FCE a few years ago now, and still suffer from some of the "injuries" that came about as a result of that FCE. But - oh - apparently I'm just "fine".

    I had a friend come with me to the office when I went through my independent medical evaluation, and they would not allow her to come in. They did, however, provide a "neutral party" (hmmmm.....how neutral can you be when an insurance company brings you in??) to "observe".

    I did get some legal advice, on the advice of one of the speakers at a residential pain clinic I attended, and I made sure I let the OT and my insurance company know it.

    Good luck, Emj - be proactive, and you might want to consider keeping a journal of all these things. If, by chance, you do end up in Court, it will help you to be accurate about what exactly did happen.

    Take care.

  • Well two things you can do. First ask them for proof that they notified you that they were terminating benefits. That would be required anywhere. How would you are anyone know that the insurance company decided that you were not in need of further treatment? Something is very fishy there.

    Second is get a copy of the IME which is your right. Then you can compare that to your doctors notes from the same time.

    I have been through many IMEs from many different specialists. Some are out right liars, some tread the line and one is awesome. Luckily my NS IME doc is the one who is awesome. He dictates his report in front of you. Asks for details as he is doing it. And is very honest in his recommendations. Luckily they are sending me back to him again in December. I have also gotten some advice from him. At the other end of the spectrum is the orthopedic IME doc who is a hack who set up a store front office for this purpose. His equipment is a table, a recycling bin and a paper clip. One week after shoulder surgery he wrote that I was OK to return to work.

    What I learned from the insurance company was to put my objections in writing to them the same day that I see the doc. You can't come crying after you see the report.

    I hope you can get this straightened out.
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