One Independent Medical Expert Per Accident and Other Terms with More Than One Possible Interpretation
The poshest private health insurance plans pay for a substantial portion of your treatment no matter which doctor you visit. Workers’ compensation insurance is quite the opposite. Your employer chooses the physician who treats you; of course, that physician can then refer you to specialists of his or her choice if it is medically appropriate to do so. If you are unhappy with the treatment you are receiving from one of your treating physicians, you can request a change of doctor, but you can only do this once. Likewise, if you and your employer disagree about whether your employer should continue paying for your treatment, you can have an examination by an independent medical expert (IME), who is usually also chosen by your employer. Common reasons for consulting an IME are disputes over whether your injury is work-related, whether you have reached maximum medical improvement, and your level of permanent impairment. If your injuries are serious and your case is complex, it is a good idea to contact a South Florida workers’ compensation lawyer even before the IME examines you.
One Examiner or One Examination?
In 2006, Luis, an employee of a concrete company, suffered a work injury that aggravated a pre-existing condition that caused him to suffer chronic neck pain. His employer denied the claim, so Luis visited Dr. Simon, an IME who determined that Luis’s symptoms, namely neck pain and arm numbness, were related to the work injury. Therefore, the employer sent Luis to Dr. Weber, a primary care physician, for treatment, and Dr. Weber referred Luis to Dr. Flynn the orthopedist. After Luis underwent physical therapy and nerve blocks to treat the pain, Dr. Flynn determined that Luis had reached maximum medical improvement.
Luis continued to have symptoms, though, and in 2009, he went back to Dr. Simon, the IME who had examined him more than two years earlier, for another examination. The judge of compensation claims refused to consider Dr. Simon’s 2009 evaluation, one the grounds that there should only be one IME examination per accident. Luis appealed the decision, arguing that the law says only one examiner per accident, not only one examination. The appeals court ruled that, in the case of serious injuries, it is appropriate for an injured worker to have his condition evaluated by an IME several times over a long period of time, but the law requires that the same examiner conduct all the examinations related to the same accident. Therefore, the court was required to consider Dr. Simon’s report from 2009 and use it as a basis for a decision about whether the employer’s workers’ compensation insurance should pay for more treatment for Luis.
Let Us Help You Today
Living with chronic pain is difficult enough, but having your employer refuse to take you seriously about it is even worse. A Sunrise workers’ compensation lawyer can defend your right to be heard. Contact the Law Offices of David M. Benenfeld for help with your case.