By William R. Cahill, Jr.
When a worker files a workers' compensation claim, the employer and/or insurer has the right to contest it, (whether it be medical or indemnity benefits).
This article focuses on the legitimate techniques an employer/insurer may use. It does not cover everything. Every employer and insurance company is different.1
Independent Medical Examinations
Insurance companies will choose a physician to examine a claimant to see if there is a compensable, work-related injury. This evaluation is called an Independent Medical Examination or IME.
The IME physician may review past medical reports of the treating physician and may look at relevant x-rays, MRIs, etc. The IME physician will generally be a specialist. For example, an orthopedic would handle a back or hip injury claim.
IMEs are generally conducted by a select group of physicians the insurance companies have used many times before and whose opinion regarding work-related injuries and extent of disability has pleased the companies.
Many times there is a dramatic difference in the IME doctor's opinion and the opinion of the treating physicians with regard to issues of causation, physical restrictions, extent of disability, and permanent impairment.
There are times where both the treating physician and the IME doctor agree substantially, in which case it's odd that the matter would be litigated at all.
An IME Checklist
If you receive written notice to attend an IME—assuming the request is lawful under the rules and statutes of your state—then you should:
- Note the specialty of the physician giving the exam
- Note the questions being asked
- Note the time and duration spent with the physician
- Note what actually takes place during the examination, such as whether the doctor checks your reflexes
This list is not all-inclusive. Any IME notes you take may be helpful if and when the matter is litigated.
Although the IME physician is not your doctor, it is important to arrive at the appointment on time, dress appropriately, and be a good historian about how your injury occurred.
Surveillance
Another tool insurers have at their disposal is surveillance.
Most claimants should have no concerns regarding surveillance, except that it may be disturbing to think someone is watching you from a public area with a video camera.
Often the surveillance falls far short of anything probative to the issue of physical restrictions. The surveillance usually shows a claimant food shopping, going to physical therapy, or doing household errands. (Surveillance has limitations which may be addressed by your attorney if such a situation arises.)
Surveillance works only if the claimant does something above and beyond the stated physical restrictions set forth by the treating physician.
We all remember cases portrayed in the news where someone has alleged a severe back injury and has major restrictions on lifting, standing, reaching, and pulling. Then the surveillance tape shows the individual water skiing for 20 minutes and jumping the wake. This does not happen often as most claimants genuinely want their injury to resolve so that they can continue to work without restrictions and provide for themselves and their family.
The other time surveillance can be an effective tool for insurers is if a claimant is working and has not informed the insurer/claims adjuster through the claimant's attorney. This can have serious consequences up to and including criminal fraud charges.
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Do not hesitate to reach out to a Teamster Business Agent for guidance or an attorney for advice regarding a workers' compensation claim. Protect yourself and your family by being informed. Knowledge is power.
1All are not created equally nor do they all follow the numerous administrative rules and statutory laws that have been enacted to protect all parties involved. And, as stated in my previous articles, the references are general and each state has its own particular nuances regarding the handling of workers' compensation cases.
This article was submitted by William R. Cahill, Jr., of Dumont, Morris, and Burke, PC., 14 Beacon St., Ste 300, Boston, MA. Attorney Cahill was formerly a principal officer of a Teamster Local and has been practicing law in MA and NH since 1996/1997 respectively. He received an Honorable Discharge from the Massachusetts State Police after 26 years of service to the Commonwealth.