One of the issues with the workers comp process that really grinds my gears are these so-called ‘independent’ medical evaluations and work clinics.
You can probably guess what that means, and you might have gone through one yourself after a work-related injury. But if not, let me tell you what goes on at one of these ‘evaluations.’
Hopefully you’ll see why you should always go with your gut, and never take anything for granted.
One of our recent clients (we’ll call him Dave) had a nasty accident at work. A pane of glass exploded in his face, leaving him cut up pretty bad.
The cuts would heal, but what worried our client was that his right eye was bothering him something fierce. Dave was worried there were tiny shards of glass in his eye, so he asked the doctor to check.
After you get hurt, the insurance company wants a professional medical opinion from a doctor to help answer 3 big questions:
Of course, the insurance company is hoping the doctor says NO to all 3 of those questions.
Their business model relies on paying as little benefits as possible—at your expense.
Anyway, Dave had no idea that this ‘medical professional’ he was referred to by the insurance company probably has a big reason to say NO, too. A lot of these doctors tend to get repeat business from insurance referrals—they recommend no further benefits be paid out, and in exchange the insurance company continues sending hapless patients their way.
The doctor basically told Dave he was fine, and sent him home with a tiny tube of ointment for his eye.
A couple days went by, but the eye wasn’t any better. In fact, it was worse. Dave knew something was wrong, so he headed back to the same (insurance-approved) doctor. This time, he went home with some eye drops.
By the end of the first week, Dave was fed up. His eye ached 24/7. He made an appointment with his own general practitioner, who immediately realized there was a small shard of glass stuck in Dave’s eye.
But you probably guessed that already.
Frankly, I find the whole story disgusting. Here you have a tight-fisted insurance company colluding with a doctor to deny an innocent, hurt man the money he needs to get better. And what’s worse, you’re putting his health in jeopardy by outright lying.
Luckily, Dave refused to take NO for an answer. Armed with the opinion of an honest doctor, he came to us for help. I’m happy to say we straightened the whole mess out, and Dave’s vision is no worse for wear.
The aim of the game here is to make you frustrated—sometimes with lies and deception—until you’re so worn out and tired, you just throw in the towel and pay the medical bills yourself.
Even if the insurance company knows beyond a shadow of a doubt they should pay up, they’ll still play these games if they think they can get away with it. They’ll keep sending you to these work clinics, run by doctors (actually nurses or physicians assistants, most of the time) who need to keep the insurance company happy.
Happy for the insurance company means minimizing your injury’s severity and giving you the cheapest treatment available.
And guess what happens when insurance is tired of paying for your treatment, or refuses to pay outright? They send you to a so-called ‘independent medical evaluation,’ where the doctor’s top priority is:
That’s why you’ve got to see your own doctor, a professional you can trust. Your doctor is the first and best line of defense you have when seeking workers comp insurance. While you may be forced to see a work clinic doctor at least once, fight for your right to visit a physician of your own choosing, one who has your best interests in mind.
But if you’ve already been through an IME and told your injury isn’t covered by insurance, we want to talk. We’ve successfully defended many people whose IME doctors claimed had no injuries—even cases the insurance companies had already slammed shut.
That said, make workers comp claims easy on yourself. If you’re hurt at work, seek your own doctor’s opinion first, and save yourself the headache later.
*The information provided on this website does not, and is not intended to, constitute legal advice; instead, all information, content, and materials available on this site are for general informational purposes only.
Davis & Sanchez