When a Pennsylvania worker is injured on the job, one of the first things they should do is seek out medical attention. For many, it means a trip to the doctor, the emergency room, or the operating table. An injured employee is required to report their injury to their employer within 120 days of the incident. If the hurt worker does not make such a report within 21 days, they will not be eligible for disability benefits from the date of the injury up until the date notice is given to the employer (assuming notice is given within 121 days)—only disability subsequent to the report.
When a report of a work injury is made, under the law, the injured worker must be presented with the employer’s and workers’ compensation insurance company’s “panel list” of medical and healthcare providers. There must be at least six providers on the panel list, and, if the list does not contain the type of provider the injured employee needs (for instance, if the worker suffered a cervical or lumbar disk herniation, and there is no orthopedic surgeon or neurosurgeon on the list), they may go outside of the panel for such treatment. The employee must treat with one of the “panel” providers for 90 days following the work injury. Thereafter, as long as the treatment is reasonable, necessary and directly-related to the work injury, they may treat with the doctor, therapist, chiropractor, etc. of their choice.
Under the workers’ compensation law in Pennsylvania, employers and their insurance companies have the ability to send a claimant (injured worker) to an independent medical examination, or IME, up to two time within a twelve-month period. Don’t be fooled by the use of the term, “independent,” however. The workers’ comp carrier gets to choose the doctor who conducts the examination, and, almost always, they choose a doctor that is not truly independent.
Many IME doctors are heavily dependent on insurance company referrals, and as such, they try to justify their opinions by showing that the injured worker is faking or exaggerating their injuries. The doctor will try to show inconsistencies between the injured worker’s complaints and statements regarding their capabilities…and what that worker does socially or as part of their daily routine. Some IME doctors will even watch recordings of the injured worker walking to and from the exam room! The bottom line is that, more often than not, IME doctors are “hired guns” of the employer and insurance company and are more interested in doing their bidding than they are in performing a fair, objective and impartial evaluation of the claimant.
The scary thing is that the outcome of the IME doctor’s examination could mean a modification, suspension, or termination of workers’ compensation benefits. Consequently, it is critical that the injured worker has had the opportunity to treat with their own medical providers before the time of the IME, in order to refute what the IME doctor says, and that the claimant is prepared to handle the evaluation.
Prior to an appointment for an independent medical examination, you should:
At Georgelis Injury Law Firm, we aggressively represent injured workers and have handled thousands of workers’ comp claims. When an insurance company schedules an IME, it is a watershed moment in the claim. If you are an unrepresented claimant and this happens, it is time to give us a call—because, as described above, “independent” does not mean independent.
We will be your ally and give you peace of mind as we navigate the complex workers’ compensation system together. You have nothing to lose—we always offer completely free case reviews, and we are available 24/7 and can come to you if it is more convenient. Simply give us a call at 1-800-HURT-NOW!
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After you are injured at work, you should receive a list of medical providers from your employer. The PA Workers’ Compensat...Read More
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