Tag Archives: claim denied

“Independent” Medical Examinations in Workers’ Compensation (Anything but “Independent”)

Today’s post comes from guest author Thomas Domer, from The Domer Law Firm.

“I thought their doctor Independent Medical Report was the last word on my case. I didn’t know any better.” 

This statement from a client I just met sums up the experience of many injured workers unfamiliar with the workers’ compensation process in Wisconsin (and many other states).

An insurance company or self-insured employer may request an injured worker submit to reasonable examinations by a physician, chiropractor, psychologist, dentist, podiatrist, physicians assistant, or Advanced Practice Nurse Practitioner of its choice. Wis. Stat. §102.17(1)(b). This examination is usually referred to as an Independent Medical Examination or “IME” although “adverse medical examination” more accurately reflects the process.  An Independent Medical Examination may be requested by the insurance company or self-insured employer in order to determine whether the claim is compensable and the extent of the disability or the necessity and type of treatment. 

Since only about one in ten injured workers in Wisconsin is represented by an attorney, nine out of ten unrepresented workers are not aware that the insurance company’s “IME” is actually an adverse exam by a doctor hired by and paid by the insurance company to issue his report. Although IME examiners would deny they routinely render an opinion in favor of the insurance carrier, my forty years of experience suggests just that. For many years lawyers representing injured workers have been proposing the terminology “Adverse Medical Examination” apply to give represented and unrepresented workers a more fair assessment of the process. Many IMEs make hundreds of thousands of dollars annually performing these examinations. At one of these examinations, my client overheard the IME physician (who had rented a motel room) speaking to a prospective young doctor trying to convince that doctor to perform IMEs. “This is a great practice.” He said.  “All you have to do is review the medical records, meet with the worker for a few minutes, and deny the claim. And for that you can charge $1,500.” Although my client’s testimony to this effect was barred, the underlying accuracy of his testimony is undisputable.

Beware the “Independent” Medical Examination.

I Filed For SSD on My Own and Got Turned Down – What Should I Do Next?

Today’s post comes from guest author Barbara Tilker from Pasternack Tilker Ziegler Walsh Stanton & Romano.

If you get a denial notice from Social Security after filing your application for benefits on your own, don’t be surprised. Most people are turned down the first time they apply for benefits. Social Security recently released a study showing that people who filed on their own were slightly more likely to get denied initially, although they received their initial decision a little sooner. Many people make one of two common mistakes when they get turned down – they either don’t do anything or they file a new application. People who don’t do anything will, of course, not receive Social Security disability benefits. Those that file a new application are just as likely to get turned down again, and may lose entitlement to benefits they otherwise would have gotten.

When you get a denial, you should file an appeal of that decision.

When you get a denial, you should file an appeal of that decision. Filing an appeal is different than filing a new application. Depending on where you live, you will either file a request for reconsideration or a request for a hearing. A request for reconsideration means that someone else at Social Security reviews your file and makes a new decision. If you get denied at reconsideration (and about 90% of people do) you should file a request for a hearing.

After you file a request for a hearing, you’ll be scheduled for a hearing held by an Administrative Law Judge (ALJ). The ALJ will ask you questions and issue a written decision after the hearing. People who appear at a hearing before an ALJ are much more likely to get SSD than those who file a new application after getting denied.

Once you receive a denial, you should contact our office right away to discuss your options. You only have sixty (60) days to file an appeal, so it’s important to act fast. Our staff will be able to handle the appeals process for you, and one of our attorneys will appear at the hearing with you. The most important thing is to not get discouraged and continue your medical treatment so that you’ll have the medical evidence you need to prove your disability.