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What if an Independent Medical Examination Doctor Doesn’t Agree with My Doctor?

IME doctorToday’s wise words come to us from my colleague Roger Moore of Nebraska.

As I have written previously,  in Nebraska, you have the right to choose your family doctor to treat you for your work injury.  For purposes of the workers’ compensation court, that person becomes your “treating doctor.”  However, sometimes an employer or insurance provider selects a non-treating doctor for an “independent medical examination” (IME). According to the workers’ group National Association of Injured & Disabled Workers (NAIDW), IMEs are used for three reasons:

  1. “to determine the cause, extent and medical treatment of a work-related or other injury where liability is at issue”
  2. “whether an individual has reached maximum benefit from treatment”
  3. “whether any permanent impairment remains after treatment”

When an IME is scheduled, this probably means your employer or the insurance company is trying to fight some aspect of your workers’ compensation benefits.  An IME doctor frequently bases his or her findings on what is often a very brief visit with a patient.  Sometimes they don’t even perform a physical examination before rendering their opinion.  Rarely do they issue opinions that are favorable to an injured worker.  For that reason, when an examination like this is scheduled, my policy is to Continue reading

NIOSH Alerts Home Healthcare Workers About Latex Allergies

Today we have a guest post from my colleague Jon Gelman of New Jersey.

NIOSH (The National Institute for Occupational Health and Safety) has published a booklet to educate Home Healthcare Workers about preventing latex allergies. Latex products are made from natural rubber, and sensitivity can develop after repeated exposure. Limiting exposure to latex can help prevent allergic reactions for both home healthcare workers and their clients.

Once Natural Rubber Latex (NRL) sensitivity occurs, allergic individuals continue to experience symptoms, which have included life-threatening reactions, not only on exposure to NRL in the workplace but also upon receiving or accompanying a family member receiving healthcare services at inpatient as well as office-based settings.

In September of 1997, the Food and Drug Administration (FDA) issued a final rule requiring cautionary statements in the labeling of all medical devices that contain natural rubber likely to come in contact with humans. The rule provides that such products must contain the following cautionary statement in bold print: “Caution: This product contains natural rubber latex which may cause allergic reactions.” Additionally, the FDA issued a final ruling that the labeling of medical devices that contain natural rubber, likely to come in contact with humans, shall not contain the term “hypoallergenic”.

Over the last few years, there has been a significant increase in the number of workers’ compensation claims filed against employers on behalf of individuals who have suffered latex allergic reactions. Scientists and government officials estimate that about 950,000 U.S. health care workers have developed an allergic sensitivity to latex.
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For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

NIOSH Acts To Prevent Lifting Injuries For Home Healthcare Workers

Today’s post comes to us from my colleague Jon Gelman of New Jersey.

The National Institute for Occupational Health and Safety (NIOSH) has published educational information to prevent musculoskeletal injuries at work. Injuries caused by ergonomic factors have been a major issue of the Federal government for decades and have been the basis for repetitive trauma motion claims for workers’ compensation benefits. While the Clinton-Democratic administration had advocated strongly for ergonomic regulations, the Bush-Republican administration took action to reject the reporting of ergonomic injuries to OSHA.

A work-related musculoskeletal disorder is an injury of the muscles, tendons, ligaments, nerves, joints, cartilage, bones, or blood vessels in the arms, legs, head, neck, or back that is caused or aggravated by work tasks such as lifting, pushing, and pulling. Symptoms include pain, stiffness, swelling, numbness, and tingling.
Lifting and moving clients create a high risk for back injury and other musculoskeletal disorders for home healthcare workers. Continue reading

Unsafe Workplaces Lead To More Injuries

 

Today’s guest post comes to us from Tom Domer of Wisconsin.

The connection between unsafe workplaces and the increased frequency of work injuries seems like a no brainer. A study released by NCCI Holdings indicated worker’s compensation claims rose by 3% during 2010 (the first rise in frequency in over a dozen years). The study attributed the increased frequency to several factors including increases in employment since the onset of the recession in 2008, workers possibly being less fearful of losing their jobs for filing claims, and a lack of light duty jobs to which injured workers could return because of the poor economy.

Because of these repeat violations,OSHA cited United Contracting and placed the firm on its “Severe Violator Enforcement Program”

One factor not referenced is the connection between increasingly unsafe work environments and work injuries. Two recent news stories in Wisconsin underscored this connection. OSHA fined a Wisconsin contractor $150,000

for violations while working on two bridges along highways in Wisconsin. The violation is more alarming because the contractors were working under a State contract to repaint the bridges. OSHA charged that the company did not have proper scaffolding at the bridges exposing workers to falls, and in fact one worker was injured in June after falling from a scaffold at one of the bridges. Because of these repeat violations, Continue reading

Premium Fraud: North Carolina Man Sentenced on Workers’ Compensation Insurance Scam

My colleague Jon Gelman shared this piece of news on his blog late last week. I am reprinting here, with his permission.

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Dan Anderson, Director, Department of Financial Services, Division of Insurance Fraud, announce the March 3, 2012 sentencing of defendant Carl Dale Fuller, 52, of Wake Forest, North Carolina.

U.S. District Court Judge Donald L. Graham, sitting in Ft. Pierce, Florida, sentenced Fuller to five years in prison, to be followed by three years of supervised release. In addition, Fuller was ordered to pay $2, 859,067 in mandatory restitution.

Fuller previously pled guilty to mail fraud in connection with a scheme to defraud National Employees Services (NES) of more than $2.8 million in what the company believed were insurance premiums for workers compensation insurance. NES, a Florida Corporation located in Avon Park, Florida, is a provider of cost-effective services for businesses that out-source employee insurance, including workers compensation insurance.

To execute his scheme, Fuller used the name David Walters in e-mails and phone calls and held himself out to NES as an insurance broker. Fuller falsely claimed that he would obtain workers compensation insurance policies for NES and the companies they represented. Instead, Fuller kept the payments and never provided insurance coverage.

From mid-2005 through September 2008, Fuller received more than $2 million of NES premium payments, which he used to fund his extravagant lifestyle in Wake Forest and Pinehurst, North Carolina. NES sent the premiums to Fuller under the name of Southeast Services, a company created and controlled by Fuller. The checks were deposited into numerous accounts all controlled by Fuller. Continue reading

Workers, Beware Of Fraudulent Employers

Could your employer be hiding something from you?

Today’s post comes to us from my colleague Tom Domer of Wisconsin.

Over the course of 35 years representing injured workers, I have heard some whoppers – Employers’ questionable tactics that make even my jaw drop. With all the insurance company generated blather about “employee fraud” incidences of employer fraudulent tactics abound. Workers beware of the following:

  • Recorded statements taken by worker’s compensation carrier adjuster while employee is under medication or in the hospital still suffering from the injury. Questions such as “It’s true you had (low back pain, arm pain, fill in the blank pain, etc.) before your work injury, correct? You’ve had lots more pain from (your motor vehicle accident, sports injury, etc.) than you’re experiencing from your work injury, correct?
  • Employer “channeling” a work to its “Return to Work Clinic” (doctors on company payroll whose opinion is “like some athletic coaches, ‘rub some dirt on it and get back in the game’.”
  • Telling employees to take sick leave rather than claim worker’s compensation.
  • Telling employees to file medical bills under their group insurance, not worker’s comp.
  • Nurse Case Manager who initially befriends the employee but later makes every attempt with the worker’s doctor to prematurely return the worker to the job before a healing occurs.
  • Employer paying worker in cash with no payroll stub (or gives workers a Form 1099 rather than a W-2). Continue reading

Prior Approval not Required for Emergency Medical Treatment

Today we have a guest post from my colleague Matthew Funk of New York.

Don't wait for approval, if you need emergency room medical treatment, get it right away.

When an injured worker needs emergency medical care, prior authorization isn’t always possible. However, not being able to obtain it does not bar a workers’ compensation claim. When a worker is hurt at work and is rushed to the emergency room for treatment, there often isn’t enough time to seek authorization from an insurance company and to obtain a claim number.

At the time of the treatment, if possible, the injured worker should let the hospital and medical provider know that the injury occurred at work and disclose the exact details of all his or her injuries. (This is sometimes an effort, since emergency staff are rushed and understaffed.) After the emergency care is provided, the worker should immediately seek the guidance of an attorney to assist in filing a claim and obtaining reimbursement for the medical care.

At the time of the treatment, if possible, the injured worker should let the hospital and medical provider know that the injury occurred at work and the exact details of all his or her injuries. 

The law provides that the cost of the emergency medical treatment will be adjusted to meet workers’ compensation payment guidelines. Many times, doctors will submit bills to the private carrier with a note stating, “Do not pay: submitted pending determination at the Workers Compensation Board”. This ensures that even if the Workers Compensation claim is not successful, the doctor can still be paid.

The employee should save all copies of all notes, receipts, and diagnostic reports that the treating physician has available, and keep an injury-and-treatment diary. The easiest way to keep to this is to simply use a calendar and record all treatment appointments, procedures, tests, medications and complaints on every given date. Make a copy for your lawyer as well.

Matthew Funk, a partner at Pasternack Tilker Ziegler Walsh Stanton & Romano, LLP, has been practicing Workers’ Compensation Law for over a decade. He is a member of the Workers’ Compensation Bar Association, Injured Workers’ Bar Association and the New York Coalition for Occupational Safety and Health (NYCOSH). He has written for the New York State Trial Lawyers’ Workers’ Compensation Decisions program and has lectured on numerous occasions focusing on Workers’ Compensation Law.

 

 

If You Have Symptoms, Tell Your Lawyer!

If You Have Symptoms, Tell Your Lawyer

Today’s post comes from our colleague Kate Fitzgerald of New York.

We represent a client whose hands were directly injured a few years ago. The insurance company, as part of its defense, is raising a provision in the law which requires an injured worker to file a claim for a direct injury within two years of the accident (WCL § 28). While interviewing the client, we learned that she had been feeling symptoms in her hands years ago, at the same time as she began experiencing the symptoms to other areas of her body. But because she only mentioned that her hands hurt now, we may not be able to get her the compensation she deserves.

Our client told me that originally brought up the symptoms of numbness, tingling and weakness in her hands with her doctor, but he felt these symptoms were related to her neck, another

If you are hurt, tell your attorney everything, even if you aren’t sure if it is relevant.

area where she was injured. The doctor tried to treat her hand symptoms by treating her neck first. He Continue reading