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I know this question has been asked and answered 100000000 times but I just can't retain anything intellectually right now. I have an IME scheduled next week. The IC changed Dr.s since the first one was on my side. In '99 the IME sent me back to work with no restrictions. 48 hours later I received a letter from my employer telling me I was due in work in 48 hours or I would lose everything. I went because I was capable and had already talked to the HR Director. Now it is all different. I can't shower, dress or drive comfortably and sometimes not alone. IF this IME does the same thing AND I get another letter from employer telling me to return to work I guess I get the employer's letter to my attorney quickly????? I guess my question is if my treating Dr. says I cannot work at all and the IME tells me I can do I go by what MY Dr. is saying and ignore the rest of the crap????? I believe since I won my claim my employer wants to terminate me so they don't have to pay my health benefits and they're looking for a legal way out. Any advise???? An
d if an IME says there is nothing wrong with me which we all know he will and my Dr. says differently does the IC stop my checks???? I feel like I am just starting out and have forgotten everything. My mind just isn't working. Sorry.

CAP
Good morning Cap. How much longer is your employer going to pay for your health benefits? By law they have to pay during your FMLA, and then if it is not "a not for profit organiation" they have to allow you to COBRA your insurance benefits for 18 more months. However, during this policy they do not have to pay your part, they just have to allow you to pay the organizations rate unless they have a organization policy that states that they will pay the employees part during a COBRA. If that is true it should be stated in your employee handbook. I said all that to clarify that i don't think that your organization has anything to gain by terminating your now. Are you not past your FMLA weeks, if so, they could have let you go at that time.

If your IME puts your at MMI and you are now receiving TTD, yes they will stop your checks. Then it is now, that you and your lawyer will want to have another IME documented by a doctor of your choice so that you have to expert opinions. Then your lawyer should file a motion for a hearing. This is were my husband is. Good luck to you. And my prayers are going up that you will not loose your health insurance. I know you need it very badly. Red

Timothy Belt

Cap, you are in PA so red1030 is incorrect in regard to the impact of MMI. If you are currently receiving WC benefits, the i/c can only stop those benefits by agreement or order of the judge. In other words, if you do not agree to having your benefits stop, they must file a petition which is then assigned to a judge. Assuming the IME does not put you at full recovery, they will also have to provide a Notice of Ability to Return to Work before making a job offer or filing a petition. They will request supersedeas when they file their petition. You will be able to oppose this request through evidence from your treating doctor. If supersedeas is granted, your wage loss benefits stop during the litigation of the petition. Medical benefits are unaffected by supersedeas. If supersedeas is denied, which is the more likely outcome if your doctor is on your side, your wage loss benefits will continue until a final decision is issued by the judge. The whole process will take at least 12 months and often longer, so you will continue to receive your wage loss benefits during that time period if supersedeas is denied.

In regard to attempting a job offer from your employer, if your doctor says you can't do the job and you don't attempt the job, it will come down to a question of which doctor the judge finds more believable. If you attempt the job and find that you can not perform it, it does add some additional weight to your doctor’s opinion since you can testify that you tried the job and why you were not able to do the job.

Good luck.
Cap, as you may know by now and the years talking about this, is, if one Doctor states you can work, and you doctor states you can't work, that it is always best to make the attempt to try and work. Even if you know you won't be able to perform the work, you need to show your employer this. that then benefits you with the proof of trying to attempt to work. I always tell people, to try and let the employer know if you become in more pain, or if the work is causing you so much pain that you need to see the doctor or return to the doctor for a new evaluation and set of restrictions. In a way, it's a tool so to speak, that can be a major benefit to you.


Red.... I just spoke to someone from my employer's office who is in charge of all employees on WC and she told me not only are they reimbursing me for what I have paid in benefits in the last 10 months but they will be paying for them until a certain date. I didn't receive the letter yet. Should get it tomorrow and it will make everything clearer. The reason for this is because in the past, and I am sure of this, their policy is to pay the benefits of all FT people while on WC. Whether it is in writing or not didn't matter. It is an implied contract between employer and employees. AM I right so far , Tim??? So that is good news so far.

Tim.....I just spoke to my attorney and I think i get it . The IME can do all sorts of things. Send me to work/ no restirctions, send me to work/with restrictions, not send me to work, etc. It has already been varified and agreed by my Dr. and my employer that I cannot return to my job. So in order for me to return they will have to offer me another position if they want me to return. Right???? I have a hard time even getting dressed in the morning so I don't know where this is going.

Badboy....I agree I have no choice but to try within reason. BUT having a hard time showering and dressing, let alone driving I don't know how long I will last at anything. A year from now may be different. I have not had any PT on my back or knee. ANd the shoulder PT is tearing my neck up again. Not to mention I still have only maybe 40-50 % ROM in my bad shoulder. Will do whatever I have to do.

Are there no people who can't return to their pre-injury jobs, are permanently injured but can work at something that go back to work and are also compensated for their injuries in the way of a lump sum???? Did I word that right?? Am I making sense??

CAP

Timothy Belt

Sure, I handle lump sum settlements all the time. I just settled a case last week where the iw couldn't do his time of injury job, but he has found in field work that is less physically demanding. I have had other clients that have settled there cases and used the money to go back to school or start their own businesses. For what it is worth, it is also common for the i/c to throw together some bogus job offer or other petition to use as leverage in settlement negotiations. Pa now has mandatory mediation in wc, so if the i/c is interested in settlement, you should know shortly. The problem, as I understand your situation, is that you need ongoing medical care. In all likelihood the i/c would want to settle both future wage loss and medical, so settlement might not currently be in your best interest.


Tim....can a lump sum settlemnt be done AND the IW returns to the pre-injury employer BUT in a different' position?? Sorry, I want to make sure this part is clear in my mind.
Also I want to say thank you for reminding about the bogus jobs. A co-worker went through this one week before they offerd her a settlement. Had a job description wriitten up within her restrictions but at the bottom had "in the absence of the head of dept. you will be responsible for doing his/her job" Well in the absence of the head of dept. she would have been so far out of her restrictions that she would have gotten screwed IF she did the job and IF she didn't. Good thing she noticed it. Good thing you reminded me.

So glad you're here. You are a true benefit.

CAPWink

Timothy Belt

It is possible to settle and return to the same employer, but it is very unusual. A settlement requires agreement by both parties. The employer and their carrier are trying to cut their losses and get out. It would be very unusual for them to agree to pay you the "go away" money and then agree to let you stick around. You are an ongoing liability with high risk of reinjury. In PA, an aggravation of a pre-existing condition is considered a new work injury, so if you were to do something to make the old work injury substantially worse, they would be back on the hook. The answer to your question, academically, is yes, but in reality, it is not going to happen.


You know, Tim sometimes I feel like an idiotRolleyes I 'm actually not but you would think so sometimes.

I knew something wasn't right and that I must have misunderstood another post in the past , that's why I kept asking. Thank you, Thank you for answering all of my questions. This is my 5th WC claim with same employer so my guess is at some point they will want rid of me. Surprisingly they haven't yet. I guess someone saw my worth.

Have a great night,
CAP
Cap, sorry for the mis information. I have always thought that is what happens at MMI. It did for us. Thanks Mr. Belt for the correction and the explanation. Red
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