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WC's IME restrictions VS Doctor?
I have another question that I want to know if others have had it happen to them. First a quick review(this is all in earlier post), I'm in Pa, I injured my lower back in Nov.06 at work. I used the WC choice of doctor, and switched to my choice in May. In July, the WC adjuster filed for a utilization review of my doctor. I was also sent for an IME in July, he wrote an inaccurate and untruthfull report, and wrote up new work restrictions, which were totally aginst my treating Dr's. The WC sent the IME's restrictions to my employer, who sent me a certified and reg. mail letter stating that the new restrictions were to begin on Mon.Aug.13, and under these I was to return to work on my machine(standing all day, operating machine with foot pedal), and allowed to lift up to 50 pounds.Sad

I seen my Dr. on Fri. Aug.10, and told him about this and gave him the letter. He wrote on my restriction paper to continue same restrictions(sedentary duty with occasionally lifting up to 10 pounds, and only standing up to 30 minutes, up to 3x's/day, and a few others things)and avoid brake press.

My Dr., lawyer, physical therapist and the Dr. that I had an 2nd Emg done at, all tell me not do the IME's restrictions, but stick to what my Dr orders. I have already been told that I may be written up due to not compying with what WC says I'm able to do. I told them that I understood but I have to follow my Dr's orders, since he is the one who treats me. I don't want to back in time in my recovery, I want to go forward and get back to the way I was. I did mention that I understand that a judge can decide when there are conflicts between DR's restrictions, as to which one to go by. They said since WC has my Dr. under review, that if it went in front of a judge, he would probably agree with IME.

Sorry to be so long again, if anyone had to deal with this please let me know what happened.

The thing with an IME is it is a one time visit vs a doctor that treats you and sees you constantly. So in most cases the weight of the treating doctor will hold more in the court than an IME. Normally an IME is used for impairment ratings, to get you back to work when your doctor says your not, etc. Like now in your case - to release you to do your job.

If you try the job and say 35 minutes into the shift your leg swells up, you need to report it to your supervisor, the company nurse, call your doctor, etc making sure that it is all documented that you tried to go by the IME restrictions and that it didn't work and caused more problems. Yes it may cause a set back - but if you get into the doctor right away after it swells this will be minimal as he will set your old restrictions again - which sounds like he did. This may also help the review to go in your favor as they can see the IME doctors restrictions are not in your best interest.

Normally my opinion is to follow what your doctor and attorney tell you to do. But experience also tells me that it doesn't take long with IME restrictions for you to be in more pain and or swelling to occur where it needs to be reported to the company nurse, supervisor and a call to the doctor to be made. I spent many months in the company nurse's office icing and heating my shoulder because of the difference in restrictions since they contacted my doctor after I was put at MMI and got him to change them to their benefit and since they controlled who I seen they would not set up any more appointments for me. This started shortly after they told me of the changes.

If your supervisor refuses to allow you to go to the nurses station if your company has one - then shut off your machine and go any way - they can not refuse you medical treatment if you need it.
Thanks Pooh for replying. The thing that ticks me off is that I was supposed to go to the Dr.that I switched to. Originally he was the one that I was released to, but I had a nurse case manager at the time,(I have had her authorization revoked) she cancelled the appnt. and set one up with a Dr. she preferred. Since this was still within the first 90 days, I had to use him.

When she came to my first appnt. April 24,07, with my current Dr. which had to called a 2nd. opinion appnt., per the NCM, even though I had already decided that this was who I would be treating with. It was obvious that she didn't care for him, nor did she like the fact that he allowed me to be in the room when he spoke to her afterwards, at the other Dr's, she wouldn't let me present in the room when they discussed my trestment, and she went to every appnt. They would wait till she was done talking to the Dr. and make my next appnt. according to her schedule.

After that initial appnt., she wouldn't let me set up an appnt. to start treating with him, she said to think it over and let her know at my next appnt at her Dr's, which was about a week away. She taked to me outside when we were walking to our cars and said to call her if I decide before then, she was saying that she didn't believe some of his diagnosis (my Pyhsical therapist had made several of the same diag. and had been sending reports about them to her Dr. since Jan, but He and her didn't want to accept them), she said that she didn't believe him when he said that if I was being treated with him months earlier, he didn't think I would have gotten this bad. I told her that I was definetly going to use him, she said again to think about it and give her a call.

I called her the next day, and told her that I was switching to him and told her my first appnt. would be May 21,07. She was not happy and told me to call the other Dr's office and cancel my appnt. for May 1,07, since I was changing, there was no reason to see him.

I now that she has caused most of the problems with the WC adjuster and me. She only went to one other appnt. at my Dr. with me, then she told me about having to go to the IME on 7/10/07, which she did go to. Then it was 7/17/07(my birthday) that the adjuster called me and tole me about the utilization review, to determine if my Dr's treatment and medications were reasonable and necesary for my injury or if he was trying to treat a pre existing injury. She hadn't been approving some of my medicines and I was paying for them. She said if I was getting results since treating with him why has he kept me on the same restrictions, instead of raising them, I told her I didn't know, but I was no where near 100% yet, maybe 50% at best. The following week I recieved the report from the IME,(which I thought was fast), and seen the medium duty restrictions.

Everyone has said the same as you about the fact that I saw the IME 1 time, and that if a judge was needed to determine which reults to use, he should go with the treating Dr. even though Wc has him going under review. I was sent notice of the review and was allowed to write a personal statement letter for the URO to read snd see what I felt about my treatment and meds., whether I felt it was reasonable and necesary. I wrote an excellant letter and told him how I have made more progress in the short time with this Dr., than the whole time before my injury.

Well I ended up writing a book here again, sorry about that. Most what I wrote are in other posts, but I know that I don't remember what has happened to each member, so thats why I tend to repeat it, to give enough info. I'm going to wait and see what happens.

Take care and be well, we all need to stick together.

Oh Vickie...I feel so bad. I can hear the frustration in your words. My first injury in '99 I had an NCM who came to every appt with me, I knew nothing and thought she was nice only to have her cut my throat a year later. This currant injury I hired an attorney before I was even denied or had seen a Dr. Within 48 hours I decided do to the extent of my injuries this time that I wasn't dealing with their crap. The IME in the first claim sent me to work NO restrictions. I complied and worked a few years befreo reinjuring. In '04 I was out with my 2nd back injury and first knee. Was out for 2 1/2 months and retuned full duty. THIS time I injured 5 body parts. The IME they sent me to 2 months after injury was on my side. I have another coming up next month and the IC has changed Dr.s. Now I wonder why. You know they need someone who will lie, conive, make up whatever. I can't even get dressed alone in the morning or drive. I know I can't work. What to do , what to do. IF the IME sends me to work with any restrictions I will probably have to try it and know I will not make it more than an hour or so. It's a game Vickie. I will always listen to my treating Dr. before anyone else. This is my 5th comp claim , same employer. I have so much damage done now that I learned my lesson. My body and mind come first. Before any amoung of $$$$, job, anything.I'm sorry I went on so much. I am having one cataract surgery tomorrow and another on the 30th. All compliments of my injuries, too many steroid injections along with diabetes in the past year. 10 injections and one medrol pack have done a real number on my body, so I'm sure all can understand my anger at this point in time. Wishing you the best.

Vick, first off your Attorney can argue the decision of the w/c IME in a Hearing, I believe the wording is Petition to Review Medical Restrictions, and if they file quick enough, mine usually files as soon as He gets any reports, you remain on TTD until the Judge rules on your case. It's going to take a Deposition of your Dr. and a Deposition of the IME Dr., and then the Judge decides who they believe to be the most credible. Even if the Judge rules against you, you can Appeal. Also, Your Employer cannot have you come back to work in Pa. until you receive a "Notice of Availability to Return to Work" specifically mapping out your restrictions. Make them follow the Law and not push you around!! And don't return to work without that return form, if you do you give up the right to argument!! This is Law, not just my opinion, and Please Protect your Rights!! Best of Luck!!Wink

If your improving then I don't see why they are fighting your treating doctor other than the fact that this NCM doesn't like your doctor because he treats you like the patient and not her. (Which means he's a keeper in the world of WC doctors!)

Also I wonder if it is known that the NCM showed up at your IME and talked with the doctor there? I think and IME is suppose to be just that independent without interference from the Insurance company at all. If she talked to the IME doctor after your exam - how much influence did she have on his decision with your restrictions? Have you tried to get copies of all writen notes of the IME yet? If so - there could be written notes from when he talked to the NCM in there - if so when you court - this could be very beneficial to your case as it clearly shows that she is interfering with your treatment and restrictions. Also request any correspondence from the insurance company, NCM (by name to the doctor) regarding you and copies of any taped notes as well. If they are close by - may mean going there and signing a release of information form again - and if they don't comply - then keep bugging them about them all - that's what I did with one doctor until I got all his hand written notes since I requested all hand written notes as well. lol

Many think just because it's an IME that they don't have to follow the hipaa laws - however they are bound by the same laws. Although they will try and say the reports and notes belong to the IC - remind them that you were the patient and until they show you that the IC was the one being examined then you are entitled to copies of your records. Most will charge a fee for them - others may not. It's up to the office itself and the amount of copying that they need to do.
Pooh....My first IME was 2 months after injuries. There was an NCM there who giggling( I wanted to smack her) went into to see the IME after I was done. I never gave this a thought until now. With my first injury back in '99 the NCM was also at that IME. I have one scheduled in Sept. What do you do IF there is one there? My attorney sends a nurse with me so he has to be aware of this and has never mentioned it to me. I'm really confused.

a nurse going with you is your right cap - but the IC is not suppose to send one if they are sending you to an IME from my understanding. Again it can be different from state to state - but IME means independent medical examination. With the nurse she will be in the room with you while the exam is done - not talk to the doctor after the exam if I am correct. (Talk to your attorney about this - but that is the way it normally works when someone goes with you.)

If there is one there - then hopefully the nurse that is going with you will know that they work for the IC and make note of it - if not - and you know they work for the IC - then the first thing you need to do is contact your attorney and let them know - or in your case let the nurse know who she is.
violent rant from my imagination Wrote:Oh man, if I where to get sent to an IME right now, and they where to tell me that I could go back to work with no restrictions, I can guarentee that I would be going to Jail! i have enough strength in my right arm to knock him down and tear his sholder violently out of socket!
I would make that IME suffer the same stuff that I have been through, and see how he handles it not long after surgery. I seriously think that the Doctors who send people to injury and worse need to be lined up and injured in some way. Broken back, torn labrum, shattered knee, whatever.
I am venting here, because this post drove me over the edge. HOW DUMB can these doctors be? They take a fat check, to basically condem a person to pain and suffering!
I hope that a reasonable judge or whoever will see that YOUR doctor is right here!
Avatar thanks to WINK!
Thank you all who replied, I'm sorry about all of the spelling mistakes, I was hurrying and didn't do a recheck.

Pooh- My company is small and doesn't have a nurses office, all we have are 2 first aid boxes. I question the WC adjuster as to why I had to go to that ICM which was so far away,(by the way the NCM made the appointment) she told me that since I'm in such a rural area that there were no others around. I asked the NCM the same question and she said that there was one closer, but since I'm in a rural area, that doctor probably knew the other doctors around the area. I also found that the WC Ins.Company and NCM have a list of doctors they use regularly.(So they can get what they want written in the report, I think). I did ask the IME before we finished, if I could be present when he spoke to the NCM, I told him that my DR. allowed it, since I'm the one being spoke about. He said that he had no problem as long as she doesn't mind. While waiting in the waiting room for him to call us in, I told the NCM that the IME said I could come in when they talk. Boy did she turn red, she said that ussually it would be between him and her, but since he said it was ok, I guess it'll be alright. (She had already supposedly gave him my records from my all of my Doctors, long before the appointment, she probably also told him that she wanted me to have higher restrictions too.) I brought my MRI and X-rays as requested. When we went in to speak to him, they acted liked old friends, he was definetly biased and for the Ins.company. He didn't say what any thoughts about my work restrictions would be, it was never brought up. He did mention that since the first EMG was don in Feb. and was positive, he suggested getting another one done to see if any changes have occured. He then made copies of some papers and gave them to the NCM, I asked if I could have a copy as well and the NCM said that they were just for her notes. We then left, I had no idea what he thought about the evaluation, my restrictions, or my injury. When the report came back so fast, even before I had the 2nd.EMG. I thought that was odd. When I saw what he wrote I was furious, and the clincher was at the end, he put in a sentence saying that after the evaluation that he spoke with me in front of the NCM and that we all were in agreement. I didn't agree to anything except to get another EMG.

Limbo-Maybe you didn't understand me, or I didn't write it clearly. I have been working on my Dr's orders of sedentary light duty, no bending,twisting or stooping, occasionally allowed to lift 10 pounds, and allowed to stand fo 30 minutes up to 3x's/day. I returned to work under the WC first doctor in the beginning of Jan, with basically the same restrictions. I did receive a Notice to return as you said then with the restrictuion clearly written on it.
This time when I received the IME report in the mail, there was another Notice to return to work, and for restrictions, it said to refer to the back of the report where the IME wrote up the restrictions. I have sent a copy of the report with post its and notes at all of the inaccuracies or actual lies marked on it, I think there was something like 18 or19.

Cap- I found out after the fact that I could have taken someone with me, to be a witness to the exam and even takes notes. I wasn't made aware of this before I went or I would have had someone go with me.Here in Pa, they can only require you to go for an IME 2 times in a 12 month period. I found a website that explained about the IME and what to be prepared for, and it says to not go alone. I can't find the name of it, but I printed out the info(about 4 pages), but I didn't have the header or footer on when I printed it, so I don't know which site I got it. I will try later or tomorrow to scan it into my computer and email it to you if it works.

Dipweed- I agree with you, on the web site that I mentioned above to Cap, it said that IME are paid normally around $1500.00 for each Evaluation for WC, more if they have to give a depo. It's no wonder they make crap up and accuse the Injured worker of exaggerating!!

Thanks again to all of you, just being able to vent helps me cope more, I'm by myself plus the dog, and all he does is sleep eat and poo. My lawyer has already filed a petition to have my TPD reinstaed, since they stop it due to missing wages for appnts. for my injury. He also is sending for all the differant doctor's records including notes, and he has contacted the bureau for all items that have been sent to them from the WC.

If anyone ever needs to vent or just to bull, feel free to email me.Take care of yourself. Please excuse any spelling since I didn't recheck this, and sorry it was so long, I wanted to try and answer all or most of your inquiries. And by the way, I have been only my doctor's restrictions and thats al I plan to do. If I get wrote up or whatever, so be it. I want to be able to play with my grandbabies next time I get to Ca. I can't do that if I get hurt worse.

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