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Termination of heart and lung benefits?
#1
I was injured in a vehicle accident in Nov of 2013. I was diagnosed with an injury to the brachial plexus (nerve). I have only treated with the approved comp doctors I was required to treat with. Both of these doctors agree with the diagnosis and have placed me on a no-work restriction due to my being a police officer. I recently saw a surgeon who stated I need surgery on the nerve. In May only 6 months after my injury I was sent for an IME. The IME doc obviously stated I'm perfectly healthy . Now I was sent a petition to terminate my benefits . Why if 3 doctors all agree would the insurance company even try to dispute this? Is this normal or des the insurance company usually won these cases? Oh by the way the IME Doc only saw me for 7 minutes and wrote a 8 pages report . Would just like to know what the process is here and if I'm going to get denied care .


State is PA
 
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#2
You need a work comp attorney who will fight for you in court.
 
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#3
Companies are real good at hiring a doctor for an IME to write a report that says nothing is wrong and you can go back to work. Start calling lawyers and find one you like to take your case.
 
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#4
Work comp laws are state specific. Can you list your state?

I agree with the above. Hire an attorney. Insurance companies try all sorts of things to try and deny a claim, including hire quack IME's to write false reports stating the patient is fine.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#5
(06-22-2014, 09:27 PM)California_Help Wrote: Work comp laws are state specific. Can you list your state?

I agree with the above. Hire an attorney. Insurance companies try all sorts of things to try and deny a claim, including hire quack IME's to write false reports stating the patient is fine.


Thanks for your response ! I'm in Pennsylvania
 
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#6
it depends on the quality of the medical evidence.
an opinion without substantial findings and reasonable conclusion is less persuasive.
the comp court rules on disputed evidence.

Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#7
In PA credibility decisions are completely up to the judge and he can accept the opinion of the defense medical examiner over the treating physicians. If a Petition to Terminate has been filed, there are many evidential and procedural issues that need to be addressed to keep your benefits coming, so I would join with the other posters in suggesting that if you do not already have a lawyer you find one quickly. PA now provides for board certification in workers' compensation. There are roughly 200 lawyers in PA with this credential. You may want to narrow your lawyer search to board certified attorneys to maximize the likelihood that you obtain counsel properly qualified to handle your case.
Timothy D. Belt
DISCLAIMER: This post is intended as general information applicable only to the state of Pennsylvania. The answer given is based only on the facts provided. This post is not intended to create an attorney client relationship, or to provide any specific guarantee of confidentiality.
 
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#8
Fraud, quack......i have many other names for them.
Why are there no consequences for an IME who creates fraudulent documents?



(06-22-2014, 09:27 PM)California_Help Wrote: Work comp laws are state specific. Can you list your state?

I agree with the above. Hire an attorney. Insurance companies try all sorts of things to try and deny a claim, including hire quack IME's to write false reports stating the patient is fine.

 
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#9
in order to charge them with fraud someone has to file a complaint.
have you?

Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#10
It is sad but there are doctors out there that only do IME's and they make good money doing it. Not sure but I always figured since they are not treating you what they write is only an opinion so no real liability
 
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