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Poll: Who here has been screwed over by the Worker's Comp insurance company?
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Independent Medical Exams - Beware!
#1
Hey Everyone,
I've been through this whole process of being denied and going through the appeal process in the State of Maine and wanted to give some people some advice that hopefully would help them learn from where I made mistakes. I hurt myself at work and had to have surgery on my back, the employer was self insured essentially with an insurance carrier used as a administrator of the process. I've heard this is quite the racket but, don't really know the whole story so I won't go any further about that. I was denied anyways the day I got offered to have a surgery performed to help me. After the surgery I started to get better but, got severe back pain that pretty much has limited everything I do. Luckily in this process I had a great doctor that backed me up and wasn't afraid to say it was work related even when the insurance company hassled him. So I have to say if anything MAKE ABSOLUTELY CERTAIN that you pick the right doctor up front to see, this can make or break it faster than anything.

Anyways back to the IME's. I went into this whole injured process thinking that as long as I did what was right that I would be taken care of since I had managed stores for the company for a while, I'd love to say the name but, I'm sure that's not allowed. That right there is one of the biggest mistakes. Insurance carriers and the employer will screw you over faster than you know what to do and the damage they do can never be taken back. Think about it, the insurance carriers do this every day. Me and you have no idea what we're doing. The first thing you want to do is call a lawyer and don't settle on the first you find, ask around. A few of the smallest ones up here in Maine are some of the best, don't be fooled by Ads and Commercials. Anytime you are asked or have to do something for the insurance company, always find out information about it by calling your lawyer, around to lawyers, and researching online. Don't believe everything you read on line, the laws vary from state to state and even when I found information it wasn't always right but, at least get an idea from it of what you need to know. The denials and use of IME's is one of the biggest scams I've ever seen. When you receive a letter saying that you need to go to a IME or Functional Evaluation, be worried. You need to be! They use these for the reasons to deny and give information to the Hearing Officer's in cases to prove their claims. My IME lasted about ten minutes where the doctor requested me to fill out information about my past medical history including any injuries I've had to my back, the area that I injured. The insurance company ONLY gives these guys what they need for information to write their report saying everything is fine with you and/or that past medical history is really to blame. So don't be surprised when they have no clue that another doctor has already stated its obviously work related or an MRI shows the problem clear as day. They don't care, they don't make money off giving insurance companies information they don't want to see in the reports. They make money from repeat business and that you need to understand from the moment you step in until you step out. Don't give them anything to use against you, be careful about what information you do give, and don't lie on any questionnaires you fill out. They can use this information as well to say that your not truthful. In my situation I had about 3 inches of medical reports that the guy had to review, not at the appointment but, in general. He asked me about a few things and wrote a report with almost nothing that I had talked to him about besides when I slipped up and didn't reveal enough information about past medical history. Honestly in your best interest don't tell them anything about any past injuries that aren't documented. They are looking for this to say that it really was a different past injury that caused everything and not the one that caused you to have surgery. These guys will try to act nice to you to get information out of you to include in the report, don't be rude but, don't give them anything either. These guys are scumbags. Seriously. Scumbags. After I left the office, and the guy stated that there was no question the amount of pain I was in. He gave his report to the insurance carrier about a week later stating that I didn't have any pain behaviors. Luckily I taped the whole visit including the part where he said at two different points about how obvious I was in pain and no question about it, etc. The report also included that the real reason that I am disabled is because, of pulling a muscle which was something I had told my doctor about during a routine visit. Another thing to note, don't tell any medical people about anything they don't need to know. This may seem drastic but, believe me its not. The report that was giving to the insurance company from the IME was included in the denial letter to the state as evidence that they really weren't to blame and just an innocent victim. We all know the truth. Scumbags. Luckily I had already signed a lawyer, had a good doctor, and had enough money to just make it by for over another year while going through the meditations and hearings. Now I'm at the end, waiting for the decision of the hearing officer. Should be any day now. And guess what, the insurance company now wants to start offering settlements. F**k off is what I said.

You need to be prepared and have the mind set that this isn't something short term, it takes a while. Don't be nice and giving because, it will be used against you the whole step of the way guaranteed. and last but, not least do not believe one single word from someone on here that says to be honest and work with the insurance company. They obviously work for the insurance companies because, anyone that has been through the process can tell you those are the last two things you want to do. I hope you all good luck, message me if you have any questions I can help with. I'll do anything now to hurt insurance companies especially after what they put me through.

Take care.
 
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#2
I don't think your experience can be applied universally to all carriers, employers, or state systems any more then a single adjuster should treat all workers, injureds, or patients the same just because of a bad experience of abuse with one claim.
each situation and circumstance is different.
some workers have great attys; others are looking to switch. some have terrible doctors others are searching for better ones. In my opinion it's more helpful if we try to respond to each poster's unique situation.
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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#3
I believe you shared some good points, but not all pertain to each of us nor who will see this.. While it's a shame many have been treated unfairly, denied medical treatments etc, the system still needs checks and balances to weed out the fakers.. As far as giving out to much personal information about ones past or previous injuries that are not recorded........... You are very correct, keep focus on your wc related injurie/s .
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#4
I also worked for a company who were "self insured" while I had problems with the insurance part,I still believe I worked for a company that is needed and run well and in fact still donate to the Salvation Army 90% of every dollar goes back to those in disaster situations with only 10% going into overhead unlike some charities that have 50% or more going to overhead.And to be honest I was in and out of my claim in 2 years from start to finish.So while I hate the rules and restrictions of picking and not having my "own" Dr I had a great lawyer that made my case go alot smoother than some.
........I love cats, I just cant eat a whole one by myself......







 
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