You’re on the job, lifting a heavy box from one place to another. Another employee, completely against company protocol, darts across your path, forcing you to twist out of the way – and tweaking your back badly in the process.
You can’t move, you can’t stand straight, and you’re in horrible pain.
Seems like a pretty cut-and-dried case where you should receive workers’ compensation, so you see the independent medical examiner required by your company’s insurance to get diagnosed.
A week or so later, you find out that your claim is being denied. The independent medical examiner found that there is nothing wrong with your back – even though you still can’t move – and has told the insurance company that there are no grounds for your claim.
Insurance Companies Don’t Leave Much to Chance
It’s in the insurance company’s best interest to not have to pay workers’ compensation claims whenever possible. If they were able to identify all the many, many places where they’re being billed fraudulently, the company would have plenty of resources to compensate every legitimate claim.
Instead of identifying real fraud, however, many insurance companies take the easier route: they get the independent medical examiner on their payroll.
Insurance companies are often in charge of who the independent medical examiner for your case is, and they will only recommend doctors whom they think will be, at best, conservative with their diagnoses. At worst, they know exactly what the doctor will say, because they pay him to say it.
In some cases, it’s an out-and-out bribe; in others, it’s simply an informal agreement that the insurance company will keep sending the doctor as many patients as he can handle, in exchange for his cooperation diagnosing in a way that’s most favorable to the insurance company.
Either way, the doctor is heavily influenced not to diagnose you to the best of his ability; he’s being influenced to diagnose you in a way that most benefits the insurance company.
How to Avoid Being a Victim
In many cases receiving ongoing lost wage benefits requires the injured worker to attend an IME. If you refuse to attend, you could lose your workers’ compensation rights. However, there is nothing to stop you seeing your own doctor in your own time, and if his diagnosis differs wildly from the independent medical examination, it may be time to step up your efforts to get the compensation you’re due.
If you believe your independent medical examination is bogus, it’s time to get a workers’ compensation lawyer involved.
It’s possible to get the independent medical examination overturned with the help of a good lawyer, and if it can be proven the examiner is being influenced by the insurance company to misdiagnose legitimate injuries, your case could do an enormous amount of good not just for yourself, but for other workers who find themselves in a similar situation with the same company.
When insurance companies try to stack the deck in their favor, it seriously damages the ability of companies to provide workers’ comp at all, and – more immediately – prevents employees from getting the compensation they’re due for serious injuries. Don’t let it happen to you.