Insurance carriers are highly experienced in reducing workers’ compensation injuries, so they can either deny a claim or pay less. One of the tools they can use to discredit claimants is medical providers who can give biased opinions to minimize injuries.
These physicians are known as ‘independent medical examiners’, and they categorically deny giving false statements or information. Some adjust their statements to sound like medical opinions, which an insurance adjuster can use to discredit a claim irrespective of injury severity.
Some of the reasons why your doctor may lie when you visit them for your workers’ comp claim include the following:
One of the biggest reasons workers’ comp doctors lie is because they are loyal to their employers. Many are conformists when evaluating workplace injuries because the insurance company hires them. Their job is to give a diagnosis that can reduce the benefits and wage payouts that injured workers are eligible for.
The thing is that the insurance company can demand an independent medical exam (IME) even though they are the ones who hire the doctors who conduct them. The exam results can be used to dispute a claim or deny it altogether. In some cases, insurance carriers can also alter the payout you are eligible for. Claimants have to undergo IMEs or risk their case being dismissed, so they have no choice but to give in.
Many workers’ comp doctors are paid exceptionally well by the insurance companies they serve, an incentive they take seriously by reducing claims. Many of them don’t have proper licenses in surgery or any medical specialty. Rather than ordering expensive tests and scans such as CAT and MRI scans that the insurance company doesn’t want to pay for, they prescribe medication instead.
The fee for workers’ comp is based on the volume of patients these doctors attend rather than time billed and work quality per case. It is one of the main reasons they may not give you a detailed evaluation or medical exam. If you believe your physician is not being as attentive and thorough as you deserve, take extensive notes during consultations and tests. A Waukegan workers’ compensation attorney can use those notes as evidence to ensure you get the maximum compensation you need.
Important note: Don’t try to beat them at their own game by exaggerating your symptoms. If a workers’ comp policy covers your injuries, they should make sense to the doctor. Exaggerate them, and they may deny your claim by questioning its veracity.
A workers’ comp doctor is a healthcare provider who treats injuries or illnesses related to a workplace accident or condition. These doctors are usually chosen from a list provided by the employer or the workers’ compensation insurance company.
In some states, you may have the right to choose your own doctor, but in others, you might be required to see a doctor from a list provided by your employer or the insurance company. It’s important to check the specific rules in your state.
If you disagree with the doctor’s diagnosis or treatment plan, you can request a second opinion or ask to see a different doctor. It’s important to communicate your concerns with your employer or the insurance company.
In some cases, you may be able to continue seeing your regular doctor for treatment related to your work injury. However, this depends on the rules in your state and the policies of your employer or insurance company.
An IME is an examination by a doctor who is not your regular treating physician, requested by the insurance company to get an independent opinion on your condition, treatment, and work restrictions.
Yes, you are usually required to attend an IME if it is scheduled by the insurance company. Failure to attend can result in a penalty or suspension of your benefits.
Yes, you may be reimbursed for expenses such as lost wages, transportation costs, and other out-of-pocket expenses related to attending the IME.
If you have a scheduling conflict or cannot attend the IME, you should contact your claims examiner immediately to reschedule or discuss alternatives.
You may be able to change your workers’ comp doctor, but you will likely need to follow specific procedures and obtain approval from your employer or the insurance company.
If the insurance company denied your workers’ comp claim because your doctor lied about your diagnosis and condition, you have the right to sue. Contact our Lake County workers’ compensation lawyers at The Law Offices of Robert T. Edens and ensure you get the compensation you deserve. We have more than 20 years of experience representing clients like you and taking insurance companies to task for their negligence and greed. Get in touch with us for a consultation today!
(Updated 10/30/2024)
The Law Offices of Robert T. Edens, Personal Injury and Workers' Compensation Law Office, have offices in Antioch, Waukegan, Grayslake, Woodstock and Barrington. We represent clients throughout the communities of Antioch, Waukegan, Grayslake, Barrington, Woodstock, Buffalo Grove, Deer Park, Gurnee, Lake Zurich, Round Lake, McHenry, Cary, Crystal Lake, Libertyville, Lincolnshire, Mundelein, Vernon Hills, Wheeling, North Chicago, Zion, Inverness, Palatine, Wauconda, Island Lake, Fox Lake, Barrington Hills, Spring Grove, Lake Bluff, Lakemoor, Long Grove, Lake Villa, Kildeer, Wadsworth, Indian Creek, Fox River Grove, Lindenhurst and other cities within Lake and McHenry Counties Illinois.
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