workers comp claim

Independent Medical Examination

independent medical examYou have a right to an independent medical examination (IME). You may request an IME if you feel you were returned to work too soon and/or if you feel you would benefit from additional medical treatment.

To make this request, you will need to mark the Report of Claim Status/Request for Independent Medical Examination (Form 38911) accordingly. This form will be mailed to you from the insurance carrier at the time your TTD benefits are terminated. This may coincide with the time that you are also released by the doctor at maximum medical improvement. Please note that you only have seven days from the date of receipt to return this completed form to the Workers’ Compensation Board of Indiana.

The Board will review your request, consider your medical treatment and prognosis, and then likely schedule you for an IME with a doctor they have chosen. If they schedule you for an independent medical examination, the doctor they send you to will only evaluate whether or not you need additional medical treatment and whether or not you should be working given your condition.

This doctor will not do the following:

  • Prescribe you medication
  • Discuss future medical needs
  • Give you a permanent partial impairment rating

Below is a list of items you need to take to the independent medical examination:

  • Original X-Rays, MRIs, CT Scans or any other radiology film
  • Any medical records for related treatment with your personal doctor(s)

Of note, if a nurse case manager or rehabilitation nurse has been assigned to your case, he or she is not permitted to attend the independent medical examination scheduled by the Board.

The outcome of this evaluation will carry a lot of weight in the direction of your case. In other words, if the IME doctor decides that you can return to work and you need no further treatment, it will be difficult for you to prove otherwise since this is a doctor that was personally selected by the Board. Likewise, if the IME doctor indicates you need more treatment and/or that you should remain off work, the Board will likely stand behind their doctor and order that your workers’ compensation benefits will be reinstated.

Q: Who pays for the Board ordered medical evaluation?

A: Your employer or their workers’ compensation insurance carrier.

Q: I have not received a form that lets me get an independent medical examination, but I have been released from the workers’ compensation doctor. What do I do?

A: You can contact the workers’ compensation insurance carrier and ask about it. If you find out that you are not eligible for an independent medical examination through the Board, then you can seek one of your own at your own expense and try to use your doctor’s report as leverage to get your benefits reinstated. Obviously this would only happen if the doctor’s report is favorable to you. If you do seek an IME, make sure you select a doctor with an excellent reputation or the Board may discount your doctor’s opinion.

Case Study: Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a chronic pain condition most often affecting one of the limbs (arms, legs, hands, or feet), usually after an injury or trauma to that limb. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. The central nervous system is composed of the brain and spinal cord, and the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body. CRPS is characterized by prolonged or excessive pain and mild or dramatic changes in skin color, temperature, and/or swelling in the affected area.

hands-crpsCRPS can be a controversial topic due to disagreements between medical professionals. Doctors aren’t sure what causes some individuals to develop CRPS while others with similar trauma do not. In more than 90% of cases, the condition is triggered by a clear history of trauma or injury. The most common triggers are fractures, sprains/strains, soft tissue injury (such as burns, cuts, or bruises), limb immobilization (such as being in a cast), or surgical or medical procedures (such as needlestick). CRPS represents an abnormal response that magnifies the effects of the injury.

Our office recently helped a worker afflicted with CRPS when the insurance company’s physician disputed the diagnosis. We arranged for another medical opinion with a well-respected physiatry (rehabilitation) physician who testified that the worker indeed suffered from CRPS.

Diagnosis is based on the affected individual’s medical history and signs and symptoms that match the definition. But because several other conditions can cause similar symptoms, careful examination is important. Since most people improve gradually over time, diagnosis may be more difficult later in the course of the disorder.

With a dispute between physicians, our office successfully persuaded the Judge to order an independent medical exam with a physician selected by the Judge. That third physician agreed with the CRPS diagnosis and our client received specialized treatment including a series of Ketamine infusions. Ultimately, our client improved dramatically and has returned to work.

Are you or someone you know suffering from Complex Regional Pain Syndrome? Call our office at 317.569.9644 or email rklezmer@klezmermaudlin.com to talk to one of our experienced attorneys to see how we can help.

When a Work Injury Claim is Denied

Sthethoscope and medical documentsSometimes a work injury claim is denied by the worker’s compensation insurance carrier. The Indiana law indicates that no compensation is allowed for an injury or death due to an employee:

  • Knowingly self-inflicting the injury or death;
  • Being intoxicated at the time of accident which is proximate cause of the injury;
  • Committing an offense which led to the injury;
  • Knowingly failing to use safety equipment or apparatus;
  • Knowingly failing to obey a reasonably written or printed rule of the employer which was posted in an obvious place;
  • Knowingly failing to perform an official duty of the job which directly led to the injury.

However, it is the employer’s responsibility to prove that such behavior on the part of the employee resulted in his or her work injury. If the employer is able to prove such, then the injured worker is barred from any compensation for his or her work injury.

In other cases, an injured worker’s claim may be denied for reasons that are not so clear. Regardless of the circumstances, all injured workers should receive written notification from the employer if their claim is being denied approximately thirty (30) days after the employer is first made aware of the work accident and injury(s).

Filing a Claim With the Worker’s Compensation Board of Indiana

If a claim is denied, the employer or the worker’s compensation insurance carrier must let the employee as well as the Board know through a written form called a Report of Claim Status/Request for Independent Medical Examination (Form 38911) within thirty (30) days of the employer’s knowledge of the accident.

Thereafter, the injured worker has the right to file a claim on his or her own with the Board, but this must be done within two (2) years from the date of the work accident.

To file a claim, the injured worker must complete and send to the Board an Application for Adjustment of Claim (Form 29109). The injured worker may also want to contact an Ombudsman at the Board for further information about this application.

Medical Treatment

Medical treatment will be on your own if worker’s compensation denies your work injury claim. Your options are to:

  1. Pay out of your own pocket, OR
  2. File with private health insurance.

Keep accurate records of the expenses your accumulate for treatment related to your work injury because this information will be needed if you contest the denial of your claim. If you do contest the fact that your claim was denied by your employer’s insurance carrier, and you file an Application for Adjustment of Claim with the Board, then medical providers who have provided treatment for your work injury cannot try to collect payment from you until it is determined who – either you or your employer’s insurance carrier – is responsible to pay.

In order for medical providers to be considered for payment when the Board determines who is responsible to pay for your medical treatment, the provider should file an Application for Adjustment of Claim for Provider Fee (Form 18487) with the Board.

This rule only applies to those who treat you for the work injury. So, if your credit card company is coming after you for not making the required payments, even if the reason you cannot make these payments is because you are not working now as a result of your work accident, you will not be protected by your worker’s compensation case. Similarly, if you have a collector calling you about a dental bill that is unrelated to your work accident, there is nothing you can do about it through your worker’s compensation case.

Have a question about a denied worker’s compensation claim? Call us at 317.569.9644 for a free consultation to see how we can help.

Giving a Recorded Statement

It is not unusual for an insurance adjuster to ask the injured worker, or a witness, for permission to take a recorded statement. A request to take such a statement does not mean the claim will or will not be accepted. Likewise, you do not have to agree to give a recorded statement in order to receive worker’s compensation benefits.

The statement will likely be taken before any decision is made with regard to the injury claim. It is done as part of the insurance carrier’s investigation into the incident.

If you do give a statement, the questions that will be asked may include questions about your job, how the accident occurred, if you had prior medical problems and so forth. Here are some suggestions to follow if you are giving a recorded statement:

  1. Be honest and truthful. This statement may be used against you later on (if you are dishonest).
  2. Do not guess. If you do not know the answer, say that you do not know or do not recall. Otherwise, you will be held to your answer.
  3. You only have to answer the question. You do not have to give more information than asked for.

Before giving a recorded statement, it is wise to have an outline ready with the facts of your claim. Go over the details of the accident and the events that led up to it. You can also note the effects it’s had on your life and the treatment you’ve received up to this point. This will keep you on track during the statement. Remember to stick to the facts, do not stray.

If you’d like the advice and guidance of an attorney before giving a recorded statement, contact the attorneys at Klezmer Maudlin at 317.569.9644.

New Guidelines for Nurse Case Managers in Indiana

A Nurse Case Manager is a Registered Nurse who is hired by the insurance company to oversee your medical treatment. A good Nurse Case Manager can be very helpful to your recovery, but a poor Nurse Case Manager can interfere with your medical treatment.

The Indiana Workers’ Compensation Board has issued new guidelines for Nurse Case Managers.

The Indiana Worker’s Compensation Board has issued guidelines for the use of Nurse Case Managers (“NCM”) in the administration of compensation claims.  A NCM may be involved in a claim to schedule appointments, help facilitate care suggested by the medical provider, and to report back to the employer and/or carrier.  However, a NCM should not express opinions, to either the injured worker or the medical provider, regarding an injured worker’s course of medical care or otherwise attempt to influence the process.  Additionally, a claims adjuster should not attempt to direct the care provided to an injured worker by the authorized treating doctor.

If you feel a Nurse Case Manager is interfering with your medical treatment in a workers’ compensation case, please call us at 317.569.9644 to discuss your case.

How Do Workers’ Comp Attorneys Charge?

Hiring an attorney for your workers’ comp claim can be looked at as an investment to make sure you receive the maximum benefits that you are eligible for. Although it is your right to either represent yourself in a workers’ compensation dispute or hire an attorney, keep in mind that our workers’ comp attorneys are highly experienced regarding the laws and system here in Indiana. But many people are hesitant because they don’t know how workers’ comp attorneys charge.

Our workers’ compensation attorneys do not ask for money up front and get paid only if there is a recovery.

Our attorney fee is set by State law and is set at 20% of any recovery up to $50,000 and 15% of any portion over $50,000. If we have any expenses, such as hiring a medical expert or collecting copies of your medical records, we deduct these expenses from the recovery.

If there is no money recovered, there is no attorney fee owed.

When deciding whether or not you want to involve an attorney, keep in mind that Indiana workers’ compensation laws are written in a way which tends to favor the employer as opposed to the injured employee. A free legal consultation with an experienced attorney may help you better determine if legal representation is needed for your situation.

Our office, from speaking to injured workers, knows that workers are oftentimes intimidated by the prospect of contacting an attorney and/or hiring an attorney. Hopefully, this information will ease that transition.

You May Be Entitled to Workers’ Comp Benefits

If you are injured on the job in Indiana, you may be entitled to Indiana workers’ compensation benefits. Under our law in Indiana, these benefits pay you, generally, three items:

  1. 100% of your medical expenses without any payment by you,
  2. Lost wages at a rate of 66 2/3% of your average pay if you are unable to work for more than 7 days, and
  3. If your injury is considered permanent or long term, you will be entitled to a settlement.

If you were hurt at work, you may also have the right to pursue a claim for additional damages. This will be the case if your accident was due to the fault or negligence of another party. These cases are referred to as third party claims or personal injury actions. If you were injured on a job site, for example, and your injuries were due to the fault of an employee of another company, you could file a lawsuit against that company and collect additional damages that workers’ compensation does not pay.

A typical example of this type of case would be a construction worker who works for a sub-contractor and is injured either due to the fault of another sub-contractor’s employee or because various safety rules were not enforced by the general contractor and the failure to enforce the safety rule(s) caused your injury.

If you have such a claim, please consider one of the attorneys at Klezmer Maudlin at 317.569.9644.