Our Workers’ Compensation Law allows and even encourages insurance carriers to hire ‘nurse case managers’ to handle and direct an injured worker’s medical care in a claim. Although many nurse case managers are generally good people, make no mistake – they are paid agents of the insurance company, making it heavily debatable whether the nurse could ever really be a ‘neutral’ party in the case. In a typical scenario, and as discussed in previous blogs, the nurse case manager will contact the claimant in one way or another, often times almost immediately after a work injury occurs, to say that she’s been asked to appear in the case in order to make sure the injured worker gets proper medical care. The problem with a statement like this is the definition of “proper” medical care. When the nurse case manager begins directing the medical care in a claim, it is fairly routine, for example, for her to shuffle the claimant away from physicians who are viewed by the insurance company as “claimant friendly”; and to start making appointments for the claimant to see doctors who are well-known in the industry to be “insurance friendly.” The hope is that by the time the injured worker figures this out, the medical evidence in the case will have already been terminally impaired past the point of no return. One protection against this is a treating physician who will tell a nurse case manager “no” when she tries to manipulate the claim; but doctors with this kind of backbone are few and far between. It’s exponentially more helpful for the claimant to be able to rely upon an experienced workers’ compensation attorney who will aggressively tell the nurse “no,” if necessary, which is exactly what Hart Law does.
Have a question about your nurse case manager? Give us a call, anytime.
Neal L. Hart, Attorney at Law
Unfortunately, under our Workers’ Compensation Law, the insurance company in a workers’ compensation case has an almost unlimited right to direct a claimant’s medical care, throughout the claim. The insurance carrier often uses this advantage, rather immediately, to attempt to impair or terminally damage an injured worker’s case; instead of just trying to restore him or her to a state of good health. It would be a common scenario, for example, for a recently injured claimant to first be sent to a ‘company’ doctor, well known to the employer, and who has treated many injured employees of that particular company in the past. In some instances, the company doctor may have certain instructions from the insurance company and/or employer, such as that an MRI or other diagnostic tests are not to be ordered unless they are imminently necessary. The insurance carrier may also hire a nurse case manager (which will be discussed in more detail in Volume 3 of this series) to further pressure the treating doctor to save costs in the claim, at the claimant’s expense.
If the company physician feels that the injured worker needs a referral to a specialist, it is very common for an insurance company to once again intervene in the medical decision making process and shift the claimant’s medical care to some other insurance doctor. If the insurance carrier doesn’t like what the specialist has to say, it sometimes sends the claimant for an allegedly “independent” medical examination, typically conducted by – yes, you guessed it – yet another insurance doctor. By the time the claim gets to this point, the ‘evidence’ generated by the insurance carrier many times so overwhelmingly disfavors the injured worker that the case can never be successfully revived, even by the most skilled of workers’ compensation attorneys. Oh, but it doesn’t stop there. Insurance companies have been known to continue paying nurse case managers, for example, to try to collect additional medical evidence, favorable to them, even when a claimant has finished treating and the case is in active litigation.
If some of all of the above sounds familiar, we’d be glad to visit with you, anytime, about how we may be able to repair your case, before it’s too late.
Neal L. Hart, Attorney at Law
Independent medical examinations (IMEs) are very common in Arkansas workers’ compensation claims. The way it typically works is that the insurance company or one of its agents contacts the injured employee, in the middle of a claim, and says: “We’re going to set you up for a second opinion.” Most claimants don’t know a whole lot about workers’ compensation law and just want to get physically better, so they usually think seeing another doctor for free is a great idea. But is it? Insurance carriers are typically very interested in two things: 1. Getting a case closed. 2. Saving as much cash as possible while doing so. In order to better facilitate this, insurance companies often reuse the same physicians they’ve retained (and paid a bunch of money to) for IMEs in past cases; hoping that the IME doctor will once again arrive at a medical conclusion that will somehow impair an injured workers’ claim.
Under Arkansas law, an IME must be, among other things, reasonable, necessary, convenient for the claimant, and actually ‘independent.’ If a proposed IME doctor is generally well known in workers’ compensation system circles as an ‘insurance’ doctor, it would be difficult to contemplate that an IME conducted by that particular physician either would or ever could actually be ‘independent’ in nature. Unfortunately, many lawyers just go ahead and allow their clients to attend an IME scheduled by an insurance company, without putting much thought into either the IME itself or the potential damage it could ultimately do to the case. Legally resisting an independent medical examination that isn’t actually ‘independent’ could mean the difference between developing a solid case for a client, while he or she remains in a state of improving physical and mental health; and having a denied claim with medical evidence too damaging to possibly ever overcome.
Have questions about an IME? Give us a call or send us an e-mail. We’re always here to help.
Neal L. Hart, Attorney at Law
Under Arkansas Law, the insurance company in a workers’ compensation claim has the right to direct an injured employee’s initial medical care. Often times, this means that an injured worker will be sent to a “company doctor” who is familiar to both the insurance carrier and employer. If the injured worker needs a referral to a specialist, the insurance company might tell the company doctor where to send a claimant for further evaluation. Under this scenario, it may not take very long at all for a work injury claim to become so overloaded with insurance-friendly physicians that it completely sinks the entire case, before the claimant even knows what happened.
Thankfully, our Workers’ Compensation Act allows an injured worker to ask for a one-time change of physician, to a doctor he or she wants to see, at basically any point during the claim. The problem is that the insurance company may only have to pay for one office visit to the new doctor, unless the new physician provides the parties with some pretty compelling medical opinions to advance the evidence in the claim. Because of this, knowing exactly when and how to use a physician change may be extremely important to the outcome of the claim. If, for example, an uninformed claimant asks for a physician change at an unwise juncture in the case, to a doctor who thinks most folks alleging work injuries are scam artists, the physician change may have just been completely wasted, or worse.
Have questions about a physician change? Give us a call. We’re always here to help.
Neal L. Hart, Attorney at Law
AWCC Bacis Facts including Change of Physician
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