Tara Reck, Managing L&I Attorney at Reck Law PLLC - Workers' Compensation Attorneys

Category: IME (Page 2 of 4)

6 Steps You Must Follow to Prepare for an IME exam

Work injury claimants call my office all the time asking for advice about IME exams. Many of them heard bad things about IME tests. They don’t know what to expect. Others ask how to prepare for the IME and what to do. The best advice I can give is to plan and be ready. To help, below are 6 steps that every work injury claimant must follow.

 

How L&I claims work

After an injury at work, you open a claim with L&I or your self-insured employer. From there, you get medical or mental treatment as appropriate. The Department of Labor and Industries (L&I) should cover your medical care. They also pay wage replacement benefits such as time-loss compensation. The attending provider is your go-to person for treatment under the claim. Your attending provider oversees your condition and refers you out as necessary.

 

One of the main turning points in every workers’ compensation claim is the IME. In fact, IME exams can cause L&I to stop paying benefits. It can also result in denying medical coverage. But first, let’s try to understand why L&I needs IME exams.

 

Why must I go to an IME?

L&I makes many decisions during your claim. It’s part of the claim administration process. For example, L&I decides to allow some conditions under the claim. They can also reject certain conditions. Similarly, your employer can push back and request to deny conditions. Furthermore, the employer can protest some monetary benefits.

 

Your claim manager or claim administrator is not a medical expert. They just follow process. Hence, whenever L&I needs input about your medical or mental condition, they can request an IME. According to L&I, the IME provides “objective medical-legal examination to establish medical findings, opinions, and conclusions”. After the exam, L&I receives the IME report. After that, they can make decisions in your claim to move it forward.

 

 

IME exams can be intimidating

Not surprisingly, work injury claimants are often nervous when they have an upcoming IME. Sometimes, I even get calls asking if a workers compensation attorney can get people out of having to go. The short answer is No. That’s unless there are special considerations or circumstances. Moreover, if you fail to attend an IME, then L&I can flag you as non-cooperative. In turn, L&I can penalize you for non-cooperative behavior. They can even suspend your benefits.

 

How to prepare for IME exam

Here are 6 steps that every worker must follow before and after an IME exam.

#1 – Take an observer

You can bring an observer with you to the exam, except for mental health exams. For example, a family member or a friend can be an observer. The observer cannot disrupt the IME provider. However, the observer can watch the exam and take notes. The observer can also serve as a witness in case you need one later.

#2 – Go over the general timeline of your claim before the exam

IME doctors often comment about whether the worker is a “good historian”. In my experience, IME doctors that state that the injured worker is a “poor historian” are less favorable. You don’t need to know every little detail. You just need to explain what happened in your claim and when.

#3 – Practice describing your symptoms

It’s going to make it easier for everyone if you can communicate with the IME clearly. It’s important for you to accurately describe your symptoms without being overly dramatic. Practice telling the IME about your symptoms. In fact, you can practice with friends and family before the IME exam.

#4 – Listen to your body and give accurate feedback

The IME doctor will perform tests and maneuvers that require your response. It’s very important to listen to your body. This way, you can give honest and accurate feedback. If a test or maneuver doesn’t, it’s alright to say it does not hurt. Similarly, if a test or maneuver produces symptoms, it’s important to describe them accurately.

#5 – Pay attention

Pay attention to the circumstances of your examination and take notes. Write down things like what time the examination begins and when it ends. Take notes of whether the examiners review medical records. Also write down how many examiners are present. Track and record if they use measurement devices or medical tools.

#6 – Plan to review the IME report with your attending provider

In most cases, L&I sends the IME report to your attending provider. However, attending providers don’t always receive it. If they didn’t – you must make sure they get the report. Your attending provider must review the IME report. It’s very important to see how your provider reacts to the report. Therefore, you must schedule an appointment with your attending provider a few weeks after the IME. This appointment will give you a chance to discuss the report. It’ll also give your attending provider an opportunity to respond to L&I.

The L&I Double Standard: Workplace Safety vs Medical Coverage

I regularly applaud and give praise to the Department of Labor and Industries (L&I) when praise is due. In particular, I’m always impressed with L&I’s workplace health and safety programs. L&I dedicates tremendous resources to studying and improving safety for workers. Moreover, the L&I website contains helpful information for employers and workers alike. On top, people can sign up to health and safety newsletters. These email-newsletters comprise valuable and important information.

 

A recent L&I safety publication

Recently, L&I sent a newsletter with the subject “Be Kind to Your Neck and Shoulders”. It caught the attention of workers’ compensation attorneys like me who represent work injury claimants. The reason it caught our attention is because it lists causes of neck and shoulder injuries. However, the newsletter’s safety topics are ones that L&I often ignores when it comes to medical coverage.

 

L&I’s own guideline not covered by workers’ comp insurance

According to the publication “working with your hands overhead can cause neck and shoulder problems. Disposition can reduce blood flow to your neck and shoulders causing you to tire out quickly. Problems can begin after 30 minutes of overhead work per day”. I concur.

 

Now, say that workers perform overhead lifting only 30 minutes out of an 8 hour workday. That’s less than 7% of the day. Yet, according to L&I definitions, an activity that’s done for 1-10% of the day is a “seldom” activity. In my experience, when a person suffers a work injury from seldom activities, there’s higher likelihood for questioning causation. In fact, chances for doubting causation increase when L&I asks IME doctors to weigh in on causation.

 

Industrial insurance coverage in the L&I claim settings

I’m a workers’ compensation attorney representing work injury claimants. The L&I double-standard in this example is extremely frustrating to me. It appears that L&I acknowledges that 30 minutes of daily overhead reaching can result in shoulder injury. However, as it turns out, it only applies to safety procedures. It doesn’t apply to actual L&I claim coverage. I don’t think it’s fair. It would only be fair if L&I applies the same standard when evaluating causation for industrial insurance coverage.

L&I Claims and Causal Relationship Challenges: Diagnoses That Come “Later”

If you have a work injury or work-related illness in Washington State, then you can file an L&I claim. Your L&I claim should cover all conditions that arise from the work injury or disease. We refer to these conditions as “causally related”. However, in some cases, it can be challenging to determine which conditions are causally related.

 

Work injury medical condition: Causation and aggravation

Under the law, a condition relates to the workplace injury if: (1) The work injury caused or aggravated the condition; or (2) The cause or aggravation was a result of medical treatment for the workplace injury. Clearly, when a diagnosis comes late, it can be difficult to establish the causal connection.

 

There are many cases where conditions arise in later stages of a workers’ compensation claim. Often, these conditions come up late due to valid and logical reasons. Common reasons include overlooking a diagnosis, or failure to obtain necessary diagnostic studies early. Another reason can be a minor injury at first, which progresses into a severe one later. Moreover, there are other reasons such as new medical conditions that develop during (or as a result of) treatment. Either way, it’s important to ensure that the Department of Labor and Industries (L&I) covers these conditions. Therefore, it’s imperative to show causal relation to the workplace injury under your L&I claim.

 

Missing diagnosis in a workplace injury

It’s very common for initial work injury or workplace disease diagnoses to be simple soft tissue issues. For example, sprains or strains. These diagnoses should heal quickly within weeks or months. However, when symptoms persist, it may be necessary to take a second look. For whatever reason, more significant diagnoses may not surface up for months or even years. When doctors make the “new” diagnosis so much later, it can raise serious questions about causation. Moreover, it can be particularly challenging if treatment wasn’t consistent, or if it continued over time. This is one reason I always stress the importance of having an attentive attending provider on your L&I claim. In my experience, if your L&I claim medical provider is attentive, then you have lower likelihood for missing diagnoses.

 

Failure to obtain necessary diagnostic studies

Another common reason for “new” diagnosis that comes in late is when doctors do not request diagnostic studies early. Many work injury claimants I represent experience the frustration of authorization denials for diagnostic studies. For example, when requesting an MRI. In the most egregious cases, I’ve seen IMEs opine there is no diagnosis because there are no “objective” findings for it. However, there are no objective findings because the attending provider’s request for an MRI is denied. Sometimes, it requires litigation to finally get the MRI. Then, when we finally get the MRI, it objectively documents a more severe diagnosis. Here, these may include disc herniation, muscle, tendon or ligament tear. In some cases, it can reveal a fracture or nerve impingement.

 

Progression of the initial work injury

Occasionally, a diagnosis may not occur until later in your L&I claim because it doesn’t progress until later. For instance, a person may experience a muscle, tendon, or ligament strain as a result of a specific injury at work or work activity. Over time, the damage may progress and become worse. For example, a shoulder stain may become a partial or full thickness tear. The same goes for knee strains that can become meniscus tears. Alternatively, back injuries that turn into full disc herniation. Here, the question we ask if whether a more severe condition developed out of the original work injury? If the answer is “no”, then the more severe injury is not causally related.

 

New injury during treatment

In Washington State, under the law, injuries that occur during treatment also fall under your workers’ compensation claim. Unfortunately, these kinds of injuries are more common than you’d expect. No one ever intends for them to happen. However, additional injuries can occur during massage therapy or physical therapy. Furthermore, they can even happen as a side effect of an authorized treatment such as surgery.

 

In my experience, the most critical thing is to ensure there’s a medical report. The report should document the injury – when and how it happened. Workers’ compensation is not about fault. Therefore, it doesn’t matter how the new injury occurred. However, we still need to establish causation. Hence, it’s important to document the fact that the injury happened during treatment.

 

Final remarks and conclusion

Causal relationship of medical conditions is always an important issue in a workers’ compensation claim. Often, challenges can arise, especially when diagnoses come later. Yet, regardless of the reason for the late diagnosis, it’s important to establish the connection. Explicitly, the chain of connections between the “new” diagnosis and the original workplace injury or occupational disease.

 

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