Situations can arise in your workers’ compensation case where it becomes entirely necessary to obtain a completely independent opinion on how to proceed. The most common situation arises regarding your medical treatment. Sometimes your attending doctor and your employer’s doctor simply do not agree on the extent of your injury or on the recommended course of continued medical treatment needed to restore you to your previous good health.
Consider, for example, a situation where you suffered a workplace injury to the discs in your lower back. Your attending physician has recommended a surgical procedure to repair the injured discs in your back. However, your employer’s insurance carrier sought a second opinion, and after an examination and review of your treatment records, your employer’s doctor instead recommended a more conservative treatment approach of intense physical therapy. Coincidently, the conservative course of medical treatment will save your employer’s insurance carrier a tremendous cost.
How can you resolve this situation where the recommendations are clearly opposite? You are going to want to follow your doctor’s recommendation for surgery. Your employer’s insurance carrier will not authorize your doctor to perform the surgery. Your employer’s insurance carrier will challenge your attending doctor’s recommendation and will contest your need for the surgery, as well as its obligation for the payment of the workers’ compensation benefits associated with the surgery, based upon their expert’s contrary opinion. Where does this leave you?
Medical Improvement and Injuries
Consider another example where you suffered an orthopedic injury to the ligaments within your left knee while trying to climb off freight boxes at your workplace. After surgery and physical therapy, your attending doctor believes that you have reached maximum medical improvement, which is the point where your treatment is complete. Despite everyone’s best efforts, you have not fully healed, and you are left with permanent injury and limitations to the movement of your left knee. Assume that your doctor has assessed you with a 17% permanent partial impairment to your left knee. In other words, your left knee will always be limited to 17% less than normal in its daily functioning. You will have some daily pain and restrictions for the remainder of your life. This permanent partial impairment rating, if unchallenged by your employer, would entitle you to payment of weeks, possibly months, of additional workers’ compensation benefits from your employer’s insurance carrier based upon the percentage of disability that your doctor has diagnosed.
In some instances, you might reach an agreement with your employer’s workers’ compensation insurance carrier, called a Voluntary Agreement, where you and your employer agree upon the extent of your permanent injury and further agree upon the amount of money due to you as compensation for your permanent injury. Sadly, these agreements are occurring less and less.
Respondent’s Medical Examination
Many employer’s insurance carriers challenge your attending doctor’s assessments through their own Respondent’s Medical Examination (RME) conducted by their paid doctor consultant. Commonly, these RME physicians disagree with your doctor’s assessment. Sometimes they will assess a far lesser degree of permanent impairment. They might even contest that you are left with a permanent impairment at all. The goal of your employer’s insurance carrier is to reduce the amount of permanent impairment benefits they will need to pay to you. Again, this leaves you and your worker’s compensation case in a stalemate. However, there is a possible tiebreaker: The Commissioner’s Medical Examination.
When there is a difference in opinion between your treating physician and the employer’s physician, the Administrative Law Judge has the discretion and authority to refer you for an additional “Commissioner’s Medical Examination” by an independent doctor either agreed to by both parties or ordered by the Administrative Law Judge in the very rare case of no agreement between the parties. This physician is selected because of their qualifications and for the simple reason that they are unbiased. They have no connection to either side and, therefore, can provide a truly independent medical opinion.
Prior to your examination, the Commissioner’s physician will be provided with your complete medical records for your workplace injury. They will also be provided with full access to any diagnostic testing that you undertook. The idea is that they will take a fresh look at your injury, your treatment, and both sides’ conclusions in making their own independent assessment. In their written report, which will be disclosed to both sides at the same time and in the same manner, the physician will be asked to provide their opinion on specific questions related to your workers’ compensation claim. Obviously, the answers to those questions, and the overall conclusions reached by the examiner, will carry tremendous weight. In our experience, when this examination produces favorable results for our client, it can often clear the path to resolution.
If you are faced with having to undergo a Commissioner’s Medical Examination, you need quality legal representation to walk you through this complicated process. Contact our workers’ compensation lawyers for help.