Ime

[katgemini]

i settled my case in jan 2006 and it has open medical. my question is i just had a IME , can workmans comp refuse to pay for my pain management if the IME says i dont need it? or will they have to go thru a review or court or soemthing to get permission to refuse furthur meds? i have been going to pain management since june 2005

[Dabbadoo7]

Something appears to be wrong with this picture.

If you actually settled your claim, you can't be sent to an IME, unless stipulated in the terms, and an atty. is not going to allow that. And, I don't know of any actual settlements that left medical as an open wallet. Because it is a final settlement, the amount of medical is also stipulated.

If your case was decided at a hearing, or in front of a judge, things can be quite different. The only thing decided at a hearing is that you are legally entitled to continuing benefits and medical coverage. In that case, you can be sent to an IME, and if he says that you don't need certain coverage, or have gotten better, the carrier can file for reconsideration, and possibly have your pain management stopped. Benefits too, for that matter. This one of the big problems with winning a hearing, versus a settlement. You need to call your atty., in order to get a correct answer. You should certainly also arrange your own IME, in order to counter any opinion given by the other dr. Your atty. should be able to help you with that also. Different states offer different options, so you may also want to look up your state laws regarding this matter. But don't just cave in!

Good luck!

Dabbadoo

[katgemini]

are you serious? did you not read what i wrote? i settled my case , got a lump sum, an i have OPEN MEDICAL with them, meaning they pay for anything medical that has to do with my injury that was THEIR fault. they can send you to a IME aslong as they are paying for your doctor appts and medicine pertaing to the injury. i settled my case jan 2006 and they STILL pay for pain management and my precriptions .my question is since my we have a AGREEMENT that they have to pay for any nessacary treatment , can they stop it if the IME says i dont need it?

[CanRelate]

What do the settlement papers say on this issue?

You mention an open medical for all injury related treatments....then you say below..."........since we have agreement that they pay for any **necessary*** treatment..."

Seems to me the settlement papers should define what that means and how "necessary" and "injury related" is determined.....what are the rights and obligations within the settlement of you as well as them...?

Regards,
CanRelate



are you serious? did you not read what i wrote? i settled my case , got a lump sum, an i have OPEN MEDICAL with them, meaning they pay for anything medical that has to do with my injury that was THEIR fault. they can send you to a IME aslong as they are paying for your doctor appts and medicine pertaing to the injury. i settled my case jan 2006 and they STILL pay for pain management and my precriptions .my question is since my we have a AGREEMENT that they have to pay for any nessacary treatment , can they stop it if the IME says i dont need it?

[Dabbadoo7]

katgemini,
Yes, I was serious, and I did read your post three times before responding.

Any settlementis final, and who should pay what must be spelled out in order to have a legal contract. Open medical is not finite. It is a misnomer that is used by many who do not fully understand their position. You are in jeopardy of losing your pain management, if the IME holds up.

I spent 15 yrs. in the system, before finally reaching a settlement, which I really didn't like. My injury effects me for the rest of my life, but it became necessary to cut my losses. And, as I said, a judges' decision does nothing but partially guarantee treatment. And in my case, it would not even come close to restoring my lost income

Everyone should realize that "open" medical is subject to interpretation, and is not in your best interest. What will be covered and when,must be spelled out.

Once again, contact your atty., because he can give you the best advice.

Dabbadoo

[rabidcoyote]

you are 100% correct in that Dabadoo7...i just finalized my settlement in front of a judge, and we did it with our doctors IME..didn't even need the doctor who did the surgeries IME. the judge found all ion our favor, IC and employer was at fault and responsible for all treatment..got almost the max # of weeks benefit in missouri that can be had for my type of injuries. this was not a hearing...it was mediation that we took in front of the judge and all parties agreed to everything in settlement papers...signed on dotted lines and said our goodbyes. takes 2 weeks to recieve the settlement check, then lawyer and i distibute the funds (his 25%, plus any costs) and we go about our lives again. NOTHING is left open here in this state. thats another thing that the OP needs to always post is the state in which they live in because of the massive diffrences in each states WC laws.:eek: good luck to all that are still fighting..never give up.......and always GET A GOOD WC LAWYER!!!!!!!! best advice i can give ya'll!!!!:p

[katgemini]

alls i know is a friend of mine has been going to pain management for 10 years now, he settled his case got a lump sum and they have been paying for pain management once a month for him for 10 years. we live in mass. i talked to my lawyer and he said they can say" ahh we dont feel like paying for pain management anymore " and they can attempt it, but he said with my medical records and the fact that i need pain management its highly unlikely they can stop, since in my settlement agreement they agreed to pay for my meds and pain mangement appt after we settled.i do know while they are continuein to pay for it they have the right to send you to an IME once a year.

[caudaequina]

people fail to realize that in every state the WC laws are totally different. for instance in NY state it is the injured workers right to videotape the ime, however the IME needs to give notice in writing if they plan on videotaping it. it states this on every notice to appear for an IME.
in NY state to settle and have continued medical coverage is extremely rare if not unheard of . in other states it is common.
ime is just one doctor weighted opione. your pain management treating doctors notes and input should be held in higher regard then an IME who see's you for a couple minutes for one visit . i would explain to you PM doc what has happened so that they make sure your notes and paperwork are up to date.
in NY state before they can stop coverage they need a hearing, however the insurance company manages to bypass this many times, and hope the injured worker gives up.
they can send you to a IME as long as they are paying for your care or paying for your bnefits.

[mariah]

My case has not been settled yet, however, the W's.C. Co. I have to go through is always telling the Dr. they will no longer pay for treatment, so we were always going back to court to get another order whenever they got tired of paying for my pain management. I filed for disability and got it, so I now use my medical card to get my pain meds. The state is aware of everything that is going on, I've been completely honest with them always, about my injury and W's. Comp. They have all my medical records and will decide when this is all over if they want to go after the insurance company for reimbursement of the money for my pain meds. This Worker's Comp, co. has done nothing but try to make my life harder than it already is. I doubt they have any idea, or have even thought about the fact that the state can come after them. I am under no legal obligation to tell them anything about this, and I hope my state does go after them. They are already aware of how this company operates,( they have been keeping their eyes on them for some time) and pulls everything they can do to not comply with the laws. If not for the state paying for my pain meds, it would just be delay, after delay, after delay, as it was for the first four years, with me always having to wait to go to court again, in the meantime being in excruciating pain, to have medical treatment authorized again. I loved my profession, but if I had known what was going to happen to me, or rather, the way my company took care of their injured staff, I would have never worked there to start with.