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A Canadian newspaper recently reported serious accusations — workers’ compensation doctors were pressured to provide opinions so claims could be denied. The Canadian paper printed the story as if it were unusual. It’s not. We see it every day. It’s the sad reality of a compensation system full of claim managers with a goal other than helping injured workers recover. These claim managers know how to find biased doctors who will help with their goal.
Most injured workers hope to recover quickly. They want to return to their jobs and their normal lives. Instead, they often face unnecessary delays in treatment as well as biased caregivers. Their calls to the insurance adjuster go unanswered and unreturned. Imagine needing medical care and having your calls ignored for weeks. That’s the reality faced by many injured workers. These problems have become an epidemic for our system.
In the workers’ compensation system, medical providers face tremendous pressure from insurance companies. It’s unjust. And, it’s at every level of medical care.
PRESSURE STARTS WITH THE GATEKEEPER PHYSICIANS
What is a “gatekeeper physician.” I use this term for the company’s initial occupational doctor. Usually, it’s a doctor or clinic performing many medical tasks for companies. These include pre-employment physicals, drug tests and initial post-injury examinations. Here, we will focus on post-injury examinations.
These gatekeepers have a clear goal — keeping medical costs low. How do they keep the insurance carrier’s medical costs low? They do several things. Here are two primary tactics:
CONTROL APPLIES TO TREATING SPECIALISTS
In Alabama, the workers’ compensation insurance company picks your treating doctor. Most specialists care deeply about their patients. But, a few do not. And, these few doctors face financial pressure. Pressure to ignore you. Pressure to say you are exaggerating. Pressure to not provide costly care. Pressure to release you (even if you are still hurting). This is another issue where experienced legal counsel can help. Over many years, we have dealt with most of the specialists in northern Alabama. We know who generally listens to their patients. We know who generally does not help their patients. A biased medical specialist can leave you with unresolved injuries impacting your life, your work and your compensation claim.
BIAS CONTINUES FOR THE FINAL IME DOCTOR
At some point, the treating doctors will conclude you have reached maximum medical improvement (MMI). That’s an important milestone. I’ve discussed the significance of MMI in prior posts. When you reach MMI, the issues of permanent restrictions, impairment ratings and future treatment needs, may all be important. Insurance companies know they can save tremendous costs at your expense by getting a biased doctor to issue opinions on these issues. These opinions can greatly affect any permanent disability benefits owed you. These opinions can also greatly affect any future care provided. A few physicians actually make their living creating biased reports for insurance companies. It’s wrong and unjust. And, you should seek advice before seeing a biased IME doctor.
Doctors should be allowed to provide you needed medical care without outside pressure. Unfortunately, that outside pressure exists. While most doctors focus on their patients, a few do not. You need to understand the system. If you are facing any of these issues, you need to seek experienced legal advice.