Sigman Janssen Legal Blog

The Independent Medical Evaluation & How it Affects Your Worker’s Compensation Case

October 09, 2017

The Worker’s Compensation Independent Medical Evaluation (IME)

 

When I receive phone calls from new potential clients who have been injured on the job, I frequently hear something along the following lines, “I injured my back about five months ago and Worker’s Compensation was paying for everything. Now my doctor is recommending a surgery, and Worker’s Compensation is not willing to pay for anything more, so they want me to see their doctor.

What is going on behind the scenes when this happens is that the Worker’s Compensation insurance carrier hears the word “surgery” and they know that may mean big money for them. It’s at this point when the insurance company requests you get an Independent Medical Evaluation. A back surgery, depending upon the type, can generate $30,000 to $70,000 in medical bills, a minimum payment to the worker of around $17,000, and weekly payments to the worker while he or she is off of work.

The Worker’s Compensation insurance carrier, in order to avoid having to pay the large medical bills, will hire an “independent” medical examiner to do an evaluation. These medical evaluators are, for the most part, in the Milwaukee or Madison, Wisconsin area. Many of these examiners do hundreds of theses evaluations every year. While it may cost the insurance company $3,000 to $4,000 to have an evaluation and report done, insurance doctors, more often than not, will say that the back problem is not work related. Thus, the Worker’s Compensation insurance carrier gets out of having to pay for the surgery. Oftentimes, the injured worker’s health insurance will pick up the bill; however, is it usually at a discounted rate. The health insurance company may only pay as little as $5,000 to $50,000 in charges. The doctor or hospital then has to “write off” the balance. Even if a worker is successful at a Worker’s Compensation hearing, the Worker’s Compensation insurance company only has to pay back what the health insurance company paid towards the bills. Therefore, even if the Worker’s Compensation carrier later loses their hearing, they still save a tremendous amount of money by having the bills processed through health insurance.

If you’ve been injured, and a Worker’s Compensation carrier sets you up for an independent medical evaluation, it would be wise to contact an attorney to discuss your situation.

-Attorney Mark V. Sewall