Injured 9/27/12 of my neck. A dr sugg Sx. Wkmen comp sugg IME. Can I file a utilization Review?

Asked over 1 year ago - East Stroudsburg, PA

I injured my neck at work 9/27/12 since then I've been on wkmen comp and was diagnosed with severe case of cervicle spondylosis. After 90 days of a treatment plan which has failed. I went to another dr and he advices Sx. My ins said to cx surgery and see IME. The problem I have I'm in alot of pain and nothing has been wking. I called an atty office to seek council but the paralegal stated wkcomp has the right and I hv to go. What is the process of filing a utilization review and do I need an atty for this.

Attorney answers (7)

  1. Levi Samuel Wolf

    Pro

    Contributor Level 13

    2

    Lawyers agree

    Answered . The short answer is yes, you need an attorney. ASAP. The consultation will likely be free. Make an appointment right away.

  2. James V. Monaghan

    Contributor Level 14

    2

    Lawyers agree

    Answered . The carrier has a right to a pre surgical IME. You can get a prospective UR but that only determines the reasonableness and necessity of the treatment. It does not deal with causal relation. You need to retain a lawyer.

  3. Richard Alan Jaffe

    Pro

    Contributor Level 13

    1

    Lawyer agrees

    1

    Answered . Initially, you should not be excepting legal advice over the phone, especially from a paralegal. Given your situation, it is recommended that you contact and Attorney who is experienced in handling Pennsylvania Workers Compensation Claims for an initial consultation to discuss your rights and obligations pursuant to the Pennsylvania Workers Compensation Act. Most Attorneys will not charge for an initial consultation and will except your claim on a Contention taxicab basis Pierde assuming you are currently receiving Workers Compensation Benefits, typically there would be no charge for representation until a Petition is filed by the Worker's Compensation Carrier.
    I take a much different position regarding the Workers Compensation subcarriers entitlement to and Independent Medical Examination. Factors going into whether or not the Defendant is entitled to such an examination Include whether or not the employer actually have the right to control your medical treatment for the initial 90 days.

    Although you can file a prospective request for capitalization Review, this process can take quite some time and it would be best to discuss this situation with an attorney.
    Http://www.phillyworkinjury.com

    This answer to your legal inquiry is based upon the limited facts stated in your question. Accurate legal advice... more
  4. Geoffrey Hillsberg

    Pro

    Contributor Level 11

    1

    Lawyer agrees

    Answered . I do not agree that the carrier is entitled to a pre-surgical IME. Depending on the facts of your case, they may be entitled to an IME, but I would not allow it to prevent or delay the surgery if you want it. You need to consult with an experienced Workers Comp attorney as soon as possible.

  5. Timothy D. Belt

    Contributor Level 13

    Answered . The carrier is entitled to an IME at reasonable intervals, but they are not entitled to cancel surgery until you undergo the IME. Furthermore, although I do not have a crystal ball handy, I can all but guarantee the IME will find the surgery to be inappropriate in regard to your injury and this will then supply the insurance company with a medical opinion to fight against the surgery. If you want to have the surgery and your doctor thinks it is a good idea, I see no reason to wait until after the IME.

    I would agree with the other posters that an attorney is a good idea especially since it appears that you are going to have a fight on your hands.

    Timothy D. Belt, Esquire Helping injured workers in Northeast Pennsylvania. belt-law@belt-law.com www.belt-... more
  6. Robert L. Cullen

    Pro

    Contributor Level 13

    Answered . I agree with James and Levi.

  7. Jennifer L. Ellis

    Pro

    Contributor Level 17

    Answered . I agree with Mr. Wolf, who is, by the way, an excellent attorney. You should contact an attorney immediately before you do anything else. That attorney can advise you moving forward and help to ascertain your next steps. The independent in Independent Medical Examination, rarely really means independent. So while you might be required to have one, you might want to take some other steps as well. Workers' Comp cases are handled on a contingent fee basis and the consultation should be free.

    For a free consultation related to medical malpractice, personal injury, workers' compensation, social security... more

Can't find what you're looking for? Ask a Lawyer

Get free answers from experienced attorneys.

 

Ask now

23,667 answers this week

2,593 attorneys answering

Ask a Lawyer

Get answers from top-rated lawyers.

  • It's FREE
  • It's easy
  • It's anonymous

23,667 answers this week

2,593 attorneys answering