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

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

  2. 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. 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.

    This answer to your legal inquiry is based upon the limited facts stated in your question. Accurate legal advice is based upon an exchange between a lawyer and a client. The lawyer can then ask about other facts that may change or confirm the answer. Without that exchange, this reply should be considered limited in value. You should rely on this answer only at your own risk. Direct consultation with a lawyer is always recommended. Answering your question does not create an attorney-client relationship. The answering attorney is licensed in Pennsylvania and all answers are given pursuant to Pennsylvania law, unless otherwise indicated. If you have further questions regarding your issue, or my answer you may contact me to discuss this issue further by calling 215-496-9607 or sending an email to

  4. 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. 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 disability or nursing home abuse, please contact Lowenthal & Abrams, PC at 1-800-876-5299. I am licensed in Pennsylvania, but members of my firm are licensed in Pennsylvania, New Jersey and New York. This post is not legal advice, but instead contains general educational information. Please do not act or refrain from acting based upon what you read in this post. Also please remember that this post does not form an attorney/client relationship between you and me. If you have specific legal questions, you should contact an attorney in your state for assistance. I am licensed to practice law in the state of Pennsylvania.

  6. 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. DISCLAIMER: This post is intended as general information applicable only to the state of Pennsylvania. The information given is based strictly upon the facts provided. This post is not intended to create an attorney client relationship, or to provide any specific guarantee of confidentiality.