i was told i need a 3 level cervical fusion by a workers comp dr back in jan.adjuster said they wanted a 2nd opinion.i was followed by PI a few different times and i no they have pics of me going to a local gym.after sitting and waiting for 3 months i decided on my own that i was gonna try and do things to make me feel mentally and physically better so i joined up and started to exercise.in june i went to a dr of my choice and he said he wants to to do a 2 level fusion.now its august and i finally recieved my info for my 2nd opinion,8 months later.i am going to the clinic but to a different dr this time...WHAT SHOULD I EXPECT TO HAPPEN AT THIS VISIT????WILL THIS DR HAVE PICS AND OTHER STUFF AND USE IT AGAINST ME?
The IME doctor may or may not see the surveillance photos. Some doctors will look at that stuff, some won't. You are required to go to the IME, so just go and do what is asked of you. If you have your ATP and your second opinion doctor both saying you need a surgery, the odds are pretty good you will get it regardless of what this new IME says. Now, that assumes that the ATP and your doctor know that you are capable of going to the gym. Sometimes if they see activity level that is high enough, they will change their opinions on surgery for the time being.
Either way, it's a good bet that you're still going to have to get a lawyer to get your surgery unless this upcoming IME also says you need it. Since the adjuster has waited so long to appove it, you can bet that he/she will fight it if the IME gives them any reason to fight it.
As you have found out the insurance company is not your friend. They want to do what they can to get out of paying for your medical care. And, if they are using their "favorite" doctor, even worse. Give me a call at 770-955-3000 or 800-900-2400 and I'll get you my report entitled "The Ultimate Guide To Winning Your Georgia Workers Compensation Case" including a section outlining"13 Dirty Tricks and Traps Insurance Companies Don’t Want You to Know That Could Instantly Wreck Your Case" . It discusses surveillance, 2nd opinions, company doctors, etc. and you will find it very helpful. You need trusted information to make sure the insurance company does the right thing and eventually pays you the full value for your case. Using doctors against you is a very common tactic. Unfortunately, you at war with the insurance company, but the good news is that after 21 years of doing Workers Compensation throughout Georgia I know that it is a war that can be won. Good luck my friend.
You really need to find an attorney to walk you through these steps. Depending on the circumstances, it may be a good idea to disclose to the doctor what you have been able to do when you go to the gym. This gives them a clear picture of your limitations, as well as undercuts any assertion that you are not hurt and trying to fool the system. If you are being up front with the doctor, it supports what you are saying about your injuries and that you have nothing to hide. Also, if the doctor feels that you could benefit from physical therapy rather than surgery, this may be an alternative you find works better than a fusion. Big if; however, I have had clients undergo fusions and do well, and others where the fusion does not last and the clients are permanently and totally disabled. Get with an attorney you are comfortable with to whom you can give all of your facts and documents, and listen to his or her advice. Why do you trust what a doctor tells you without trusting another professional to help you with your case?
Do you have an attorney? If not you need one. Insurance companies do not play fair in particular when an attorney is not involved. If you do not have an attorney and you would like to discuss the matter further, please feel free to give our office a call. We will review your case free of charge.
Darrell B. Reynolds,
Attorney and Counselor at Law
2385 Lawrenceville Highway, Ste D
Decatur, Ga. 30033
Without more facts, it is difficult to determine exactly what this new IME doctor will be seeking, or whether he will have access to surveillance photos or videos, if any surveillance exists. The fact that you have been advised by an authorized treating physician that you need a multi-level fusion will make it difficult for the insurer to deny or refuse you this medical treatment regardless of whether they may be trying to limit their exposure by means of an IME or through the use of surveillance. Based on your question, I cannot determine if you have an attorney, and if you do, then you should discuss the specific facts of your claim with them offline. If you are currently without legal counsel, however, then you should hire an experienced Georgia Workers' Compensation attorney immediately, and I would welcome to discuss your claim with you directly. In addition, while I represent injured workers statewide, I would also recommend that you consult local attorney James Ivey, a workers' compensation attorney in Tifton for whom I have a great deal of respect and with whom I have worked closely in the past. Attorney Ivey also has a profile here on avvo.com should you wish to contact him directly. I wish you the very best in your claim and with your continued recovery.
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