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Worker comp

Lodi, NJ |

Hi
My injury was in 1-21-2013
Hurt my lower back at work . Went to the ER .. Did an X-ray same day . After several weeks of PT .Did one injection.The worker comp DR said that I'm a mmi .. And suggest a surgery ..Went to the IME Dr like 6 weeks ago .. I did not receive a copy of his exam .. The worker comp nurse kept telling me discuss the surgery with your family before doing it or you can just find another job that don't requires lifting or bending .. She told me that twice .. Before the IME appt and now too.. Is that her business to tell me that and why she keep saying that .. Why didt I receive a copy of the IME exam .. My next appt with the dr is Monday to talk about the surgery .. Is she trying to settle my case ??
Thank you
Pierreannie7982@gmail.con

Attorney Answers 7

Posted

A couple of things to be careful about with what you are describing. First, the comp nurse is not there to help you. She/he may seem helpful and friendly but be mindful they are agents of the insurance company. Their job is to make sure the doctor does only what is necessary and aid in focusing only on your returning to work. They are NOT there to help you. Also, the IME doctor is not independent. Usually, when the insurance carrier sends you to an "IME" doctor they are looking to either terminate benefits OR are trying to move the case to settlement.

I would suggest contacting a certified workers compensation law attorney immediately. If you would like i can be reached at 609-771-8611.

Be mindful, that because you were hurt at work in the course of your employment you are entitled to three very specific rights. You are entitled to receive medical care which is paid for by the workers compensation (WC) carrier. However, in New Jersey the wc carrier gets the right to dictate medical care. They tell you what doctors you have to see. If you are out of work and receiving treatment and NOT MMI then the wc carrier has to pay you what is called temporary total disability benefits. This is the second benefit and continues as long as you are seeing a doctor who has you out of work and is recommending treatment. This benefit represents 70% of your gross weekly wage. Finally, if you have sustained an injury as a result of the work accident you are going to be entitled to receive an award for that injury which is the third thing you are entitled to receive.

I hope this is helpful and good luck but again contact an attorney immediately. It sounds like the wc carrier is getting ready to terminate your care.

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Asker

Posted

Thank you so much . Very informative May I ask why are they ready to terminate my case as long as I'm seeing and following their DR orders and receives 70% of my weekly gross wage since the first day of the injury ? Thank you

Samuel Michael Gaylord

Samuel Michael Gaylord

Posted

As a result of your still getting treatment and paid they would not terminate your benefits. Usually, when a comp carrier schedules a second opinions or IME it means they are trying to avoid having to pay benefits or for surgery or some other benefit. So, they get an IME to say doesnt need treatment and rather then abide by the treating doctors opinion they go with the IME. If you are still to go back and see the treating doctor and if the IME agreed with the surgery then they will not terminate your benefits. I hope this clarifies my earlier remarks.

Asker

Posted

Actually the IME agreed with the doctor about the surgery .. Do you think they might set up another appt for IME .. On this coming Monday I will see the DR for discussing the surgery date

Samuel Michael Gaylord

Samuel Michael Gaylord

Posted

Its good the IME agreed. IT means that the condition must be bad enough where all the doctors are agreeing. As long as that is the case, the carrier will continue to provide benefits. I would suggest seeing the doctor on Monday talking about surgery and making arrangements. I would then also make an appointment to see an attorney be it my office or another wc specialist to make sure you understand all of the legal options as you move forward. Thanks again and good luck.

Asker

Posted

Thank you again Will contact you on Monday

Samuel Michael Gaylord

Samuel Michael Gaylord

Posted

Great. I can be reached at 609-771-8611

Posted

My colleagues are correct that the nurse case manager is NOT to be trusted. However, She is simply giving you sound advice. Lumbar fusion has a VERY low success rate and almost certainly will prevent you from going back to your prior work. You are NOT entitled to the IME report but the two doctors obviously agree on the need for surgery or it would not be an option.

This is a potentially career-ending injury. It would be a mistake to go through this without an experienced WC attorney to guide you. Good luck.

If this information has been helpful, please indicate by clicking the up icon. Legal Disclaimer: Mr. Candiano is licensed to practice law in Illinois and Indiana. The response herein is not legal advice and does not create an attorney/client relationship. The response is in the form of legal education and is intended to provide general information about the matter within the question. Links: CJCandiano@CandianoLaw.com http://www.CandianoLaw.com

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Posted

Thank you mr Charles Actually the DR says that I can't go back to my job

Posted

Nurses are hit and miss in compensation. I have seen very good ones that do not take the approach that they are advocates for the insurance company and others that clearly seem to act like they are secondary claims individuals. On average I find them to be helpful to both sides. Typically, nurses are assigned to difficult treatment cases. However, they are not allowed in the examining rooms without your consent. It seems that you have a serious injury and the advice that she is giving is correct. You are entitled to every medical note, test result, mri, etc.. It is your body and your medical treatment. If you ask for something they must give it to you. You should discuss with an attorney. Good Luck.

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Christopher G Meikle

Christopher G Meikle

Posted

PS. If you are uncertain about surgery ask for a second medical opinion.

Asker

Posted

Thx mr Christopher

Posted

You should contact an attorney to discuss your case. Whole each state is a little different I can't think of any reason you should not be provided with the IME report. I do agree with both NJ attys that generally the nurse case manager is not your friend and cannot be trusted to give you advice because they are usually looking out for the ins co not you. I also agree that the IME is not usually an truly independent dr.

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Posted

Many times surgery will be targeted to relieve radiculopathy (nerve pain in the legs from the back) and not just for back pain. It is a big decision and you want the best surgeon possible. Be wary of anything a workers' compensation nurse or adjuster tells you.

Michael J. Dennin, Esquire www.denninlegal.com 866-665-5709 (toll-free) mdennin@ciecka.com

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Posted

If you need surgery for the comp injury then you have not yet reached "MMI."

This answer is intended as general information and not as specific legal advice. If you want to have a free consultation with me, please contact me through AVVO.

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Posted

Dear bobby The DR who did the injection Wrote down MMI

Posted

It is difficult to say what is going on with what you describe. If you are MMI then I don't understand why the comp doctor is recommending surgery. I would have to speak with the insurance adjustor, the insurance attorney, and I would have to review all the current medical records to see what exactly the doctor is saying. Please contact my office to discuss your case in more detail. Thank you.
Sincerely yours, -Ronald Aronds, Esq.-

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