Independent Medical Exams or IME’s

Perhaps it comes from reading hundreds of them. While medical exams arranged  by the Department of Labor & Industries or a self-insured employer may be called “independent”, they seem to be anything but “independent”. I generally refer to them as panel exams or defense medical exams. Whenever a dispute, question, concern or confusion arises in a claim, a medical exam is scheduled. The reports are often boilerplate, the same physicians show up time and time again. They seem to stall medical treatment rather than facilitate it.  

 

Be that as it may, if you are scheduled for such an exam, you need to go. Failure to attend will likely result in some negative action being taken on your claim. The Department or the self-insured employer has the right to have you evaluated by a physician or physicians of their choosing. These exams can be scheduled for any reason, and pretty much as often as they want. That said, I do have some suggestions.

 

If the date or time of the exam is inconvenient, it is ok to reschedule. Just call the phone number on the notice and reset the exam for a better time.  Despite what a frustrated claim manager may tell you, you are allowed to go on vacation, make plans, and have appointments unrelated to your claim. You are not at the beck and call of your claim manager 24/7. While your personal activities can not completely prevent your cooperation with reasonable claim management requests, they may make you temporarily unavailable, necessitating an exam be rescheduled.

 

If you have an emergency and need to cancel the exam at the last minute, call. It happens. Hopefully, not to the same worker over and over again, but it does happen. It could be the weather, or car trouble, or a sick child. Whatever the reason, call the facility and your claim manager as soon as possible. Unless you have a pattern of last minute missed appointments, it will not be grounds for suspending benefits. Although, you may be asked to write a short statement about the reason for the last minute cancellation for your file. The exam will be rescheduled.

 

If your injury makes driving difficult, you can ask that transportation be provided. Usually, the Department or self-insured will arrange a taxi pick-up. If you are traveling from out of  Washington State, travel will definitely be provided, as well as hotel accommodations if necessary. If you do drive, keep track of your mileage and submit a travel reimbursement. You can get a form here.

http://www.lni.wa.gov/FormPub/Detail.asp?DocID=1631

  

Take someone with you. If you have an attorney, they can not go with you. But, you can certainly take a friend or family member. Not only will this give you some piece of mind, it will be an extra set of eyes and ears.  Your companion may sit through all parts of a physical exam. They will not be permitted to sit through a psychiatric or psychological evaluation.

 

Report any misconduct or inappropriate action by the physician who examines you or any other person associated with the facility where you have the exam. The Department will take action if they receive a number of valid complaints involving a particular provider or facility. If you have a concern about your exam, put it in writing right away and send it to your claims manager. It is perhaps human nature to view complaints made only after the report is received as a bit less credible. Complaints can be sent to:

IME Quality Assurance
Provider Review & Education Unit
Labor & Industries
PO Box 44322
Olympia, WA 98504-4322
360-902-6818

Do not rest up before your exam. I tell my clients to go about their normal activities before an exam, so the provider can see them in their normal state. Keep in mind it is important to be honest with the examiner. Not every test will cause symptoms, and you should be straight up about what does and does not effect your condition.

 

You are entitled to a copy of the exam report, although, the examiner will not send a copy to you. If you have an attorney they will get a copy of the exam and send it to you and your medical provider and request any necessary response. If you do not have an attorney, send a request for a copy of the exam in writing to your claim manager. While there is no law which says the request has to be in writing, I find it harder to ignore or forget about if it is in writing. When you get a copy of the report, take it to your attending medical provider. While the claims manger should send the report to your doctor, it does not always happen. Ask your physician to review and forward any comments directly to your claims manager.

 

You may find a second medical exam is scheduled shortly after  a report is received from the first exam. This is an unfortunate outcome of claim mangers looking for a “preponderance” of medical opinion. Many claim managers seem to feel this means the number of opinions on a particular issue, completely ignoring the quality or credibility of those opinions.  There is not much you can do about it.  If you have an attorney they will make the appropriate arguments, and work with your physician to obtain helpful information to forward to the claim manager.  However, to avoid being found uncooperative and having your claim or benefits suspended, you will need to attend the follow up exams.

 

The Department is currently drafting new Rules defining who can conduct these “Independent Medical Exams” and what those exams should look like. There is some hope these new Rules will serve to improve the quality of the exams themselves and make them more objective and fair.  I suppose we’ll see. In the meantime, these exams are a necessary part of your journey through the workers compensation system. Understanding them, and following a few common sense suggestions will  improve the experience.

38 thoughts on “Independent Medical Exams or IME’s

    • In Washington State, is a self-ensured employer required to notify the worker in writing that an IME has been scheduled? Also, are they required to give the worker a certain number of days notice prior to the appointment date? Thank you.

      • You will get written notice of a scheduled IME. Although you are generally required to cooperate with such an examination, if the date and time scheduled creates a conflict it is a simple matter to get the exam reset. So long as you are not trying to obstruct the exam, getting a different day or time is not a problem.

  1. Regarding the IME, my form says, “allow 1-2 hours for physical exam and 2-8 HOURS!! for mental”. Umm, it is my back not my psyci that needs treatment, I don’t get it. FURTHERMORE, this is my OWN blasted insurence company, not the ladies that hit me… My injury happened in Aug and it is now March. I was being treated ONLY by a chiropractic doc. It is gonna cost them a lot more $$ this way if they would have let me see him once a month for $45 a adjustment….

    • My name is Troy.

      I was injured in 2003, have had four surgical procedures, was found to be 100% disabled 5 years ago, my wife was forced to give up her career to become my non-professional attendant care person (When I say my wife gave up her career, she really gave up a lot, traveling the world, making six figures and working on the sea, That’s Love) and I still have to go to an IME Wednesday. I am going through this because about a year ago my arms started to burn, especially my left arm. I asked my Doctor what was going on and he ordered an MRI of my Cervical Spine, the MRI the carrier failed to authorize 10 years ago. The doctor increased my meds, ordered steroid treatments, all this after my MRI came back showing a massive hern. at C5-C6. The doctor also asked why I didn’t have this MRI 10 years ago. Anyway, all of these prescriptions were filled up to that point. Then the doctor said I needed surgery to remove the disk material because it is HUGE. So my doctor wrote a prescription for me to have a consultation with a Nero surgeon. That’s when the carrier put me under surveillance,

      “The doctor also asked why I didn’t have this MRI 10 years ago.” I’m pretty sure this is what started all the trouble.

      They watched us for six months and recorded a total of forty- five seconds of video (45) The funny thing is they pictured me following doctors orders. I was trying to do the things all my doctors insist I do before the atrophy in my back becomes irreversible. I am unable to drive for more than a few minutes at a time so I don’t even bother unless my wife can’t. I can’t walk most of the time, have to use a power chair to be able to do anything and live with the most God awful pain I never knew was possible.

      So after ten years of this you would think this crap would be over but NOOOOOO, I am being forced to wait for a hearing with the JCC before I can receive medical treatment I should have received ten years ago, hell I might end up homeless if these crazy people get their way (Even though Social Security and the Department of Health, not more than a few month’s ago, checked on me and found my condition had not improved) They even asked if there was anything I needed. At the time I said no, because I still receive my benefits from my carrier. Now I am not only afraid I may have to live with this new pain for the rest of my life and might have to fight for my benefits all over again.

      Keep in mind this is all happening after 8 years of living in a home I was unable to get my wheelchair in or out of, over 100 falls while I was using my crutches. There’s also the torture and more torture. I have been forced to wait for medical treatment that has resulted in the reduction of my pain level on more than half a dozen occasions, we have been insulted, our land trespassed upon, called trash in open court by the carrier, oh, it goes on and on.

      Remember, it’s not about the money, It’s about your life or the lack there of. I’ve been getting money for ten years, I was earning six figures when injured. I may have taken a pay cut, but it has always been enough to live on, care for my family and keep my daughter in college.

      After 8 years of arguing I was given a partial settlement so we could move into a home that was not a threat to my life and now they are pulling this crap on me for what reason I don’t understand.

      The more I write of this story the more really bad memories and feelings start to fill my mind. The one thing I have learned from all this? I have been treated worse than a criminal from a medical point of view for the past ten years. I was legally tortured both mentally and physically for the past ten years and nobody can do anything about what these people have done to my family. The carrier and the case manager have the right to cause you what ever harm they deem necessary in attempts to take away your benefits. And, I have lost the best part of my life to these crazy people. I am now 44, 34 when injured, have been to the doctor 250 times since this happened, been to Civil Court, been called a fraud and my wife and children have been publicly humiliated. The thing of it is, it’s still not over and I don’t know how much more I can take. So many people have it worse than I but what happened to my rights, I am still a human being born and raised in America, Indiana for God’s Sake. I had never missed a day of work. Worked for the same company for almost 10 years. I have never been fired from any job. Take good care of my family, put my daughter through college. But I feel like I am useless, I am sad everyday, I cry everyday, I feel pain everyday and what for? Is this really worth it? The answer has to be YES or I couldn’t go on living.

      I am just going to post this as is, if there is anything I can do for anyone write me ts8250@aol.com. Maybe that’s what I’m supposed to do, help others get through the horrible world of Workers Compensation.

      Sparticus

  2. In Washington, at an IME, if the IME doctor suggests xrays or lab work, does the patient have to submit to those procedures? For a back injury, does the patient have to submit to a psych test?

    • As a generally rule, the worker needs to cooperate with such medical exams, unless he or she has “good cause” for not cooperating. This would include cooperating with routine testing, but would not likely extend to invasive procedures. For instance, you cannot be forced to undergo surgery. I tell my clients that diagnostic studies like x-rays and MRIs may help us objectively demonstrate the medical problem, and help tie it into the injury claim.
      As for a psychological evaluation, such exams are generally sought when there has been some suggestion of a mental health issue, such as depression, which has arisen as a result of the industrial injury, or which may have pre-existed the injury, but is now hampering recovery. Again, you would have to demonstrate “good cause” for refusing to cooperate with such an evaluation. Such good cause may very well be that you are not claiming any mental health issues arising from your injury, and have no history of mental health issues which are impeding your recovery.
      Whether a worker has “good cause” for not cooperating with a medical exam requested by the Department or the self-insured employer is a very fact specific, case by case, determination. If the Department finds there was not “good cause” your benefits can be suspended. I would suggest you talk to an attorney before you decide not to follow through with testing or evaluations ordered by the Department. These suspensions can be troublesome to undo, and you might do your claim more harm then good by refusing to cooperate.

  3. I have been fighting for a settlement for over seven years. I have multiple injuries, all of which can not be fixed. I have had two surgeries to the right knee, a lowere back injury, s i dysfunction, left shoulder injury, and both feet injured with the left foot having permanent damage. I have attended over 5 IME’s, all of which lasted no more than 15 min’s. They have never done any x-rays or other testing. IME’s are just plain ridiculous. I feel that they should do cat scans, mri’s, nerve testing etc, be very thorough. But then that is not to the advantage of L and I. I have an attorney, but sometimes I wonder even about them. I have done everything that L and I has requested. But enough is enough. I have all my medical records. I have over 8 of the best doctors stating that they can do no more for me. I have all the facts and findings including several mri’s that show the damage to my back. So why is it that they won’t set up pension or offer settlement. Is their a time frame for getting this closed?

    • The answer to your immediate question is “No” there is no set time line for resolving a Labor & Industries claim. It takes as long as it takes. Sometimes there are issues revolving around medical stability, a claim can not be closed (even with a pension) if further treatment is anticipated. There are often vocational and return to work issues to resolve. Unfortunately, it may some times take several circles of medical exams and vocational referrals to get a claim closed or even moving in the right direction. It is not a perfect system, and it certainly has its hurdles and roadblocks which have to be professionally navigated.

      Now, for the unsolicited advice. If you have an attorney – talk to them. I can not tell you how many phone calls I get from injured workers who are already represented by an attorney. My advice is always the same. You have a legal representative, they work for you. Make an appointment, face to face if you can, by phone if a personal meeting is not possible for whatever reason. Ask your questions. If you have an attorney who will not take the time to meet with you and answer your questions, then get a new attorney.

      Keep in mind, this may result in getting answers which are not what you wanted to hear, like ‘there isn’t anything I can do to get further benefits for you’ or ‘we don’t have the medical evidence to take this any further’ – but at least your questions have been answered.

      • No Terri, it still has not been settled. And in fact they are now forcing me to go through Vocational Retraining, even though my own doctor has said I will not be able to return to work…That my injuries are permanent, cannot be fixed, nerve damage, Protruding Disk, and Both feet injured with nerve damage, left shoulder injured and is allowed under L&I, but they are preventing any type of help at this point….Deny, Deny, Deny…all Doctor’s recommendations…will not allow left shoulder to be filmed…etc,etc…They also want to retrain me as a filer…When I was injured I worked two jobs, one being my own business..earning over 60,000 a year..now they want to retrain me for a minimum wage job, which seems illegal…for one thing…but it has been almost ten years and still I am fighting them…I am the injured worker who has to live with these injuries…who lives every single day in excruciating pain, my attorney doesnt seem to be working for me, but seems to be working for them…

      • You are bumping up against one of the limitations of an L&I claim. The department is not responsible for returning you to work at wages equivalent or even close to those you were making at the time of your injury. In fact, if you can earn minimum wage or above, then you are employable. Or, in your case, retrainable.

        It sounds like you are in a retraining program now. That would have happened only if some medical provider reviewed and approved a specific job analysis, describing a specific job, which you are physically capable of performing (assuming you obtain the necessary skills) While you may have permanent limitations and disabilities, this in and of itself, does not mean you are not capable or some work. I really encourage my clients to take vocational retraining as a positive thing. It is not offered to many injured workers, and can be a very valuable tool to improving your life. It is the one time someone else is going to pay you to learn a skill or get an education. What you do with it after that is entirely up to you.

        Again, if you have an attorney, write down your questions and make an appointment. Those of us who do this type of work try very hard to help our clients understand the process (and its limitations) and answer whatever questions they have.

  4. i like many of the injured workers have been fighting l and i for almost seven years. last year i was approved for the vocational retraining program, i choose option 2 and the department even though approved my schooling, my claims manager has repeatedly denied my ppd award and is under appeal again. my question is this. how is it that they are able to accept the responsibility to retrain me for sedentary work due to the fact that i will never return to any of my prior work before the accident, but yet they can try and deny my ppd award, isnt the retraining admiting that there has been permanant damage since i will never do that work again.

    • I gather from your post that there is a dispute regarding the rating of your permanent partial disability. As a result, the closing of your claim and the PPD award have been delayed. It would be highly unusual for you to have no impairment, and yet have been found eligible for vocational retraining. I suspect the issue revolves around which impairment rating is correct, rather than being a dispute over whether there is any impairment at all. Without detailed medical information I can not tell you what a reasonable PPD award would be. I generally start by looking at the opinion of the treating or attending medical provider. However, sometimes the workers medical provider will not or cannot provide an assessment of permanent impairment. In that instance we try to get a evaluation from a consulting medical provider, and the Department will, of course, have the opinions of the IME physicians. These types of disputes over a PPD rating are exactly the kind of issue you need to take to an attorney.

  5. Why is it,or what WAC or RCW code is it, that protects IME providers from RCW codes such as RCW 70.02.080, 51.36.060, OR 70.02.005, with regards to failing to furnish the injured worker with a copy of an IME report, if the injured worker is not represented by an attorney? From what I have read and understand, an IME report is part of my permanent medical record, therefore, I (as an injured worker) am entitled to a copy of the report, from the (IME) provider. Also, how is it that IME providers offices, do not have to have HIPAA information out?

    thanks

    • You are entitled to a copy of the IME report. Make a request in writing to the Department or the third-party administrator handling your claim, and they will send you a copy as soon as they receive it. If you have a state fund L&I claim you can see and print a copy from the Department’s Claim and Account Center on-line – just look for Imaged Documents.

  6. I was informed yesterday on the phone when I called L&I about my upcoming IME that I would not have daycare for my children due to the day it was on because I had just recieved the paperwork in the mail the day before from the place I am to go for it. I explained to my case manager that previously the days I would not have an issue w/ getting daycare for my childre. On the forms it plainly states that you are not allowed to bring children w/ you. I explained to L&I that I am more than happy to go but I do not have someone to watch my children being that it was short notice to find anyone. I was then preceeded to be told that I would have repricutions on me for cancelling the appointment and that I would have to pay for the cancellation fee for not going. Are they allowed to do that to you? Then I get a return call from L&I telling me that the scheduler said to bring my children w/ me and if they could see me they would. I can not even do that because I am limited to what I can carry because of the injury I sustained while on the job. I feel like I am being bullied by L&I and they are making threats towards me because I do not have daycare for the day they scheduled the appointment.

    • While it is your responsibility to provide child care for your medical appointments, the Department is generally pretty flexible about rescheduling exams if you have a conflict. I suspect the CM is more worked up about what sounds like late notice on the need to reschedule. They usually give several weeks notice of an exam, so generally there is plenty of time to make arrangements. The Department can assess to you the cost of a missed exam, although they rarely do so, particularly if you notify them before the date of the exam that you have a conflict. I would suggest you do your best to arrange childcare. If you absolutely can not do it, contact the CM and ask for the exam to be rescheduled. If the CM absolutely refuses, ask to speak to the Unit Supervisor. Stress that you are willing to go to the exam when rescheduled, you just are unable to make arrangements for childcare for this particular date.

  7. Does a TPA have to inform you they scheduled an IME and can they have one done where you don’t attend? I was never informed by the TPA they scheduled an IME and the IME was done without me attending.

    Are there any laws about doctors who perform IMEs from being associates or partners of doctors that the claimant has seen before? The doctor who “performed” my IME is a business partner of doctor who failed to diagnose the condition and receives referrals from another doctor who misdiagnosed me.

    • It sounds like the TPA had a ‘records review’ done. This is not the traditional independent medical exam – because there is not actual physical exam. The Physician simply reviews the available records and then writes a report addressing whatever question is at issue. And, to answer your question, there are no rules prohibiting a physician from evaluating you more than once, or evaluating you if a colleague has been involved.

      That said, these are all very fertile ground for cross examination. If the TPA takes action based on this records review an attorney will be able to have a little fun;

      “Doctor, when you evaluate a new patient in your practice do you conduct a physical exam?”
      “Doctor, why is that physical exam so important?”
      “Would you agree that a physical exam is important in the formulation of your diagnoses and treatment plan?”
      “Would you agree that you would be in a better position to understand your patient’s condition, after a physical exam, than another physician who never laid eyes on your patient?”

      All kinds of fun . . .

      • The Department of Labor and Industries ordered an IME not a ‘records review’. Does that make a difference or can the TPA do what they want?

      • The TPA can do what they want. But, that might not satisfy the Department. Some issues may be adequately addressed with a records review, making a physical exam unnecessary. Other issues may require the actual physical exam. You may want to talk to an attorney about how best to address the situation.

  8. I recently had a PPD. rating and I am not happy about it at all I had Shoulder Surgery. For the second time on the same shoulder. My first Surgery they had to shave part of my Collar Bone to repair my Rotator Cuff I was sent to a PPD.rating back in 94-95 I was never paid for that, I was much younger and knowledge of this I had none it was an on the job injury been at the company for 29 years. I was given a 4% rating I know Drivers who had the same surgery just with Microscopic and was paid 9,ooo-19,000.Thos dollar amounts were based on 8-12 percent. I had Surgery in 06-30-2009. I have asked for my Rating form 94-95 they have yet to send it to me . I just feel that I am being ripped off again this surgery was to repair the same damage back in 94

    • I would suggest you have your attending medical provider review the PPD rating and give an opinion on the nature and extent of your impairment. If your doctor does not provide impairment ratings, ask for a referral to a colleague who does.

      It is also important to point out that comparisons to other people are not a lot of help. Every situation is so different, and compensation systems are different. Permanent impairment in a WA L&I claim will be very different from a Federal Longshore claim. So, comparing your injury to someone else’s won’t really give you any helpful information.

      Impairment ratings are based on physical findings on exam. Pain, changes in life style, or future medical needs are not factors to be considered. That said, sometimes the impairment ratings just do not seem to compensate for everything you’ve lost.

  9. Is there a set number of IME’s that a TPA can send you to in a set period of time? I was sent to 3 IME’s in 4 months!!!! After winning a long awaited appeal decision in my favor because of the outcome of my 2nd IME(2nd IME in 6 weeks), the TPA immediately sent me to ANOTHER one. I received notification Feb 5, 2010 that per the last IME report, they were submitting my claim for closure. It has been almost 2 full months since receiving that letter, and they have not submitted anything to L&I with regards to closure. CAN THEY DO THAT???? They cut off my time-loss two months ago and are dragging their butts to file for claim closure. Is this legal? I can’t even file an appeal until they submit for closure!
    thanks for ANY input….

    • Unfortunately, many TPAs operate under their own definition of a “preponderance” of medical evidence. Instead of correctly interpreting this to mean the greater weight of the medical evidence, considering the credibility and quality of the medical opinions, they think it means ‘quantity’. So, they schedule serial IMEs to try and get two reports that say the same thing. They then believe they have a ‘preponderance’ of medical evidence. To answer your direct question – no rule which prevents multiple IMEs. Failure to attend without good cause may result in a suspension of further benefits and action on your claim until you do attend.

      Without access to the complete file I can not tell you whether it is appropriate for the TPA to close your claim or not. I can tell you that you should make decisions for yourself about ‘what’s next’. If you think you are not receiving benefits which you are entitled to receive, time to get an attorney on board. If your physician believes you need more medical treatment a report should be sent to the self-insured section of the department outlining the diagnosis and treatment plan, and specifically asking for an order addressing the treatment. If the claim is still open, your Doctor does not have to have preauthorization to refer you for a consultation. Sometimes that can result in obtaining additional medical opinions which support your claim. On the flip side, if you have been released to return to work, you don’t have to wait for the claim to close to look for work. If it is appropriate for the claim to close, ask the department to nudge the TPA to file their SIF-5 requesting claim closure.

  10. my story is similar to the posts here..after being injured 7 years ago,i finally settled with l&i and recieved a pension 2 weeks or so ago..my problem is not with the attorneys fees,although for 4 years,i was belittled,called names,no communication etc..all in all a horrible experience while ive sold everything and almost went homeless,,ok..the lawyer told me that in order to win my case,i had to see “their” doctors for a “counter ime”..1 for a pce,1 for a psyche ime,and 1 for a med ime..which is fine and i did that and we “won” the case when l&1 settled a few days before court predictibly..when i went to pick up the backpay offset check from my attorney i was stunned that a $33,000 settlement,all i got was $7600!! they charged me $14,000 for 3, 1 hour long ime’s plus paperwork!! what a scam..i have no problem paying the 33% attorney fee and 15% of every monthly pension check for the rest of my life.(even though i think thats insanely greedy of attorneys to do that to poor people)..but to charge people $5000 for 1 ime,$3 or 4,00 for another..$40 per page for paperwork etc…dont attorneys and doctors have ethics?

    • Keep in mind these litigation costs are not what the attorney is charging you – they are what the particular expert is charging your attorney. So, I may hire a vocational expert to do a forensic evaluation and provide testimony. That expert bills my office, and those costs are placed on the client’s cost bill. We may pay those costs upfront, but ultimately those expenses are the responsibility of the worker, win lose or draw. We do not have any type of fee or cost shifting in our statutory system when the worker prevails at the Department or Board level.

      If you are facing litigation you should absolutely talk to your attorney about the anticipated litigation expenses. Keep in mind that you are in the driver seat. We only proceed with litigation when the client has told us they want to fight the department for their benefits. In your particular situation, you ultimately prevailed, in large part because the attorney had built a good case. Building that case takes the work of medical and vocational experts, all who expect to and should be paid for their work. If you have questions about the particular charges you should feel free to call the attorney or the office bookkeeper. They should be able to answer any questions.

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  12. I had an IME in July 2010 and now Jan 2011. They are still paying time loss, but nothing moving forward on closure. I had a 48% body part loss, and a 11% total loss as per IME, with NO return to job of injury, and Drs ( IME and my own) have both agreed on limited use of hand. My question is how long will this go on? They are only once a month re-upping the Claims Mgr review for ONE more MONTH. Over and over. I am hoping for a retraining but wonder at this as well as I am nearing retirement age. Any thoughts?

    • If you will not be released to return to work at your job of injury then there will be a vocational assessment. This assessment will be used to determine if you are employable, within your physical restrictions with your current set of transferable work skills, or whether further vocational service are necessary to return you to work.

      It can be a slow and often times frustrating process. I tell my clients to start figuring out ‘what’s next’ in their lives. The Department will go through its process to move the claim forward and ultimately to claim closure. That doesn’t mean you have to put your life on hold. Figure out where you want to go from here, and start moving in that direction.
      And, definitely call an attorney if you have questions or need help with your claim.

      • Spoke w CM today and am puzzled. IME doc states 48% upper body impairment and CM says it is 8%. Which is almost 50% to less than 10%. What am I to expect? How is my settlement based? They are also trying to say I have transferrable skills, which will mean an end to the case and no retraining or “options.”
        Ideas?

      • It’s hard for me to answer your question about your PPD without more information. The AMA Guides for Rating Permanent Impairments has a system for converting impairment ratings based on body part. So, for instance, a wrist impairment is converted to an arm impairment. The wrist is a smaller body part, so the number would be larger. When the rating is converted to the larger body part, the arm, the number is smaller. But it is all done based on charts which make the ratings essentially equivalent. That may be what is at play in your situation, and it may be appropriate. Or the CM may be misreading the report and doing it all wrong. Like I said, hard for me to say one way or the other without knowing more.
        The Department will do, or has done, and Ability to Work Assessment to determine if you have transferable work skills and can return to some type of reasonably continuous gainful employment. You will have an opportunity to dispute this determination to the Vocational Dispute Resolution Office. If you think you do not have the skills which are being relied upon to determine that you are employable you should absolutely file a dispute. Beware, you have a fairly short 15 day window to file a dispute once you have received the employability determination.

  13. What exactly defines the term “Uncooperative” in the minds of L & I ? I recently missed an IME due to having never received a letter that L & I documents as having sent. I asked my claims manager why their wasn’t access to the letter that had directions to the office where I was supposed to appear for the IME ? If their website had this information posted, it would prevent this kind of failure, be it L & I or the Post office or whomever was at fault. This website is taxpayer funded, so all information pertinent to an IW should be available and at the immediate disposal of the IW…for instance if an IW were to be required to travel for an appt., and needed some relevent information, for instance Address or Phone number to contact the Dr.,this information should be readily accessible so as to prevent missed appointments.

    • If the Department believes you are not cooperating with the process of obtaining medical or vocational exams they will send a ‘noncoop letter’. You will have an opportunity to provide a written explanation with good cause for the situation. It is not unusual for an exam date to get miscommunicated, or for a worker to have car trouble or some other reasonable explanation for the missed exam. Take the opportunity to provide a written explanation, indicated that you are willing to attend the exam when rescheduled. Benefits will only be terminated if you have no reasonable good cause for the action which the department is viewing an noncooperation.
      You should also know that all of your claim information is available on-line. The department has a Claim and Account Center. You have to register and get a password. Once you have access you can see everything in your claim file, including letters which were sent but you might not have received, or received and lost. This is a really great resource and will allow you to keep in touch with the action being taken on your claim.

  14. i have been through surgery for shoulder inpengment, low ab hernia, spain lumbroso, and low back pain, surgen for shoulder say i will not return to gainfull empolyment, my pa doctor says i can never do construction or dry wall again, “hanger taper drywall 27 yrs” im 50 yrs old, all injurys were at the same time, took over 4 months for this L&I doctor to even allow a MRI, 8 months after injury before surgery, which my surgen say ruined the biceps, triceps ” have a right arm of a 5 yr old now can only lift 7 lbs, lift hundred LBS many times a day for yrs, and im right handed, this after 4 months from surgery, and now has 1 yr from injury, they gave me a IME,….what same doctor that let my arm shrink to nothing before he would even do the MRI, is the IME…! he then spent 15 minutes in the room he poke me with a pin, had me stand up, bend over, lift elbows, raise my arms then sit, ask me if i had stomch issue i said yes, he said its not related to you injury, see a gastroaligist” spelling ?”, told him about the pain in my biceps was still wild burn all the time, itched arm pit as well, said good its healing, found i have bad arthritis in my spine L1& L2 are coated and disc is thined, low L4&L5 have swelled disk and my hip is missallined, said that i was getting old, it happens, have nerve damage as well from hernia, blue ball syndrom? touch me wrong and its like being nailed in the balls after affect, as well as a constaint burning under the skin above the scar, he said how i feal does not matter, only if injurys are repaired.
    now his very short report show’s on the L&I page Iparment rating 1 to 0, or as 0
    notes say healthy male 50 yrs of age no complaint or issues scare”s healed nicely
    no difformitys, ready to return to work, or go training,
    WTF
    i have been rated as 43% on my arm but he wave it as 100% because he said you had a impingement, your arm was locked, you had surgery, now its free , thats fixed thats what we do, your out of shape and need to get back out there, “pat” on the back you can do it (RAGE)
    so basicly he blew off everything, and said good to go, no pay off, can never do my job again,
    50k a year, and fought them 8 months just to get 700.00 every 2 weeks and they say its 65% …..of what?
    feel burned and about to be throne away like trash

    • You are obviously frustrated and angry. Often a work injury can turn your life upside down and the constraints and administrative processes involved in a workers compensation claim can compound those feelings. I tell all my clients, you are in charge of the rest of your life, not L&I. While I can make sure you get the benefits you are entitled to receive, you are the only one who can get your life back on track. I suggest you get an attorney. If nothing else, having a go between to work with the claims manager and answer your questions can reduce some of the stress and anxiety.

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