medical evaluation

How Diagnostic Tests Can Affect Your Workers Compensation Claim

June 13, 2020 By James Hoffmann Leave a Comment

Diagnostic testing may be requested by the insurance company in order to confirm an injured worker’s diagnosis.

Diagnostic testing is a process of evaluating a person’s medical status to either reach or confirm a diagnosis.

Testing takes on many forms, from X-rays, MRIs, blood tests, or even CAT scans. A medical professional will choose which tests to perform on a patient based on the symptoms they are showing, which will also help them determine the treatment needed.

However, diagnostic testing may also be requested by the insurance company in order to confirm an injured worker’s diagnosis.

Why Would They Require It?

Virtually the only real reason the insurance company can ask for diagnostic testing in a workers’ compensation case is to confirm a worker’s diagnosis.

Usually, whenever a worker’s comp case reaches the insurance company, an adjuster will analyze the claim and first see if it has merit, by determining if, in fact, the worker’s injury or illness is a result of employment. Under Missouri’s worker’s compensation laws, workers can only access these benefits if their condition is a direct result of their job.

For common injuries like slip and falls, chances are rather low for anyone to doubt your claim (though it does happen). But for more complicated conditions, it’s likely for the insurance company to ask for additional tests, usually ones done by doctors they have worked within the past.

How Diagnostic Tests Can Affect Your Worker’s Compensation Claim

Your entire claim could very well depend on the diagnostics test. Consider this scenario: you file a claim with your employer to receive treatment for asthma. You work on a construction site and often inhale many chemicals and particles, which over time has led to asthma.

However, the insurance company may not be that convinced this is true. It could be that you haven’t worked on the site that long, so they question if the job itself leads to the condition. Or, they had another doctor look at your file, and the doctor believes you don’t have asthma, just another, maybe smaller issue.

In either case, the insurance company can take their doubts and ask for another diagnostic test. If the test they run comes with a different result, your entire claim can be dismissed, or you may end up seeking treatment for a different condition.

What Are Your Options?

The diagnostic testing won’t necessarily break your case since it will be done by a medical professional, but there is a chance it could.

Medical testing isn’t a perfected science as people would like to assume, and sometimes the results can be interpreted differently by different doctors. To protect your rights, and your benefits, get in touch with an experienced workers comp attorney.

They can step in and make sure the insurance company does not take advantage of your situation.

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What is a Functional Capacity Evaluation and How Does it Impact my Workers Comp Claim?

September 4, 2019 By James Hoffmann Leave a Comment

Your doctor may recommend a Functional Capacity Evaluation. If so, you are probably wondering what this means, and how it could impact your claim.

FCE (Functional Capacity Evaluation) is a type of evaluation done to see if an injured worker has recovered enough from their injuries to go back to work. They are like physical therapy sessions where you are asked to perform a series of tasks, and one session can take up to three or even four hours. The tasks can vary, but you may be asked to lift weights, stretch, walk, bend, and other exercises to see how your physical condition is.

An FCE is generally nothing to worry about. However, you should know some things going in.

Why Are They Needed?

At some point, your doctor will need to decide if you are able to go back to work. However, though they know a lot about your medical condition, they are not trained to assess your physical abilities to perform certain tasks, which is why the FCE is done by another professional.

The person who performs the evaluation will record your performance and send it back to your workers’ comp doctor for analysis. In many cases, doctors will decide whether you are capable of resuming normal or modified work activities based on the evaluation.

However, the FCE is not a simulation of a normal day in your workplace. It has a set of physical exercises that, in some cases, have nothing to do with your work. As a result, it is possible to score well on the FCE, but not be able to resume your work.

Can I Lose My Benefits?

If the FCE determines you are capable physically to perform a variety of tasks, and your doctor clears you for work, then yes, you will no longer receive workers comp benefits. The problem is, if you go back to work, and are unable to perform your regular activities because your condition hasn’t improved yet, you’ll most likely need to be given another position that can accommodate you.

However, if you’re employer does not have such a position available, unfortunately, it is possible to lose your job. This is why it’s so important to educate your doctor on the particularities of your job. When they receive the FCE, tell them if the activities you were asked to perform don’t resemble in any way the physical strain your job normally poses.

What Can You Do?

You have the legal right to refuse to perform any task the FCE therapists asks you to. To protect your rights even more, you can take a friend with you and have them record the session.

It is also a good idea to speak with a St. Louis workers compensation attorney, who may accompany you to the meeting, and intervene if needed. Additionally, a lawyer can help you fight to keep your benefits until you’re fully recovered.

How to Communicate Effectively With Your Workers’ Compensation Doctor

November 12, 2018 By James Hoffmann Leave a Comment

Following the tips on this list will help keep you and your workers’ compensation doctor on the same page.

One of the crucial steps in the workers’ compensation process is when you see your company doctor. The reason is that the extent of your damages informs your entire claim, and a doctor is the one that judges that. Thus, it is incredibly important to communicate effectively when you reach this stage. Here’s how.

Come Prepared

One of the worst things you can do when you see your doctor is fail to be ready for the assessment. But what does being prepared mean? For work injuries, you will want to recall your story leading up to your accident, pain, and limitations. The best way to do that is by writing everything down. Even if it feels strange to come to the doctor with a notebook, doing so is a smart idea.

Say More Rather Than Less

The last thing you want is for the doctor to assess you based on limited information. If that happens, your report could end up missing critical details. The possible result of falling into this trap is you getting fewer benefits than you deserve because the doctor didn’t know how severe your damages were. You can avoid this mistake by sharing the true extent of your injuries.

Listen Carefully

The other side of the coin is listening carefully. The doctor will likely tell you how you should describe your pain, what your damages are, and what your treatment options are going forward. You’ll want to understand these issues well. One way to do so is by writing everything down or requesting that the doctor provide a copy of medical records.

Ask Questions

Just because the doctor is an expert and you aren’t doesn’t mean you shouldn’t ask questions. Instead, you should fully understand your physical state and how you can get better. The best way to do that is by asking a lot of questions and resolving any gaps in understanding.

Be as Accurate as Possible

Two mistakes workers often make are overestimating and underestimating their injuries. Your personality will likely dictate which you are more in danger of. For the former, you could lose your benefits later on because your overestimate is seen as a lie. As far as the latter, you might get a meager compensation package because you described your injuries as less severe than they really were. Both outcomes are unfavorable.

Share Your Opinions and Preferences

Though the doctor is the expert in the room, you know how you’re feeling better than anyone else. If a treatment option doesn’t sound right to you, don’t accept it right away. Instead, do your best to share your opinion with the doctor and get an explanation for why your gut feeling might be wrong or right.

Following the tips on this list will just about ensure that you and your doctor are on the same page. That being said, sometimes workers find that they cannot communicate well with their medical provider, despite their best efforts. This and other circumstances often complicate the workers compensation process. Therefore, it is always a good idea to get in touch with an experienced St. Louis work injury lawyer as soon as possible following a work-related injury. Your attorney can access your claim for FREE and help protect your legal rights every step of the way. Give the Law Office of James M. Hoffmann a call 24/7 at (314) 361-4300 for a FREE Case Evaluation.

How Functional Capacity Evaluations Affect Workers Comp Cases

October 17, 2018 By James Hoffmann Leave a Comment

At some point in the workers’ compensation process, your employer may ask you to take a functional capacity evaluation (FCE).

A function capacity evaluation will assess your physical capabilities post-injury. If you are well enough, you may be able to come back to work. Even if you are not, the result can help you and your St. Louis work injury lawyer fight for your workers comp benefits. Here is what you need to know about these tests.

What Are They?

A functional capacity evaluation is a test given to injured workers to understand the extent of their injuries. If you receive one, your ability to do things like walk, lift objects, and complete other physical activities will be tested.

Why You Might Receive One

There are many reasons why you might get an FCE. The following are a few of the most prevalent.

Disability Eligibility – One benefit you might receive is for disability, which is given to those that cannot complete regular work activities. An FCE can prove your physical condition.

Medical Needs – FCEs can tell you and your lawyer if you will incur extensive medical costs when caring for your injuries.

Returning to Work – At some point, your damages may subside and you will be eligible to come back to your job. FCEs can tell your employer if that is possible.

Who Will Give It to You

Two professionals might administer an FCE. The first is your company doctor, provided that they have a certification to do so. If they do not, the company doctor will outsource the task to another medical professional that does have a certification. Often, this person’s official position is as an FCE Technician.

What to Expect from an FCE

At first, the technician will likely ask you a series of questions about your job, injury, and health history. Once they have an idea of who you are and what your damages are, they may explain how to describe your pain. That usually means using a specific type of language to tell them where you’re hurting and how badly. Lastly, they will likely have you complete regular job functions such as standing, walking, pushing, reaching grasping, balancing, bending, and more. As you complete these tasks, they will take notes on how you look and when you feel pain.

How They Affect Workers’ Compensation Cases

If you receive an FCE soon after your injury, the results can inform you and your lawyer on how much compensation you deserve. If your abilities are compromised, they will likely entitle you to more benefits. Additionally, those results can tell you about how much money you’ll need to spend on physical therapy going forward. Lastly, an FCE can tell your employer whether or not you can come back to work. If you do well in the test, you may return to your old position or start working in a light-duty capacity. In these situations, your compensation would typically stop.

Now that you understand FCEs, you have a general idea of what to expect if you receive one. No matter what the results are, they are generally a positive thing for you. If you perform well, that means your health is improving. If you do not, you may be able to raise the sum of the benefits you are entitled to.

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What If the IME and My Physician Disagree?

March 28, 2018 By James Hoffmann Leave a Comment

In Missouri, if you hurt yourself while you are work and performing under the scope and authority of your employment duties, then you are generally entitled to workers’ compensation benefits. Workers’ compensation is insurance coverage that is meant to cover an employee in the event that they are hurt while working.

There are very specific things that you have to prove to collect workers’ compensation benefits. The first is that you were engaging in work-related activities.

The Next Step

If you can prove that you were engaged in a work-related activity when injured, you must then show that you were in fact injured and to what extent. To do so, you have to seek medical attention to document what happened and to verify that you not only were hurt, but also how severely you were hurt, what your prognosis is, and what type of treatment you will likely need to recover from your injuries.   The extent of your injuries will determine what benefits you are entitled to. For workers’ compensation, you are eligible to receive economic damages for medical costs and lost wages. If the injury is severe enough, you are also eligible to collect temporary disability or – in extreme cases – permanent disability payments. If you collect temporary disability benefits, you will get a portion of your salary while you are unable to work. The aim is for you to heal and return to work as quickly as you are able to do so.

What is an IME?

An Independent Medical Examination is when the workers’ compensation insurance carrier demands that you be evaluated by another medical professional. If the insurance company either believes that your injuries aren’t real, that they aren’t as severe as you claim, or even that they weren’t related to work activities, then they might require you to see another physician. It is their obligation to pay for the evaluation. However, you generally do have to comply, or they can deny your benefits going forward.

So What If the IME and My Physician Disagree?

If your physician and the IME come to a different conclusion, then the insurance company might try to deny you coverage, cut your benefits and demand that you return to work. However, you do have the right to appeal the IME’s diagnosis. In some cases the IME can be overridden, and your benefits will not be discontinued.

If you are asked to participate in an IME in Missouri, it is usually because the insurance carrier believes that either your physician has misdiagnosed your injury, exaggerated it, or that the injury didn’t happen the way that you claim. The intent is to try to limit their liability. Even if the IME doesn’t agree with your physician and the insurance company denies your claim, you do have the right to appeal the decision. To ensure that you get your case heard and that you have someone on your side it is imperative that you speak with an attorney who has experience handling Missouri workers compensation claims to help you get all that you are entitled to and have the time and resources to heal. For a FREE case evaluation, call the Law Office of James M. Hoffmann 24/7 at (314) 361-4300.

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Do I Have to Comply With a Request For an Independent Medical Evaluation?

March 4, 2018 By James Hoffmann Leave a Comment

By denying the IME, you risk losing your workers compensation claim and ending up with nothing.

It is a law in the state of Missouri that all businesses or organizations with employees carry workers’ compensation insurance coverage. It’s not just used to cover an injured employee if they are hurt, it also ensures that one workplace accident with an employee doesn’t completely bankrupt a company or business. Workers’ compensation coverage will pay for anyone who is hurt while they are performing under the scope and authority of their employer.

Personal Injury vs. Workers Compensation

The major difference between personal injury and workers’ compensation is that when you make a workers’ compensation claim, although it isn’t based on any negligence on behalf of your employer, you are not entitled to receive any non-economic damages like pain and suffering. The trade-off is that a worker can be 100% at fault for their own injuries and still file a claim, as long as they can prove that they were doing work-related activities when the injury happened.

When you file a workers’ compensation claim, it is imperative that you have the proper documentation to show that you were not only injured, but also that you were injured while working under the authority of your employer. If you can prove those two things, then the only other issue might be the severity of the injuries that you are claiming. There might be times when an insurance company will question not just whether your work injuries were sustained while you were engaged in work-related activities, but also whether your injuries are as severe as you claim – or if they are even real at all.

Complying with the IME

If you have documentation from a physician, there are times when an insurance company will ask you to comply with an independent medical evaluation, or an IME. When asking for an independent medical examination, the insurance company will want you be evaluated by someone other than your own physician, to make sure that both physicians have the same diagnoses and conclusions regarding your injuries. The insurance company has the right to demand that you see someone that they choose. And although they have to pay for it, you do not have the right to deny the IME request – or you could risk losing your claim and ending up with nothing.

When to Hire a Workmens Comp Lawyer

If it is found that the IME disagrees with your physician’s recommendations or diagnoses, then there is a way to argue your case so that you don’t end up not getting your medical bills paid or having to return to work before you are healthy enough to do so. The best way to handle any discrepancy is to hire a St. Louis workers’ compensation lawyer to argue your side and to ensure that you receive the settlement that you deserve – not just for the here and now, but for any medical problems that could arise in the future. A St. Louis workers’ compensation attorney can help walk you through the complexity of the demand for an IME and any related issues.

If you have been injured at work and are having your claim denied, contact the Law Office of James M. Hoffmann today. We have more than 20 years of experience with helping injured workers receive the benefits they need and deserve. Call us at (314) 361-4300 or fill out our online case evaluation form to request a free consultation.