The Workers’ Compensation Medical “Evaluation”
FREE CONSULTATION
30 YEARS EXPERIENCE
OVER $100 MILLION COLLECTED
ONLY WORK COMP
I don't like insurance companies and only represent the injured. I am not a large advertising law firm that settles cheap to meet monthly quotas. We fight hard for every client. The compensation we obtain for the injured is both federal and state tax free. We never ask our clients for a penny as all cases are handled on a contingency fee.
James Hoffmann
314 361 4300
[email protected]
FYI. There are a lot of TV ads and billboards claiming "bigger is better." That is not true. Some of those firms are from out of state and simply hired a few attorneys here in Missouri. And, always remember, quality over quantity. One good trial attorney is way better that 100 average attorneys who only settle cases to meet monthly quotas to pay the millions in advertising fees.
Law Office of James M Hoffmann LLC
Jim Hoffmann
2001 S. Hanley, suite 325
St. Louis, MO 63144
314 361 4300
[email protected]
God bless, love and hugs
Jim
Fighting for the injured.
James Hoffmann
Your Missouri car accident and workers comp lawyer
314 361 4300
[email protected]
Proud to fight for the injured.
Law Office of James M Hoffmann
2001 S. Hanley suite 325
St. Louis, MO 63144
314 361 4300
[email protected]
James Hoffmann
St. Louis, Mo work comp and car accident lawyer
314 361 4300
Law Office of James M Hoffmann
314 361 4300
[email protected]
Law Office of James M Hoffmann
2001 S. Hanley, suite 325
St. Louis, MO 63144
314 361 4300
[email protected]
Your Missouri car accident and workers compensation attorney
Glad to help. All cases on a contingency fee which means we will never ask a client for a penny.
Law Office of James M Hoffmann
James Hoffmann
Remy Hoffmann
Missouri personal injury attorneys
314 361 4300
[email protected]
The LIRC in Nouraie v. MO. Baptist Medical Center et al, Injury No.: 10-111746, March 13, 2013, sanctioned the employer for refusing medical care in connection with a repetitive use claim. The Employer obtained an expert long after the wrongful denial of benefits. This did not justify the prior wrongful denial. The LIRC explained:
“In any event, whether an employer has sent a worker for a medical examination prior to denying a claim is a factor for our consideration in determining whether an employer had reasonable grounds for denying a claim.”
The LIRC in Nouraie also explained:
“The courts have instructed us we are only to award such costs “where the issue is clear and the offense egregious.” Landman v. Ice Cream Specialties, Inc., 107 S.W.3d 240, 250-251 (Mo. 2003). We think it is clear that employers have an obligation to investigate the circumstances giving rise to alleged work injuries before denying benefits. And where the worker is available to discuss the injury, we think any reasonable employer conducting an investigation designed to determine whether an injury is work-related would discuss the alleged injury with the worker. In the instant case, Ms. Bequette, as employer's agent, denied evaluation, treatment and benefits to employee without even discussing employee's alleged back condition with employee. We think employer's act of denying workers' compensation benefits to employee before even discussing the alleged injury with employee constituted an egregious offense. Based upon the forgoing, we find employer defended this claim at the outset without reasonable ground.”
Merry Christmas.
James Hoffmann, Missouri work comp and auto accident attorney
314 361 4300
[email protected]
Claimant, a full-time carpenter for Employer, developed low back pain in September of 2017 making cabinets and displays for the Employer. Claimant’s job is physically demanding. Cabinets and displays can range from 60 to 500 lbs. Claimant job duties include lifting displays weighing up to 500 hundred pounds during the assembly process. Carts, each with 100 lbs of materials, are brought to Claimant who must lift the materials from each cart and assemble same. In October 2017, Claimant’s job duties caused his low back soreness to become severe pain with numbness down his right leg. At the final hearing, the Employer/Insurer produced no evidence of non-work activities that could have caused, or did cause, Claimant’s low back pain.
When Claimant’s low back pain became severe in Oct. 2017, he sought treatment with a chiropractor, Dr. Lynch, on 10/17/20217. Claimant then, on 10/23/2017, reported to Employer a repetitive use work injury to his low back. He went sent to Concentra by the Employer but left due to delays in providing immediate treatment as he had severe pain and radiculopathy. He went immediately to an urgent care and returned to work with a light duty slip for 6 weeks for which the Employer complied.
Despite asking the Employer for additional treatment during the next few months, none was offered. He kept the Employer informed of the treatment he was receiving on his own. IN December 2017, Claimant contacted attorney James Hoffmann who instructed Claimant to hand deliver a letter to the Employer making a written demand for treatment. Claimant delivered the letter in December 2017. At the hearing, Employer presented no evidence that it disputed the contents of the letter.
Immediately after receiving the letter, the Employer contacted the Insurer which then sent medical authorizations to Claimant who signed and immediately returned same to the Insurer. The Insurer then obtained a statement from Claimant in Dec. 2017 where Claimant informed the adjuster of a repetitive use low back injury at work and need for treatment.
After 6 weeks of light duty, Employer requested another light duty slip which Claimant provided.
Claimant continued to work light duty until Feb. 15, 2018, when Employer informed Claimant there was no more light duty and sent Claimant home. In the meantime, neither the Employer nor the Insurer offered treatment. The Employer’s attorney was aware of Claimant’s treatment as he was sending copies of Claimant’s medical records to Claimant’s attorney received via the authorizations signed by Claimant.
In Feb. 2018, Claimant’s attorney obtained a medical report from Dr. Armond Levy who related lumbar disc herniations and the necessity of surgery to Claimant’s work for Employer. Several demands were sent IN Feb. 2018 to the Employer for the surgery recommended by Dr. Levy and for TTD. At the hearing, Employer presented no evidence of any response to the demands for treatment and TTD made by Claimant’s attorney in February 2018.
Claimant then underwent 2 surgeries on his own for his low back, the first being in March 2018 and the second in August 2018. During that time, no TTD or treatment was offered. When Claimant returned to work in November 2018, after recovering from the second surgery, he was informed by the Employer that he was fired.
The Employer eventually sent Claimant to a physician, Dr. Bernardi, in November 2018, who is of the opinion that a person cannot suffer a repetitive use herniated disc. It is his opinion that herniated discs can only acute, and that any degenerative changes in the low back are genetic and cannot be caused by repetitive use occupations. In other words, Employer sent Claimant to a doctor who disagrees with Missouri law which specifically recognizes and accepts repetitive use injuries. Claimant had zero chance of a favorable opinion from Dr. Bernardi
This is the lawyer you want to hire! Just read the reviews. It is all true. Incredible! He will get you every dollar of lost wages, get you every ounce of medical treatment, and get you the highest possible award from the Division of Workers Compensation.
Law Office of James M. Hoffmann
2001 S. Hanley, suite 325
St. Louis, MO 63144
314 361 4300
[email protected]
Your Missouri workers comp and car accident attorney.
So, why did the doctor shave areas in the knee that were not symptomatic? Look at the bill: a meniscus surgery is onl $3000; but for every other area he "cleaned up", he gets $3000 for each area.
Law Office of James Hoffmann
314 361 4300
[email protected]
Your Missouri workers comp and car accident lawyer
James Hoffmann
314 361 4300
[email protected]
Law Office of James Hoffmann
314 361 4300
[email protected]
James Hoffmann
attorney
St. Louis workers comp and car accident lawyer
314 361 4300
[email protected]
I have represented numerous first responders in Missouri workers comp and car accidents. Heavy ambulance doors have caused severe post concussion syndrome and TBI's. Lifting victims has caused herniated discs requiring cervical and lumbar fusion surgeries. Glad to help our hero's.
Law Office of James Hoffmann
2001 S. Hanley, Suite 325
St. Louis, MO 63144
314 361 4300
[email protected]
Law Office of James Hoffmann
St. Louis personal injury and work comp lawyer.
314 361 4300
[email protected]
Per Tillotson v. St. Joseph Med. Ctr., 347 S.W. 3d 511 (Mo. App. W.D. 2011) to determine need for treatment, surgery, and treatment after surgery. Treatment need only be reasonably required to cure and relieve the effects of the injury. Id. Section 287.140.1 RSMo states in pertinent part that the Employer shall provide such medical as may “reasonably be required.
To be entitled to future medical care the employee must establish that there is a reasonable probability that he will need future medical care. Forshee v. Landmark Exc. & Equip., 165 S.W. 3d 533 (Mo.App. E.D. 2005) An [Employee] does not have to provide evidence of specific medical treatments or procedures which will be necessary in the future in order to receive an award of future medical care. See Chatmon v. St. Charles County Ambulance, 55 S.W.3d 451, 459 (Mo.App. E.D. 2001).
Employee has already satisfied the burden of proving a compensable injury. Here, defense's authorized Dr. Spears on 4/26/2010 opined "if she doesn't get improvement in her radicular pain, then the next step is going to be a microscopic transforaminal lumbar interbody fusion to remove the foraminal stenosis." He went on to state the January 2010 incident was a "fall (that) aggravated significantly a pre-existing condition". This is enough under Tillotson, Forshee, and, Chatmon (supra) to award further treatment.
Please also see Maness v. City of De Soto, 421 S.W.3d 532 (Mo. App. 2014). The court rejects Employer's contention that the mere existence of degenerative disc disease in the cervical spine and neck symptoms prior to the work accident requires a determination that Claimant's injury is not compensable.
See also the following in support:
If the evidence establishes that an accident caused a
disability or aggravated a preexisting condition or infirmity of an employee,
which produces a condition that would not have resulted in a normal, healthy
individual, an award is authorized. Fogelsong v. Banquet Foods Corp. 526
S.W.2d 886 (Mo. App., K.C.D. 1975)
An aggravation of an existing infirmity caused by an accident or occupational
exposure arising out of and in the course of employment is compensable under
Chapter 287, RSMo, even if the particular accident (occupational injury) would
not have produced such result in a normal and healthy individual. Mashburn v.
Chevrolet-Kansas City Division, General Motors Corp., 397 S.W.2d 23 (Mo.
App., K.C.D. 1965)
Law Office of James M. Hoffmann
2001 S. Hanley
St. Louis, MO 63144
314 361 4300
[email protected]
James M Hoffmann, attorney
2001 S. Hanley, suite 325
St. Louis, MO 63144
314 361 4300
[email protected]
I see this all the time with neck injuries, low back injuries, disc herniations, rotator cuff tears, meniscus tears: doctors do surgery under workmans comp and then blame ongoing pain on a made up pre-existing condition.
James Hoffmann
Your Missouri workers comp and car accident attorney
314 361 4300
[email protected]
Law Office of James M. Hoffmann
St. Louis, MO car accident and workers compensation lawyer
314 361 4300
Glad to fight for the injured worker in Missouri.
Law Office of James M. Hoffmann
St. Louis, Missouri workers comp, car accident, injury attorney.
314 361 4300
[email protected]
These reviews are correct. This attorney is incredible. He knows workmans compensation, fights for denied treatment and wages, and gets your on the job injury rated by the best doctors. I will be using him from here on our great experience.
It does not take a large law firm to fight an insurance company. It takes a good lawyer. There's a reason why injured insurance adjusters and injured insurance doctors call me to represent them. They know I fight and will not back down.
Law Office of James M. Hoffmann
St. Louis, MO workers comp and auto accident attorney
314 361 4300
[email protected]
If the doctor says that you suffered a compensable injury by accident, then the legal standard for determining employer’s obligation to afford medical care under the Missouri workmans comp law requires the employer to provide treatment reasonably required to cure and relieve the effects of the injury. The prevailing factor standard no longer applies.
Further, it is immaterial that treatment may have been required because of the complication of a pre-existing condition or that treatment will benefit both the compensable injury and a pre-existing condition.
The fact that medical treatment may also benefit a non-compensable earlier injury or condition is irrelevant.
Whether or not claimant may have needed future treatment even if the injury did not occur is irrelevant to the analysis of whether future medical care flows from the injury actually occurred. With respect to permanent partial disability it is immaterial that the employee had a prior condition as an employee is entitled to compensation for disability rising out of the medical treatment reasonably required to treat the injury.
With respect to future medical benefits, the claimant need only show reasonable probability because of the work-related injury, future medical treatment will be required. A claimant need not show evidence of the specific nature of the treatment required.
In other words, prior conditions, such as arthritis, is irrelevant if the doctor says you suffered a work injury. The employer/insurer must treat both.
James Hoffmann
St. Louis, Missouri workers comp and car accident lawyer.
314 361 4300
[email protected]
The Law Office of James M Hoffmann was referred to me from a previous client, that was extremely impressed, with his service and outcome.
I met with Jim Hoffmann to discuss a car accident. Three cars were involved, my car was totaled, and I was seriously injured. After meeting with Jim the very first time, I immediately felt comfortable, and knew that he would have my back, and would fight for me.
Throughout my journey, I dealt with a lot of pain and several issues that lasted for years. During this time I had to contact Jim and Jamie (Jim’s wonderful assistant) many times. Every time I sent an email with questions, I received feedback extremely quickly!
I feel Jim negotiated a great settlement for me!
The Law Office of James Hoffman will be the first place I contact if I ever need his help again!
Suzanne Charles
James Hoffmann
St. Louis, MO auto accident and workers compensation lawyer
314 361 4300
Glad to fight for the injured Missouri worker and those injured on car accidents.
James Hoffmann
Missouri personal injury attorney
314 361 4300
[email protected],
Jim Hoffmann
Missouri workers compensation and car accident attorney
314 361 4300
St. Louis, MO
Compensation? Get this lawyer. Simply better than all the rest.
James Hoffmann
314 361 4300
[email protected]
James Hoffmann
Missouri workers compensation and auto accident lawyer
314 361 4300
[email protected]
Writing a proposed award for an upcoming work comp trial for an injured Missouri worker. L4-S1 lumbar fusion with plates and screws. Pursuing permanent and total disability plus denied medical. Here is the case law on denied medical in MO workers compensation:
The employer is held liable for medical treatment procured by the employee only when the employer has notice that the employee needs treatment, or a demand is made on the employer to furnish medical treatment, and the employer refuses or fails to provide the needed treatment. Hawkins v. Emerson Electric Co., 676 S.W.2d 872, 880 (Mo.App.1984).
The courts have consistently held that an award of past medical expenses is supported when the employee provides (1) the bills themselves; (2) the medical record reflecting the treatment giving rise to the bill; and (3) testimony identifying the bills. Martin v. Mid-America Farm Lines, Inc., 769 S.W.2d 105, 111-12 (Mo. 1989).
The pertinent case law requires employee to prove that the past medical expenses were “due” to support an award of interest. McCormack v. Stewart Enters., 956 S.W.2d 310, 314 (Mo. App. 1997). As explained in McCormack, this means employee must show that he actually paid the bills, or received demands that he pay interest on the bills, or suffered some other loss, such as a doctor refusing to provide additional treatment until employee paid his bill. Id.
Law Office of James M. Hoffmann
314 361 4300
James Hoffmann, attorney
314 361 4300
[email protected]
Gold bless
James Hoffmann, attorney
314 361 4300
Law Office of James M Hoffmann
St. louis, MO injury attorney
314 361 4300
Want to avoid the following common scenario?
Your employer and their workers’ compensation insurance company immediately retain counsel to fight you. I strongly recommend that every injured employee immediately hire an experienced workers’ compensation attorney who can put an end to the games played by insurance adjustors.
Reporting Your Injury
If you are injured on the job in the state of Missouri, you have 30 days to report the injury to your employer. The employer’s rules cannot shorten this time. They may try to bully you by saying you failed to comply with the employer’s 24 hours reporting rule and, therefore, do not have a claim. However, in fact and law, you have complied with the reporting requirement by either telling your supervisor, filling out a reporting form, or by a note from you to the HR manager. There are multiple ways to report an injury. If the employer ignores your verbal report, then hand deliver a letter to them and be sure to retain a copy.
After several days, an insurance adjustor calls you and requests a recorded statement. You’re told that no treatment will be provided until after an investigation is performed. Missouri workers’ compensation laws do not allow this conduct. Once your injury is reported, the employer/insurer must provide medical care. Do not give a recorded statement. If the adjuster refuses to provide medical care, fax a letter to the adjustor confirming his or her conduct; then give a note to your employer explaining what the adjustor is doing; report the conduct to the MO Div. of Workers’ Compensation Fraud unit in Jefferson City, MO; and seek treatment on your own so that you have medical documentation of a work related injury.
Workers’ Compensation Medical “Evaluation”
You then receive a letter or call from the workers’ compensation insurance adjustor that an “evaluation” has been scheduled with a doctor. You think it’s for medical treatment, however, upon arrival at the doctor’s office you are asked to fill out pages of intake forms which contain numerous questions about how the injury occurred, your past employment history, and questions like “did you report the injury?”. Many questions are ambiguous and never asked by a true treating physician. Many questions only have space for a yes or no answer when the answer is not as simple as yes or no and you need to write an explanation. The body chart is poorly drawn and they want you to mark several different symbols only on the body chart when you would rather just write an explanation. They refuse to let you leave with the Questionnaire and say that the appointment will be cancelled if you don’t complete it before your appointment time. And you think… this is going to be my doctor???
Write anything you want on the doctor’s intake forms. Scratch through “yes or no” and write out your explanation. Write anywhere you want. Write in the margins. Write on the back side. Ask the receptionist for a blank piece of paper if needed. If parts are confusing, write “this is confusing…I am here for back pain and leg numbness from my work injury”. Don’t let anyone push you around.
On numerous occasions, clients have told me they had to wait 2 or more hours to finally see the doctor. My recommendation is this: after one hour tell the receptionist you are leaving. Then, give a note to the claims adjustor that you left the doctor’s office after waiting more than an hour past your scheduled time. In your note, request a physician that will be timely, courteous, and professional.
If you do actually see the doctor, you have the right to record the evaluation. Tell the doctor that you are recording the evaluation. Use a video camera if possible.
You are surprised when the doctor tells you that he is not authorized to treat you but was only authorized by the work comp adjustor to do an “evaluation.” Frustrated, you explain that your back pain is from your work injury, that your leg is getting number by the day, that you can’t sleep at night, that your supervisor is harassing you because you take unscheduled breaks for back pain and are working slower. You explain that you waited 3 weeks for the appointment and that the claims adjustor said it was for medical treatment. The doctor then won’t answer any of your questions and says that a report will be sent to the adjustor. Weeks later, you are still waiting, still in pain, and your boss is still picking on you.
Contact Us for a Free Case Evaluation
The above scenario is not uncommon. In fact, from the moment you are injured on the job it becomes you versus your employer, a billion dollar insurance company, their doctor, and attorney. To ensure that your legal rights are protected and that you are appropriately compensation for your work related injury, it is important that you speak with an experienced workers’ compensation lawyer. Call our law office today at (314) 361-4300 to speak with a St. Louis workers’ compensation lawyer with over 30 years of experience. We can provide you with free advice with no obligation.
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