Tag Archives: doctors

Contact a Workers’ Compensation Lawyer, Even if Your Medical Bills Are Being Paid: Here’s Why

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Nebraska is a state that has a “prompt payment rule” for medical expenses in workers’ compensation cases. This means that so long as your employer has sufficient knowledge that your medical care is necessary because of the injury, your bills should be paid. This is a huge plus because even a minor workers’ compensation injury can cause an employee to rack up thousands of dollars in medical bills.

In Nebraska, delay of medical payment is treated as a denial of a claim. That is why a delay in paying for medical bills from a work injury gives the employee the right to pick their own doctor for a work injury.

The issue of doctor choice brings up a couple of the hidden dangers of the prompt payment rule.  Many times, employers will promptly pay medical expenses for doctors who will oftentimes release employees before they are done healing and return employees back to work before they are ready. Employees need to be able to know their doctor-choice rights before they agree to an employer/insurer-oriented clinic or doctor – especially if that doctor is not their family doctor.

Secondly, employees can get lulled into contentment when an employer pays their medical bills. Medical benefits are one aspect of workers’ compensation benefits; the other is loss of income benefits. An employer/insurer may use their leverage with a doctor to minimize loss of income benefits. Also, when employees get into litigation, they are oftentimes confused by the fact that an employer will pay for medical benefits, but not loss of income benefits, or will deny that the injury is even work related. This is related to the prompt payment rule. Just because an employer pays medical bills, that doesn’t necessarily mean that they or a workers’ compensation judge will believe those medical bills are related to the work accident.

Are Big Business and Big Insurance Making Nebraska Doctors Scapegoats?

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New legislation has been proposed to reduce the quality of medical care for workers under the guise of reducing costs

Evidence-based medicine and utilization review (EBM/UR) of medical care for workers’ compensation are currently being pushed by big business and big insurance interests.

We are facing such legislation in Nebraska this year.

One reason supporters of this way to control medical care for workers give seems to be that medical care currently provided is “inefficient.”

This is a euphemism for medical costs are too high. I view this as critical of physicians and other health-care providers who are taking care of injured workers. The Florida Medical Association (FMA) has recently responded to this type of criticism of the medical profession. In their case, the Office of Insurance Regulation (OIR) and National Council on Compensation Insurance (NCCI) say workers’ comp rates are being raised because drugs are dispensed directly by doctors. But an OIR report, according to the article linked below, “shows virtually no difference in the cost of such drugs whether dispensed by doctors or pharmacies,” so the FMA disagrees with blaming their doctors for rate increases.

This quote is from the story linked to above: “The truth is that the NCCI and carriers have used physician dispensing as a scapegoat for hundreds of millions of dollars in rate increases when other medical costs have been the real cost drivers in workers’ compensation,” the group charged. “The numbers are fabricated in an attempt to eliminate doctor dispensing.”

Emergency Medical Treatment Does Not Need To Be Authorized

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If you don’t obtain prior approval for emergency treatment, you can still file a workers’ comp claim.

Today’s post is by my colleague Matthew Funk of New York.

When an injured worker needs emergency medical care, prior authorization isn’t always possible and obtaining it does not bar a workers’ compensation claim. When a worker is hurt at work and is rushed to the emergency room for treatment, there often isn’t enough time to seek authorization from an insurance company and to obtain a claim number.

At the time of the treatment, if possible, the injured worker should let the hospital and medical provider know that the injury occurred at work and the exact details of all his or her injuries. This is sometimes an effort since emergency staff are rushed and understaffed. After the emergency care is provided the worker should immediately seek the guidance of an attorney to assist in filing a claim and obtaining reimbursement for the medical care.

At the time of the treatment, if possible, the injured worker should let the hospital and medical provider know that the injury occurred at work and the exact details of all his or her injuries.

The law provides that the cost of Continue reading

Workers’ group: What an “Independent Medical Exam” really means

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Good information from NAIDW. The “Independent” part of the medical examination is a misnomer. One judge on the Nebraska workers compensation court refers to IMEs as DMEs — Defense Medical Examinations. Regardless, injured workers need to treat the examiner with courtesy and respect as the defense medical examiner can hurt a worker’s case. In Nebraska, workers can also be sanctioned by the court for failing to attend examinations. On the positive side, defense medical examinations sometimes confirm the opinions of treating doctors. When that happens, my experience is that it comes up in cases where the injured worker is severely disabled. If a DME confirms the treating doctor’s opinion, then this a positive development for an injured worker, leading either to a good award or settlement.
What is a Independent Medical Exam? (IME)
www.naidw.org
Independent medical examination An independent medical examination (IME) occurs when a doctor/physical therapist/chiropractor who has not previously been involved in a person’s care…

13 Tips for How to Deal With A Difficult Doctor (Part 2)

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doctorTwo weeks ago, I shared a post with some tips for workers’ compensation attorneys on how to deal with difficult doctors from my colleague Len Jernigan. In this follow-up post, I’ll share the remainder of Len’s ideas on how to take matters into your own hands when you are having trouble working with the doctor on your case. As with all medical matters, being an informed patient is at the core of these tops.

(8)     Explain case procedure and why you are there.

Unfortunately, I had the experience of walking into a deposition once and the first question from the physician was “What’s going on here and what’s this got to do with me?”  Just prior to a deposition is not the time to be answering this question.  Some physicians have never had their depositions taken before and they are unnerved at the prospect.  Explain the process and explain the necessity for medical testimony.

(9)     Ease tensions.

Behind every physician-patient relationship there is the potential for a medical negligence claim. Ease that fear by Continue reading

How To Deal With A Difficult Doctor (Part 1)

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Good quality medical care and honest opinions about the care are essential for a worker to receive proper benefits. Len Jernigan, a colleague of our firm from North Carolina, has written one of the best articles I have ever encountered on dealing with doctors. This is a good informative piece for injured workers, their families and professionals working with these cases. We face all of the problems discussed in this article on a daily basis in NE and IA.

A doctor’s opinion is crucial to every workers’ compensation claim.  Most doctors give honest and rational opinions. As we all know, however, there are some physicians who have a different agenda and either do not take the time to properly evaluate a patient or they intentionally downplay the potential seriousness of the injury.  For attorneys working on a workers’ compensation case, the following steps may help in the search for the truth.

(1)     Check the doctor’s credentials.

It is a strange but true fact that some experts have falsified their curriculum vitae.  If a physician has lied about his qualifications, his expert opinion just went out the window.  One way to verify credentials is to check the American Medical Association’s web page.   Select “Doctor Finder” and then follow the instructions until you get to “Find a Physician” and type in the name, address and zip code.  If you are seeking a specialist, a doctor certification can be checked by phone with the AMA.  For medical doctors call (800) 776-2378.  For osteopathic doctors call (800) 621-1773, ext. 7445.

(2)     Check disciplinary records. 

According to the Federation of State Medical Boards 4,432 disciplinary actions were taken against 3,880 physicians in 1996.  There are approximately 650,000 licensed physicians in the United States.  The Federation is responsible for promoting high standards for licensure and practice, and serves as the primary center for collecting, monitoring and reviewing actions taken against physicians. (A full report can be obtained by calling (817) 868-4000.  The report is also available on their web site.  Sidney Wolfe, a physician who is director of the Public Citizens Health Research Group, a consumer watchdog organization, has analyzed this document and his report can be obtained by calling (202) 588-1000.  A list of “Questionable Doctors” can also be obtained from Public Citizen for each state.

(3)     Communicate, communicate, communicate.

It is important to find out as much as you can about the physician involved in your case.  See if he is listed on the internet.  If he has written any articles, see what the focus is.  Ask other physicians, nurses, hospital employees and others in the community about this person.  Now, with this information in hand, schedule an appointment to talk with the doctor.  Try not to schedule it during his lunch break, or while he is seeing patients.  You want his undivided attention and you will not get it if he is thinking about some medical crisis sitting in the next room.

(4)     Build a relationship. 

Lawyers who specialize in workers’ compensation are likely to see the same physician Continue reading