Independent Medical Examinations Archives - Workers' Compensation Defense

March 16, 2020 General / Temporary Total Disability (TTD)

Redefining Total Disability: How to Approach Nonschedule Claims After Jacobi

In a post-2007 reform world, the percentage disability became more important for one major purpose: establishing a capped benefit system for nonscheduled awards. From a carrier perspective, this was a positive and a step in the right direction as the Board was finally placing limits on the number of weeks that a claimant with a partial disability rate can receive benefits. The issue arose then of what to do with a claimant who was classified with a nonscheduled award, but subsequently had a period of …

March 16, 2020 Disability Benefits / New York

Practice Tips and Tactics Involving Additional Providers in New York

On January 1, 2020, additional medical providers have been authorized to treat claimants under the New York State workers’ compensation system. Physicians, chiropractors, podiatrists, and psychologists are joined by physical therapists, occupational therapists, physician’s assistants, nurse practitioners, licensed clinical social workers, and acupuncturists as Board-authorized providers. Not all approved providers have blanket approval from the Board, though. The differences in approval of the expanded providers give the carriers and self-insured employer the upper hand in some situations under New York State workers’ compensation.

Of note, …

January 6, 2020 General / Medical Expenses

How To Ensure Your IME is Compliant with Section 137

In order for an Independent Medical Examination (IME) report to be compliant with Section 137 of the Workers’ Compensation Law, a copy of each report must be submitted by the practitioner on the same day and to the Board, the insurance carrier, the claimant’s attending physician or practitioner, the claimant’s representatives, and the claimant themselves in the same manner (WCL Section 137(1)(a)). “If a practitioner who has performed or will be performing an independent medical examination of a claimant receives a request for …

July 29, 2019 Disability Benefits / General

Causal Relationship for Preauthorized Surgeries: Questioning Causality

It is easy to accept preauthorized surgeries as a foregone conclusion where the site of surgery is established and the procedure is approved by the Medical Treatment Guidelines. However, it shouldn’t be.

Earlier in 2019, Goldberg Segalla’s workers’ compensation team won an appeal on this very issue. The claimant underwent preauthorized left shoulder surgery on a file established to the left shoulder for an injury that occurred in 2016. However, the claimant underwent left shoulder surgery secondary to a 2004 motor vehicle accident prior to …

July 15, 2019 General

Get It Right the First Time: Why You Should Not Skimp on an IME Cover Letter

We have all been there. The workers’ compensation law judge has directed the carrier to produce an Independent Medical Examination (IME) within a specified number of days. Somehow, we managed to get the report completed timely, even after many scheduling attempts, cancellations, or claimant no-shows. Then, your IME consultant failed to address the key questions.

We can try our best to have the law judge grant the carrier an opportunity to obtain an addendum, but the reality is that we run the risk of preclusion …

April 8, 2019 General / New York

Combating Injured Workers’ IME Reports

Employers, carriers, and third-party administrators are all too familiar with Section 137 of the New York Workers’ Compensation Law and 12 NYCRR Section 300.2, as they govern Independent Medical Examinations (IMEs). Failure to meet or substantially comply with the necessary requirements of Section 137 puts you at risk of having your IME report precluded by a workers compensation law judge. The same holds true for injured workers when they are the party that produces an IME report. As such, it is important to recognize when …