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Medical Treatment and Second Opinions

IMPORTANT:

By now you should have:

  1. Provided a Notice of Injury to your employer.
  2. Filled out a form CA-1, CA-2 or CA-2a.
  3. Requested form CA-16.

Medical Treatment

Your Primary Treating Physician:

You have the right to select your own primary treating physician. That doctor is your gateway to medical treatment and is the primary opinion regarding your ability to return to work. It is critically important that you choose the right doctor. We can provide critical advice and counsel at this phase of your claim.

The right doctor will be technically proficient and workers' compensation savvy. He or she will work with us to get the necessary testing and diagnoses for all your conditions. Your doctor will also be sure not to return you to work until it is safe for you to do so.

The wrong doctor (or company chosen doctor) will probably not make all necessary referrals and testing and will sign off on the first job the company suggests you can do.

IMPORTANT:

Don't take your opportunity to choose your treating physician lightly. Contact us so we can help you get started in a productive direction with a good and helpful doctor.

NOTE:

If you have been sent to a particular physician by your employer, that person may not be considered your physician. You may be entitled to a one-time change. Subsequent changes may also be made if there are good grounds to request such changes.

Click HERE for the Normal Course of Medical Treatment and Conflict chart.

IMPORTANT:

THERE IS NO DOLLAR MAXIMUM OR TIME LIMITATION ON YOUR MEDICAL CARE.

Second Opinions

The Second-Opinion

The claims examiner may require you to attend a second opinion for a number of reasons including:

  • Inadequate medical progress under your doctor
  • Insufficient work restrictions by your doctor
  • To create a conflict in order to terminate money or medical benefits

NOTE:

Essentially all reasons for a second opinion by the claims examiner are to create a conflict to upset or stop your benefits. The claims examiner can also obtain a conflict by submitting the medical information to the District Medical Advisor (DMA).

The Process

At various stages of your claim, the claims examiner may determine that she needs a medical opinion beyond the opinion of your treating physician. She selects the specialist and arranges for the second-opinion evaluation appointment.

The claims examiner prepares two documents. One is the Statement of Accepted Facts (SOAF); the other is a list of questions to the doctor. Both are sent to the second-opinion doctor before he conducts his evaluation.

If a conflict exists between the opinions of your treating physician and the second-opinion doctor, then OWCP must send you out for a referee/IME examination. The claims examiner also provides the referee physician with the questions and the SOAF.

What We Can Do

We determine whether the SOAF should be challenged. We also determine whether the claims examiner has asked leading questions that make it easier for the doctor to make opinions against you.

If the details surrounding the injury are incorrect or inaccurate, they must be addressed. The doctor, must have accurate information. We also confirm that the claims examiner does not ask those deadly leading questions. Leading questions can kill cases because they allow the doctor an opportunity to exercise his own prejudices.

We essentially do everything possible to level the playing field for you so the examining doctor can give an unbiased opinion. It is very important that we review all documents before you attend a second opinion evaluation.

Referee Specialist/Independent Medical Examiner (IME)

A referee specialist (RS) is enlisted as an impartial IME when there is a conflict between your doctor and the second opinion. The choices of the doctor are selected on a rotational system.

You have the right to request and review the names of the IME physicians considered. We can provide you with a great advantage by knowing which of the group is most likely to provide you with a favorable report.

If you have simply been provided with the name, address, and date of the IME, contact us immediately so we can assert your rights to nullify the opinion of that physician and secure another physician more likely to be favorable to your position.

If the claims examiner requests a second IME doctor and report because they didn't like the first IME doctor and report, you should let us know.

NOTE:

Often times, the claims examiner will ignore the clear requirement for an IME when there is a conflict between your doctor and the second opinion doctor. The CE should request a third opinion. Instead he/she may deny your claim and give the greater weight to his/her second opinion doctor. This action is should be challenged by your attorney.

The quickest way to find out if you deserve more is to ACT NOW! Place a FREE INITIAL CALL today. If you have a specific question that you would like answered by email,CLICK HERE,and an attorney will respond within two business days.

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