What if I refuse medical treatment or miss a IME evaluation? »

What if I refuse medical treatment or miss a IME evaluation?

workers comp claim benefits

What Happens If I Refuse Medical Treatment or Do Not Attend an Independent Medical Evaluation While on Pennsylvania Workers’ Compensation

A workers’ compensation attorney can be highly beneficial if you are an injured employee.  It can be very difficult to understand the laws that govern your need for medical treatment.  Your duty as an injured worker is to report the injury to your employer as soon as possible and follow through with your medical care.  Below are some helpful practical tips to keep in mind.

Treating with the Panel Providers for the first 90 days: After you report your work injury to your employer, they should provide you with a list of what are called “Panel Providers” for you to choose from for your treatment for the work injury.  If your employer does not have a list of Panel Providers, then you are free to treat with whomever you choose for your work injury.  The purpose of the Panel Providers is for the workers’ compensation insurance carrier to control your treatment for the first 90 days.  If your employer has a list of Panel Providers, and you do not treat with one of them, then the insurance carrier can deny payment of your medical bills, except in emergency situations where you may be life flighted or taken by ambulance to a hospital.

Do I still get benefits?  Typically, if your workers’ compensation claim has been accepted, you will receive wage loss benefits, but this will depend on whether the workers’ compensation carrier has issued a Notice of Compensation Payable or a Notice of Temporary Compensation Payable. If a Notice of Compensation Payable is issued, you will continue to receive wage loss benefits until you either settle your case, or a workers’ compensation judge orders some sort of modification, suspension, or termination of your benefits.  If a Notice of Temporary Compensation Payable is issued, then you may receive either medical benefits only, or both medical and wage loss benefits for a period of only 90 days.  After the workers’ compensation adjustor makes a determination of whether to deny or accept your claim, then you will not receive any additional benefits, if denied; if accepted, then you will continue to receive either medical only or both medical and wage loss, depending on your circumstance.

Rights to a second opinion:  If you are receiving workers’ compensation benefits, and it is past the 90 days from the date of injury, then you most certainly can seek a second opinion as to your injury, and do not need to treat with the panel providers any longer.

The right of workers’ compensation carrier to obtain an Independent Medical Evaluation:  The carrier has the right to ask you to submit to an Independent Medical Evaluation, known as an IME once every six (6) months. The purpose of the IME is to evaluate your medical condition regarding the work injury.  The workers’ compensation carrier chooses a physician of their choice to perform the one-time evaluation, which you must attend.  If you fail to attend, then the carrier will hire a lawyer to file a Petition to Compel the examination.  Unless there is a very good excuse, most Judges will readily grant to Petition to Compel, and then you will then have to attend a rescheduled examination with that physician.  If you again fail to attend the examination you will then most likely have your benefits suspended.  If your benefits are suspended, this means that you will no longer receive your wage loss benefits.  Obviously, it is best to just go when requested to do so.

Is there any medical treatment that is reasonable to challenge or refuse while receiving Pennsylvania workers’ compensation benefits? Let’s say that you attended an IME, and that Dr. recommends non-invasive treatment, such as physical therapy, injections, or medications that would end your disability so that your workers’ compensation benefits could end; do you refuse?  Although every case is different, the usual answer is no.  If you refuse reasonable treatment that may end or limit your disability, the carrier again will hire a lawyer to attempt to suspend your benefits, arguing that you are refusing reasonable treatment.  You, on the other hand, with the help of your lawyer can seek the advice of your treating Dr. as to this suggested treatment.  If there are legitimate arguments, then these can be made to the assigned workers’ compensation judge.

It is always best to seek guidance from an experienced workers’ compensation lawyer to navigate your way through these and all other issues regarding your workers’ compensation case.