It starts out with you unfortunately suffering an injury at work, whether it is a physical or mental injury, or an occupational disease. Either you are fortunate enough to have your claim accepted from the beginning, or you fight and win your claim, and then you begin receiving workers’ compensation benefits, wage loss and medical. As time goes by, you are treating and hopefully healing well enough to return to some type of work. Depending on your injury, you may be on workers’ compensation for a period of months or even years. While you are receiving benefits, the workers’ compensation carrier, and specifically your Claims Adjustor will be trying to figure out a way to stop or reduce your benefits. It is not a matter of “if”, but a matter or “when” this will happen.
The initial start to try to undermine your benefits comes with you receiving a letter advising that you are to attend an Independent Medical Evaluation. The workers’ compensation carrier is permitted by law to have you attend one of these exams every six (6) months, so two (2) times a year. What is this? An Independent Medical Evaluation is when the workers’ compensation carrier hires a physician to perform a one (1) time examination of you regarding your work injury. The chosen Dr. will receive all of your medical records pertaining to your work injury and it will be up to you to take all of your diagnostic studies, that you have…. such as x-rays taken after the work injury, MRIs, cat scans, etc. The Dr. will review everything provided, then take a history from you at the time of the examination. After the exam, the Dr. will provide his written report to the carrier with his or her opinion as to your condition, again, relating to the work injury, as well as their opinion as to your work capabilities. From this point, based on the Independent Medical Evaluation (IME) report, either the workers’ compensation carrier will take steps to reduce or stop your receipt of your wage loss and/or medical benefits, or not.
Let’s say that steps are taken through the workers’ compensation legal system to try to alter your benefits; this process will involve a Workers’ Compensation Judge and lawyers. This process could take up to a year in litigation, not to mention, be very stressful. The good news with this process is that there is a mediation process, to allow the parties to try to settle the case. In these circumstances, depending on the evidence on either side, it may be the best result for you, as the individual to settle for a lump sum amount, and move on with your life.
Let’s look at the flip side…. the IME Dr. found that you are still disabled to some degree, but your employer does not have any work available for you to return to, in any capacity and the workers’ compensation carrier simply wants to be done with your case. If you are approached about settling your case, you must ask yourself whether you are done, or almost done with your treatment for the work injury. The reason for this is that most carriers want to resolve the entire case, both wage loss and medical for a full “Compromise and Release Agreement”. This is the name of the settlement document. If you settle your case too soon, you will not be able to continue to have your medical treatment paid for by the carrier after the Agreement is approved by a Workers’ Compensation Judge.
The best way to ensure that you are settling your case at the right time for your particular situation is to consult with an experienced workers’ compensation lawyer.