These words go through the lips of thousand of injured workers daily,
so don't feel that you are alone. Basically, if
the insurance carrier wants this exam they are looking to terminate your
benefits and medical care by stating you
either weren't hurt on the job(AOE/COE), you are MMI( maximum medical
improvement) or P & S ( permanent
and stationary), or understate your injuries-i.e. your percent of permanent
or residual disability. This is all about
MONEY- SAVING THE INSURANCE CARRIER MONEY. DENY FURTHER TREATMENT, DENY
TTD
PAYMENTS, DENY PPD PAYMENTS, DENY VOCATIONAL REHABILITATION AND DENY
ANY TOTAL
DISABILITY AND TRY TO GET YOU BACK TO WORK!
It is important that you do not take this exam personally. It is the
doctor's job- he has BEEN BOUGHT AND
PAID FOR BY THE INSURANCE CARRIER. WHY? Most likely because he is biased
against claimants, is
very conservative with his suggestions for future medical care and earns
a great deal of money from doing these
exams every day for insurance companies. There must be a reason why he
can do so many!
If you have been passive in the wc proceedings up until now , this is
the time to get active. If you do not have a
lawyer, this is the time to get a free consultation. There are three
basic steps to go through involving this exam.1)
Pre-exam review of your case 2) Notes, witness, your behavior DURING
the exam 3) What to do right after the
exam.
Once you have the name of the doctor who is to perform your exam, you
can do some preliminary screening on the
doctor's background. Check out http://www.healthgrades.com (be
sure and rate your bad docs here- get the
word out!
AMA, http://www. ama-assn.org?/ go to doctor finder;
check out your state medical/osteopath
boards http://www.docboard.org
PRE-EXAM REVIEW OF YOUR WC CASE
First of all get very familiar with your state labor codes(especially
the sections dealing with medical-legal exams.
(As an example, in California the sections of the labor code dealing
with medical exams are: 4050, 4061 4062).
This website<<msn...>> lists the state codes by state on HOME PAGE
Get familiar with your injury. Get out your papers from the day claim
was made and all supporting documents
having to deal with your medical treatment . When you have your diagnosis
at hand, here are some websites to
check out:
Is it malingering ? at http://www.postgradmed.com/issues/1999/12_99/kiester.htm
You need to be familiar with the workers comp jargon http://www.mesgroup.com/IMEs/Reference_Information/tests.htm
For individuals claiming musculoskelatal NERVE injuries, neck or back
injuries, any where from head to
toe, you must check out the Merck Manual Dermatomes diagrams
or http://www.aafp.org/afp/99020lap/575.html pages 6 aND
7, WHOLE ARTICLE IF YOU HAVE TIME
.
.. Dermatomes are the parts of the body where nerves normally sense things-
a map of their sensory limits. For
example if you have a T7 (thoracic area 7th vertebrae) herniated disc,
you normally don't get pain down the back
of your thighs. You get it in the chest area. If you complain of pain
outside of these normal dermatomes, your
injury will be attributed to psychological problems, some "other" non
work injury, faking it, ETC. There can be
exceptions, but in the vast majority of individuals, these are the pain
patterns innervated by a particular nerve
group AND THIS IS WHAT THE DOCTORS ARE TAUGHT IN MEDICAL SCHOOL. Pain
can be referred to
another area. Hip pain for example can refer to the knee. But hand pain
for example does not refer to the
knee. I usually recommend that people print out 2 copies of the body.
Draw your pain spots and where the
pain flows. Check it out against the drawing. Hopefully you will have
a strong correlation. There have been
several studies published which attempt to correlate if someone has non-organic
pain(i.e. psychological
problems that cause THEIR PAIN) BY ANALYZING THESE SIMPLISTIC PAIN DIAGRAMS.
AND THE
DEFENSE WILL USE WHATEVER IT CAN TO DISCREDIT YOU.
The exam will have several tests to determine if you are faking or overstating
your pain or injury. To get familiar
with some of the standard orthopedic and neurological tests check out
:
This site is also a good reference to check out upon receipt of the report
from the exam ;check out terminology at
http://www.mesgroup.com/IMEs/Reference_Information/ortho_terms.htm
to understand some of the
report.
Waddell's is a favorite term of defense attorney and wc carriers . to
understand it check out ......
for YOU OR YOUR ATTORNEY TO DISCREDIT a waddells test see
http://www.gelmans.com/Articles/Waddell97.html
To get familiar with proper conservative medical treatment for your condition
check out the California Industrial Medical Guidelines. They give timelines
for appropriate treatment and not appropriate treatment by timelines
each report is 10 -21 pages long and can be identified by the ending
word before ...HTML at
http:www.dir.ca.gov/imc/NMS.html
http://www.dir.ca.gov/imc/LOWBACK.HTML
http://www.dir.ca.gov/imc/NECK.HTML
http://www.dir.ca.gov/imc/SHOULDER.HTML
http://www.dir.ca.gov/imc/ELBOW.HTML
http://www.dir.ca.gov/imc/HAND.HTML
http://www.dir.ca.goc/imc/KNEE.HTML
They also have guidelines set up for to examine different parts of
the body. If you have carpal tunnel for instance read how to check the
hand and wrists. It doesn't matter what state you are from. These are
just general guidelines to give you an example of a good exam. Most likely
yours will fall short of these. Then you can compare your ime exam with
the guide after the exam.
Write out your answers to the following questions to refamiliarize yourself
with your injury, treatment, and healing
to date.
1) Your medical history and prior injuries to body parts claimed in
this injury.
2) How the injury occurred.
3) What parts of your body were injured
4) What are your main symptoms
5) What causes you pain and loss of function?
6) What activities aggravate your injury
7) What treatment has made you feel better?
8) What activities do you limit or restrict so as to not aggravate your
pain or discomfort?
9) What medication has helped your pain?
10) What were your job duties at time of injury?
11) If you have a detailed job analysis already approved (usually special
form for wc) take this only with you to
give to Doctor so he knows exactly how much time you spent doing specific
activities.
Read these answers over many times and practice stating them. Have a
friend or family review it they may
remember some details you don't. You should be prepared to discuss the
frequency of your pain, the duration and
average intensity of your pain.
Do not take this paper with the rest of your answers into the exam room
with you. It will look like you were
coached or need to be coached to "remember the details of your accident".
An additional website to review for additional questions that may be
asked by ime doctor, is from a defense ime
site:
