A a few years ago, the Workers' Compensation Division conducted a study on "independent medical examinations" and determined that there was some evidence of bias in the conclusions reached by independent medical examiners. Many claimant's attorneys feel much more strongly about this bias, which continues today. However, there are some tools for injured workers facing a denied claim.
Often times, in order to prove a claim and overcome a denial, the injured worker must provide a medical opinion that explains the relationship between the injury event at the work place, and the resulting medical condition. This can be expensive, and in many cases, the only treating physician is one who is not a specialist, like an orthopedist or a neurosurgeon. One option is the "worker requested medical examination," also known as a "WRME." This article discusses the basic requirements for a worker requested examination.
First, in order to request a worker requested examination, the worker's attending physician must disagree with an independent medical examination report. Sometimes, the insurance company will send the report to the attending physician, and he or she will not agree with the findings or conclusions from the examination. Other times, the insurance company will not send the independent medical examination to the attending physician, and the injured worker is free to seek the attending physician's position on the independent medical examiner's opinion.
Once the injured worker has the "non-concurrence" and hand, he can then approach the Oregon Workers' Compensation Division, and seek a worker requested examination. With the written request, the injured worker must include a copy of all the claim denials, a copy of the requests for hearing, and a copy of the letter showing the attending physician did not concur with the independent medical examination report. The injured worker also must provide his contact information, and contact information for any doctors who have treated the condition at issue in the claim, or previously treated the claimed condition.
The Division then reviews the request, and determines whether not the injured worker is eligible for a worker requested medical examination. A recent case from the Workers' Compensation Board found that an injured worker was not eligible for a worker requested examination because the independent medical report was the result of a medical records review, not an actual in person examination. This case shows how strictly the Workers' Compensation Division interprets the rules.
If the worker requested examination is approved, then the injured worker and the insurance company both receive a list of potential examining physicians. Each party is entitled to strike one physician from consideration, and the Division will remaining names on the list. Of course, the parties can also agree to one of the physicians, which does sometimes occur.
The injured worker is responsible for scheduling the examination within a required timeframe, and the insurance company is responsible for providing the examiner file materials. The injured worker can submit a letter asking specific questions in addition to this questions asked of the insurance company compelled medical examiner.
The medical examiner then performs an examination much like an independent medical examination, reviews the records, and responds in writing to the questions from both the injured worker and the employer.
Sometimes, a worker requested medical examination can help an injured worker. Other times, the medical examiner may find that the claimed condition is not related to the on-the-job injury. It is still possible to pursue a claim even after an adverse opinion in a worker requested medical examination.
If you have a denied claim, and need to know your options, will call us at 503-325-8600. We had significant experience helping injured workers with denied Oregon Workers' Compensation claims.