When a Doctor Finds Nothing Wrong with a Workers’ Comp Client
A doctor’s diagnosis is a key part of any workers’ compensation claim, especially if your claim is denied or disputed. Your treating doctor can provide a highly credible witness concerning your injury and whether it was caused by fulfilling work-related duties. However, what happens if your physician determines there is nothing wrong? In these cases, it can be difficult or impossible to secure the compensation you deserve.
The exact result of this situation depends on the doctor making the claim. The opinion of a treating doctor—i.e. the doctor you choose to treat you for your injury—will be far different from that of a company or IME doctor.
Under Illinois workers’ compensation law, you are entitled to your own choice of doctors. A treating doctor with whom you have a long-term patient-physician relationship will be highly likely to act in your best interests, so if you have legitimately been injured on the job, they are very likely to indicate as such.
However, in some cases, your treating doctor may determine that either your injury isn’t significant or that it didn’t result from work. In these cases you may seek a second opinion. This could help your claim, especially if the physician providing a second opinion is measurably more competent than the previous one or if they specialize in your particular injury.
On the other hand, it could complicate matters, especially if your employer has a preferred network of doctors. In these cases, your choice of doctors is limited to one of your own and one within the employer’s network. If you need a second opinion, that of your employer’s doctor could be far less likely to help.
If you are restricted to one doctor of your choosing and one within your employer’s PPN, the odds are already stacked somewhat against you. The upside is your own personal doctor will likely have more weight in a workers’ comp trial than that of your employer, so if your physician deems your injury severe enough to warrant compensation, but the company doctor does not, that will likely work in your favor.
In some cases, the insurance company may request that an Independent Medical Examination, or IME, be carried out. They will send one of their own doctors to determine whether the diagnosis of your own physician is legitimate. The problem here is a matter of mixed loyalties, and it can complicate your situation in various ways.
For instance, the IME doctor may initially confirm the severity of your injury, but if you need further treatment or more time off work to recover, they may later minimize your injury in order to lower the cost to your employer.
Do I Have a Case?
Fortunately, if it comes down to a conflict of opinions between your own treating physician and an IME doctor, an arbitrator or judge will often rule in favor of your own doctor’s opinion since they are aware of the mixed loyalties of other physicians. If this is the case, you stand a good chance of winning in a trial.
That said, you will want your claim reviewed by a workers’ compensation attorney. Hart David Carson LLP can determine whether you have a viable case in the event of a work injury.