What if I Disagree with the Doctor in my Pennsylvania Workers’ Comp Case?

Because they are in a business- it’s called medicine.

The insurance company doctors are paid to see things the insurance company’s way, and the treating doctors have incentive to treat patients.

No one can see pain. And while an MRI or EMG may show abnormalities, the doctors have wiggle room to opine that such findings are pre-existing or degenerative, and not related to a work activity.  I have said it before and I’ll say it again- medicine is just as much an art as it is a science.

Talk to your workman’s comp lawyer. Sometimes, it’s better to iron things out with your physician- if they are willing, of course, and sometimes it’s better to move on and find a better advocate.  You certainly want to avoid the appearance of doctor shopping so it’s always better to have continuity with a doctor, but sometimes you don’t see eye to eye and need to move on. If you speak to your work comp attorney about the situation, he or she will be able to analyze your case, the circumstances you are in, and the backdrop of your case, to be able to give you sound advice.

Call the Certified Philadelphia Workers’ Compensation attorneys at Cardamone Law for help with your case by dialing (267) 651-7945 today.

The Doctor is Minimizing the Severity of the Injury

Independent medical doctors under the Pennsylvania Workers’ Compensation Act are not “independent”. They are hand picked doctors- not by the presiding Judge, but by the employer or insurance carrier. The IME doctors do not treat an injured worker. They simply examine the injured worker, review medical records, and take a history. Then, they issue a report with their findings.

In many cases, the IME doctor will characterize the work injury as a mere strain or sprain. By characterizing the work injury in this minimal way, it becomes much easier to opine that the injured worker has made a “full recovery”- as sprains and strains only tend to last for a few days to perhaps a few months. They try to bolster their opinion by claiming a lack of “objective findings” to support the “subjective complaints”.

In contrast, the treating doctor- who actually treats the injured worker rather than getting a quick snapshot of their condition-is more likely to recognize the true extent of the injury. Whereas IME doctors like to hang their proverbial hat on “pre-existing degenerative changes” (ie, arthritis) as the cause of the current symptom complex, the treating doctor often opines that the work injury aggravated or accelerated those changes. In addition, the medical experts often disagree about the diagnostic studies and whether certain findings are traumatic or degenerative or a combination of both. In cases where the IME doctor blames “arthritis” for the symptoms, it becomes absolutely critical to understand the injured worker’s pre-work injury treatment, if any, regarding the affected body part so that a logical analysis can be undertaken to determine if that theory makes any sense.

The IME vs. the Treating Doctor vs. the Injured Worker

No doctor can step into an injured worker’s body and feel the symptoms. So, what happens is the subjective complaints have to be weighed in the context of the other components of the case such as the history, sequence of events, clinical findings, diagnostic studies, etc- in an effort to determine causation (what is causing the symptoms) and extent of disability.

Since many of the experts cancel each other out with their varying opinions, the Work Comp Judges will focus in on the credibility of the injured worker’s testimony- looking at such things as 1) is the injured worker’s testimony consistent with their doctor’s testimony?, 2) do the diagnostic studies correlate with the diagnoses and symptoms? or, 3) did the injured worker give an accurate history regarding how the injury occurred and any pre-existing treatment or symptoms affecting the same body part in question?

The IME Doctor Says that I am Ready to Return to Work but I Disagree

Nothing infuriates an injured worker more than an IME doctor issuing a report stating that they have made a complete and full recovery. Luckily, everyone is entitled to due process and has their chance in court to address the report, and to present medical evidence of their own that demonstrates a different point of view.

It is not uncommon to have a treating physician find a patient to be disabled while an insurance company doctor says the person is “fully recovered”. This is a large part of why we have so much litigation in personal injury law and workers’ compensation. The injured worker usually calls me in a scenario like this- completely baffled. They just want to feel better and get back to work, but they are also set back by the anger and emotional trauma from the absurdly different medical opinions.

One common example of doctors and patients not being on the same page is after surgery. The surgeon will want to stress all the positive things- such as improving range of motion, less pain, well-healed surgical incision, etc.   (and it’s perfectly fine to note improvements that have taken place but sometimes they overdo it, possibly to justify the surgery or to have a paper trail to fend off malpractice allegations)  On the other hand, the surgeon may minimize or understate the ongoing problems that you are experiencing- despite a surgery that may have been done as well as it could have been done. The failure to document your ongoing limitations, or the failure to state them accurately, can negatively impact your Pennsylvania Workers’ Compensation case. This is why it is important for you to have an experienced attorney who will obtain your records and analyze them, to make sure the doctor’s records truly reflect your condition- and not simply the improvements you have made.

There are plenty of good doctors. However, there are some real jokers out there too- looking to make money with no regard to common sense- or medicine. And this occurs on both sides of the proverbial fence.

If you want me to review your case and whether your doctor is advocating for you, but more importantly, giving you the treatment you need, I am happy to review your medical records. Having studied medical records for 12 years in Pennsylvania Work Comp cases, and having deposed doctors approximately 500 times, I have learned how to quickly sort through the medical aspect of a case.