Pennsylvania Workers Comp: Can I refuse medical treatment?

MA110x75ORGI frequently get asked questions about medical treatment.  One of those questions revolves around surgery and whether an employee must undergo surgery or some other medical treatment.  The easy answer is, yes, you can refuse any medical treatment you do not want.  HOWEVER, the important follow up question to that is, will a refusal of medical treatment impact my workers compensation benefits?  That answer is, yes, it may have a substantial impact on your benefits.   Let me explain.
In Pennsylvania, you may forfeit benefits by refusing ‘reasonable medical treatment’.   The appropriate section of the law is
§306(f.1)(8) of the PA Workers’ Compensation Act.  The law states that an injured workers who refuses reasonable medical treatment forfeit their rights to compensation for the injury or for any increase in their incapacity that results from refusing the treatment.  The phrase “reasonable medical treatment” has been defined by PA Courts to mean treatment that is “highly probable to cure the health problem and enhance the injured worker’s prospects for gainful and fulfilling employment.”
It is important to note that reasonable medical treatment would be treatment recommended by YOUR doctor.  If your doctor recommends a specific treatment, such as surgery, a test, injections, or some other treatment that would help you get better, and you refuse, your workers’ compensation benefits will most likely be terminated.   Equally important for you to understand is that the reasonable medical treatment comes form your doctor, not from the insurance adjuster, nurse case manager, or your employer.
Workers Compensation rights are extremely valuable rights.  It is important before you sign anything, consult an experienced workers compensation attorney.    If you insurance adjuster, employer, or nurse case manager is causing you problems or stress, it’;s simple, call Mooney & Associates right now.   If you’ve been injured at work and live in the Waynesboro, Chambersburg, Shippensburg, Carlisle, Harrisburg, Gettysburg, Hanover, or
York
areas, don’t wait to protect and get the benefits you deserve.  Call Mooney & Associates at 1-877-632-4656 for a FREE CONSULTATION.  Your insurance carrier likely has an attorney constantly reviewing your claim and file, you should have your own!

 

What is an Independent Medical Examination (IME)?

46dcc-medicalequipOften I get questions from injured workers asking if they have to attend an independent medical examination, otherwise known as an IME.  The quick answer to that questions is — Yes.  The workers compensation insurance carrier is entitled to have an injured worker examined by a doctor of their choosing every six months.   Insurance carriers typically like to refer to these examinations as ‘independent’, hence the name of the examination, however, they are far from independent.   Let’s take a look at a few aspects related to these IME exams.

Significance

The insurance carrier may request an IME for several different reasons.  First, they may simply be inquiring as to whether the diagnosis of your treating doctor is indeed correct.  Second, the insurance carrier may be utilizing an IME to get an opinion that certain treatment or surgery is not reasonable or necessary, which gives them cover to begin denying certain medical bills and surgeries.  In essence, they are trying to limit their scope of medical liability.  Third, and most frequent,  they are taking hostile action against you by sending you to an exam in which the IME doctor will either opine that you can work light duty or give an opinion that you are fully recovered, regardless what your treating doctor believes.

Your Response

Quite simple.  Protect your self.  Many times you may feel like your insurance carrier and employer have treated you well through out your work injury.  That may be true.  However, if you receive a notice for an IME examination, all bets are off.  Call Mooney & Associates today to get a FREE CONSULTATION.  If you have been scheduled for an IME, your workers compensation carrier is beginning to take hostile action against your rights.  They may be taking steps to try and suspend or terminate your benefits.  They may be taking steps to begin denying certain procedures, treatment, or future surgeries.  Many times these examinations are schedule because of advice of the insurance carrier’s legal counsel.  You should have legal counsel as well!  An IME is a direct threat to your workers compensation rights and  benefits.

Transportation & Reimbursement

Often times, these examination may be an hour or two away, especially for injured workers living in Central Pennsylvania.  Your workers compensation carrier is responsible for either providing transportation to and from the examination or reimbursing your for mileage.

If you receive a notice for an Independent Medical Examination, don’t hesitate to protect your rights.  Call Mooney & Associates today at 717-632-4656 or 1-877-632-4656 to schedule a FREE CONSULTATION.  We have twelve locations through South Central Pennsylvania to meet you at.   Additionally, for more information, visit us on the Web at http://www.mooney4law.com.   You can also Like our Facebook page to keep up with our firm.

Treating with your Employer’s panel doctor

One question I frequently get from potential workers’ compensation clients is how long must I treat with a panel doctor/provider.  The answer is, it depends.  There are a few nuances about the treating with a panel doctor that could effect your case.

First, the general rule is simple.  If your employer has a panel list of provider, the PA Workers Compensation statute requires you to treat with the panel provider for the first 90 days after your injury date.  Does that mean you can’t see any doctor of your choice during that time period?  No.  It just means if you chose to go your own doctor or get a second opinion within the 90 days, the workers compensation insurance carrier can properly deny paying for that medical bill.  However, you are permitted to treat with your own doctor at your own expense.

Second, your employer must have the panel listed posted somewhere on location where the employee is expected to see them.  In most instances, it is likely an employee break room.  Second, the employee must have signed an acknowledgement when hired AND right after the injury.

Another provision of the law regarding panel doctors that is not readily understood by injured workers is the fact that if a panel list exists, you are free to treat with whichever doctor you choose on that list.  Your employer can not dictate which doctor you treat with on that list.  If you are unhappy with a panel provider, you are free to select another doctor on the panel list.

It is equally important to understand that even if all obligations are met and you treat with the panel physicians/providers, on the 91st day after your injury date, you are then free to treat with whatever provider you wish and as long as the treatment is reasonable necessary, the insurance carrier must pay.  

Finally, and a very important point as well, if you receive a Notice of Compensation Denial, in which your employer/insurance carrier is denying you workers’ compensation benefits, then the panel provision does not apply.  If your injury is denied, you can treat from day one with a doctor of your choice.

These rules can be complex and confusing.  If you have any questions or would like to consult with us regarding your work injury, simply give us a call at 717-632-4656 or toll free at 1-877-632-4656.

Mooney & Associates represents injured workers in South Central Pennsylvania including Franklin County, Cumberland County, Adams County, Dauphin County, York County, and Fulton County.