Dealing with Denied Workers' Compensation Medical Bills and Disputed IMEs

Introduction:

In workers' compensation cases, medical bills can sometimes face denial due to an Independent Medical Exam (IME), which may conclude that an injury is not related to the accident or that treatment was unnecessary. This can lead to a denial of coverage for those medical bills. However, there are steps you can take to address such denials, particularly in the United States.

In this article, we will explore what happens when a worker's medical bill is denied because of an IME finding, and discuss possible legal actions you can take, such as obtaining a rebuttal opinion or seeking a competing expert.

Understanding the IME Process

IMEs are assessments conducted by a doctor chosen by the workers' compensation insurance company to evaluate an injured worker's condition and treatment. If an IME concludes that an injury is not work-related or that a treatment was unnecessary, it can affect the payment of medical bills.

Key Points: The outcome of an IME can lead to the denial of coverage for medical bills. There are various processes and regulations, such as medical bill fee schedules and Utilization Review, which may impact payment. The denial can depend on the specific state's workers' compensation laws.

Steps to Address Denied Medical Bills

When a medical bill is denied due to an IME, there are several steps you can take to try to resolve the issue:

1. Rebuttal Opinion

If you believe the IME is incorrect, you can request a rebuttal opinion from your treating physician. This written opinion can provide a professional assessment that your condition is work-related or that the treatment was necessary.

2. Competing Expert

Another option is to obtain an independent medical evaluation (IME) from a doctor of your choice. This can help counter the insurance company's findings and provide a competing opinion.

3. Utilization Review

States like Illinois have medical bill fee schedules and utilization review processes. These procedures aim to ensure fair payment for medical services, and there are protections in place for patients, such as preventing them from being billed for unpaid balances.

Legal Assistance

Dealing with denied medical bills and disputed medical causation can be complex. It often involves navigating the legal and regulatory landscape of workers' compensation, which is why seeking legal help is crucial.

Key Points: Consider hiring a lawyer experienced in workers' compensation law. Show your lawyer any written responses to your questions for accuracy and clarification. Ask your lawyer for guidance on disputing the IME and understanding the legal rights applicable to your case.

Conclusion

The denial of workers' compensation medical bills due to an IME can be frustrating, but it is not the end of the road. By understanding the process, gathering additional expert opinions, and seeking legal representation, you can take steps to address the denial and ensure you receive the medical attention and compensation you deserve.

If you need help finding a lawyer skilled in workers' compensation law, let me know, and I will guide you through the process.