Success Stories- Full Duty Verification, pre-existing conditions and money saved on IME
A client hired a worker and within 3 weeks she filed a workers compensation claim for back injury. She had not reached 90 days of employment, therefore no physical had been done that would have screened for a pre-existing condition. This employee was out of work for approximately 4 months. During the time she was out the employer had changed the shift lengths from 8 to 12 hour periods.
We contacted the insurance company adjuster and the nurse case manager to develop a plan of action for this claim. It was decided that the claimant was to have an Independent Medical Exam, but she was released to return to work full-time by the treating, before the scheduled exam.
The employee returned to work, but began complaining of pain the first day. She returned to the treating doctor who ordered that she return to full-time duty for 8 hours a day the first week, and then she was to work the full 12 hour shift from then on. The employee went to her own doctor who released her to work 8 hours per day.
The original treating doctor and the employee’s doctor were contacted and confirmed that she would be able to work the full 12 hours per day. Not long after the employee was informed of this, she voluntarily quit and signed off her claim.
After discussing with the insurance company, we had her IME cancelled. This could have cost the client $1200 and we wanted to reserve the exam in the event she would attempt to file a petition at a later date. (PA only allows an IME once every six months) It was discovered from medical reports that surfaced later that this individual had a variety of pre-existing conditions and even a history of surgeries. This only shows the importance of a pre-employment physical and cooperative, proactive broker.