Majority of Workers’ Compensation Cases Based on Faulty Medical Reports


One of the most crucial aspects of the system of workers’ compensation is the medical confirmation of an injury. Sadly, there are doctors who provide diagnosis in favor of insurance companies in exchange for money. In effect, truly injured workers are cleared for work and will not get any workers’ compensation benefits.

The primary reason for a medical confirmation is to rule out the possibility of fraudulent claims by establishing that the worker is truly injured. Under the law, only workers with bona fide injuries can get medical care and replacement wages. Both these benefits are usually paid for by the company’s insurer.

In a workers’ compensation case filed in New York, an injured worker is seeking medical benefits for injuries that he has sustained while on the job. Upon visit to the doctor, it was confirmed that he has injuries secondary to falling while on the job. However, the medical report submitted by his doctor to the workers’ compensation board cleared the driver for work and said that the driver has no injuries at all.

The doctor later on said that he lied in his reports because it’s the only way that he can get paid for his services.

The above-mentioned dispute is not an isolated case. Thousands of workers’ compensation claims have been taken out of the system because of their doctors’ fraudulent information. Instead of the exams designed to flush out workers who only exaggerate their injuries to get unnecessary care, truly injured workers also get affected.

Insurance companies, in the existing law, are allowed to order an allegedly neutral exam but they would select the doctor and that’s where the disputes would begin. 

There are states like New York that uses independent medical examiners and this leads to further mistrust in the system. The weight of examiner’s opinion matters a lot because it can empower the insurer to slash benefits, stall a case and even withhold medical treatment. This oftentimes results in workers being mislabeled as dishonest.

Another common concern regarding examiners in the workers’ compensation system is that most of the examiners are older and semiretired. These physicians no longer treat patients and so their capability to provide correct diagnosis is being questioned. However, insurance companies assert that doctors don’t need to undergo any form of special training because their license in their authorized specialty is enough.

There’s also the inclusion of brokers who are used by insurance companies to look for doctors. Most of these brokers are not registered with the state and although blatant, no legislation has been passed, yet those caught are penalized.

At present, majority of the cases in workers’ compensation contest the examiner’s opinion. But since most of the medical examiners under the workers’ compensation system are listed per state, it becomes easy for judges to dismiss clinic findings especially when particular doctors’ names come in. 

However, even if the clinic findings are dismissed, it would still take months and even years before a resolution is achieved. In most cases, workers get tired of waiting and eventually give up. This adds to their ordeal even further.

It is then very important that the lawyer you choose can represent you well in order to help speed up your case. If you are in Louisiana, call John Fox & Associates at (504) 891-3303. You may also log on to their website at www.johnfoxassociates.com.

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