Non-Subscriber Medical Treatment

The Answer is No! You can always get medical attention on your own! You are not breaking any laws by going on your own to get a serious medical opinion about the true nature of your work injuries. Remember that the claim for medical and wage benefits under your employer’s work injury insurance plan is separate from your right to file a lawsuit for employer negligence. Because the main goal of these insurance plans is to manage work injury claims, like yours, so that they limit exposure to lawsuits and limit expense to the employer. Your adjuster will tell you that you are “required to ... Continue Reading

Pre-existing conditions in work injury cases Work injuries can happen in variety of ways. Because our bodies change through the natural process of aging, employers and their insurance companies rely on test results showing degeneration (age-related changes) to argue that your injury is Pre-Existing. The can use age-related changes seen on X-rays or MRIs to argue that any work injury you are claiming is really a result of natural processes and you do not have a true new (acute) injury. First of all, you should never believe a physician who is telling you that all your complaints of pain are ... Continue Reading

An Adverse Benefit Determination after you see the IME doctor If you’ve been receiving treatment and then, suddenly, you are asked to go see a doctor for the first time, chances are, that examination is a Defense medical examination or an IME. After you see the IME doctor, you typically will receive a letter with the report informing you that, based on the good doctor’s examination, your benefits have been terminated. That letter informing you that your rights have been terminated is an Adverse Benefit Determination. It informs you that you a have a right to appeal the decision, but you have ... Continue Reading

What is an IME? If you’ve been injured working for a Texas Non-Subscriber employer, you may have received some treatment and then you’ve been asked to go see a doctor for an Independent Medical Examination or an IME. What is an IME? First of all, it’s not INDEPENDENT in any sense of the word. It’s the set-up. This is a Defense ordered and payed medical examination where essentially you are going to see a “doctor” for the first time and he is going to answer some questions asked by the insurance company. For example, whether your injury is related to the work accident or whether, at this stage ... Continue Reading

The truth hurts. In a nutshell, the adjuster in your case is delaying your treatment because they don’t want to have documented evidence of your injury. Approving tests that confirm that an injury is work related is not in the best interest of your employer and of the insurance company. This is also why the adjuster tells you that you cannot go see your own doctor. Well, you really can but, it will be at your expense. It’s not always possible to go see your own doctor and so an injured employee usually elects to wait for approval of the recommended tests, like an MRI. Remember that insurance ... Continue Reading

If your employer is a Texas Non-Subscriber, your treatment will be determined by what benefits you have in your employer EMPLOYEE BENEFIT PLAN. Either at the time that you hired on with your employer or, when your employer purchased their non-subscriber work injury insurance, your employer asked that you sign some insurance paperwork. Usually, at that time, you would have received the employee version of the PLAN called the SUMMARY PLAN DESCRIPTION. As part of this insurance arrangement, you very likely also signed an agreement to arbitrate any work injury dispute with your employer. In ... Continue Reading