The Workers Compensation Insurance Company Has the Right to Request an IME.
The law is clear. The insurance company is entitled to schedule IMEs (so-called “independent medical evaluation”). But the IME must be done at a reasonable time. If you’re out of state or cannot attend the scheduled IME for some other reason, contact the insurance company immediately in writing and ask them to reschedule the exam.
Do You Need to Collect Medical Records for the IME Doctor?
There is nothing in the law that says you do. The IME is the insurance company’s expert and it is their responsibility to provide him with all the records he needs. The insurance company should have been collecting your records since shortly after you were injured.
Why Does the Insurance Company Want an IME?
There are several reasons the insurance company might want an IME and they all boil down to: the insurance company is looking for excuse not to pay your benefits. Some of the typical questions they will ask their “independent” doctor are:
Are you really injured?
Is the work injury the cause of medical treatment?
Is the work injury the cause of disability?
Can the injured worker go back to work?
Does the injured worker need future medical treatment?
Does the injured worker have a permanent impairment?
Where Do Insurance Companies Find IME Doctors?
They have two sources. If the IME doctor is practicing in Alaska, be aware. He’s working both sides of the street: giving insurance companies the opinions they want (and getting paid) and treating injured workers (and getting paid). The common denominator here is the doctor is getting paid by the insurance companies and that is where his loyalty lies.
Otherwise, there are staffing agencies that provide doctors for “IME” evaluations. Here are some of those companies in Alaska cases:
You should. If the insurance company wanted to continue paying your benefits, it wouldn’t have scheduled an “IME.” There is nothing “independent” about these evaluations. The insurance companies have established relationships with the evaluators. They pay these doctors, many of whom are retired, lots of money. And the insurance companies are shopping for a particular opinion, one that is favorable to them and unfavorable to the injured worker.
What Should You Do?
You need to go to the appointment.
If they get the opinion they want, they will immediately cut off your medical benefits, your disability benefits, or both. And then you'll be scrambling to collect your records. Don't wait.
Meanwhile you should be collecting a complete set of your medical records. You will need them to fight for your rights if the insurance company controverts your case. That means contacting every provider that saw and asking their records department for all you records. You are legally entitled to these records.
Why Bother Fighting?
Because the insurance companies lose these cases all of the time. Most often, they lose because the Alaska Workers Compensation Board decides the so-called “IME” doctor was wrong. For a list of cases employees won, check out:
You don’t need to wait until your claim is controverted to speak with an attorney. Find out your rights are and what you should be looking out for.
Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 35 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com
All consultations are free!
To make an appointment (in person, telephonic, or zoom), email: keenan@keenanpowell.com or call: 907 258 7663.
I’m getting a lot of calls lately. Injured workers are worried. They have been sent to an"independent" medical evaluations. And, they have every reason to be concerned. If your insurance company is sending you to one of these doctors, then you should be worried too. The insurance company wants to cut off your benefits. And it hired Dr. Bauer or Dr. Youngblood to give them a reason. They don't care if you aren't finished treating. They don't care if you can't go back to work. They want to stop paying your disability and medical benefits.
Ain't Nothing "Independent" About Them.
Dr. David Bauer and Dr. Scot Youngblood are two insurance company darlings. They have been traveling up to Alaska frequently as of late. And they have been producing reports for years. But there ain’t nothing independent about them! These doctors are paid thousands of dollars for every report they write. And they keep writing these reports no matter how often the Alaska Workers Compensation Board shoots them down which is over and over again.
Once the insurance company receives the “independent” medical evaluation report, they will cut off your benefits immediately. They should send you a Controversion Notice. But they don’t always. Not to worry, you don’t need a formal notice to start the claims process.
If you want to see what the notice should look like, the forms are available on the Alaska Workers Compensation Board's website: Workers' Compensation Forms (alaska.gov).
Short story: if your insurance company is sending you to see one of these doctors, its because they intend to cut off your benefits, you're in for a fight.
What to do? Start collecting all your medical records from your treating physicians and call an attorney.
Contact an Experience Workers Compensation Attorney
Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 35 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com
All consultations are free. To make an appointment, email: keenan@keenanpowell.com or call: 907 258 7663.
Word has it that so called "independent medical evaluations" are taking place again in Alaska. One of the doctors being flown up to evaluate injured workers is Dr. David Bauer. Odds are if the insurance company has scheduled an appointment for you to see Dr. Bauer, he is going to deny your claim.
Dr. Bauer's History of "Independent Medical Evaluations"
Doctor Bauer has been evaluating injured Alaskans for several years and a number of cases involving him have gone to hearing before the Workers Compensation Board. Take a look and see if any of these cases sound like yours. In each case, Dr. Bauer denied the employee was entitled to benefits. And in each of these cases, the Employee won.
Lifting injury, herniated disc.
In Serafin v Denali AK Fed Credit Union and Liberty Mutual AWCB 17-0032 (3/21/17), the Employee injured her back lifting and moving a small refrigerator at work. She was diagnosed with a herniated disc and annular tear. Dr. Flanum performed a microdisctomy.
The Second Independent Medical Evaluator (SIME), Dr. Coulter, found the injury was work-related and treatment reasonable and necessary.
She continued to have pain and had a second surgery.
The insurance company sent her to see Dr. Bauer who concluded the February 24, 2010 work injury was not the substantial cause of any then-current disability or need for medical treatment, including surgery. Dr. Flanum disagreed with Bauer’s opinion. The SIME doctor, too, disagreed with Dr. Bauer. After the SIME doctor’s deposition, Bauer wrote a rebuttal letter stating: I do not believe the work injury from February 24, 2010, is the substantial cause of the need for medical treatment from January 19, 2012, through January 31, 2014. In my medical opinion, Ms. Serafin's occasional back symptoms between 2012 and 2013 were due to the progression of degenerative disease consistent with age. The symptoms from mid-2013, when she had the disk herniation, through 2014 are due to a sudden and unrelated event. Therefore, the 2010 work injury is not the substantial cause of her disability or need for medical treatment.
At his deposition, Dr. Bauer testified the 2010 MRI study as revealing a disc “bulge” rather than herniation. He believed the February 24, 2010 work injury was not the substantial cause of Employee's need for treatment, but only an aggravation of a pre-existing degenerative condition which resolved. Because disk bulges can be caused by aging, Dr. Bauer believes the disc bulge was present prior to and not caused by the 2010 work injury. Employee had an “age appropriate” spine on the imaging ….Referencing academic literature, 70-80 percent of studied individuals with one-level disc herniation had no identifiable, known cause. The majority of these injuries are caused by a “wrong move” or even turning over in bed.
In Henson v Apicda Joint Ventures, Liberty Mutual AWCB 18-0044 (5/11/18), the Employee tripped in a freezer container in the course of his employment and injured his leg and back.
The Employee was examined by Dr. Kirkham, who recommended Employee find sedentary work, based on the April 20, 2016 FCE. Dr. Kirkham states “... chef is a light duty position and not a sedentary duty position, so he would not be able to return to work as a chef.”
The Employee attended an EME with R. David Bauer, M.D. Dr. Bauer found no objective or physiological basis for Employee's pain complaints, no objective or physiological reason Employee could not return to his job at the time of the injury, or other heavy-duty work.
The Employee won a remand to the RBA for modification of her previous denial. While the Board did not address the credibility of Dr. Bauer’s report specifically, it found instead that the Employee and her treating physician were credible.
The Employee won!
Dr. Bauer a "no show" at the hearing!
In Cavitt v D&D Services and Ohio Casualty Company AWCB 18-0060 (6/25/18), the employee fell from scaffolding at work and fractured his elbow. He had partial elbow replacement surgery. He had a second surgery because hardware came loose due to osteomyletis (infection.) His treating physician recommended continuing follow-ups every year or two because of infection and stated that in future there would be additional surgeries and that he could not go back to the job he was doing at time of injury or subsequently.
On January 25, 2018, Employee was seen by Dr. Bauer for a second EME. In addition to examining Employee, Dr. Bauer reviewed medical records dated after his April 26, 2017 EME. Dr. Bauer's diagnosis was unchanged since his April 2017 EME report, and he continued to find the work injury was the substantial cause of Employee's disability and need for medical treatment, and treatment to date had been reasonable and necessary. However, Dr. Bauer found Employee had reached medical stability as of the date of his examination and the only further treatment needed was a home exercise program and continued use of his elbow brace, although a functional capacity evaluation would aid in determining appropriate restrictions for future employment. Dr. Bauer rated Employee with an eight percent permanent partial impairment.
When the Employee filed a claim and took the case to hearing, the insurance company, Ohio Casualty (a Liberty Mutual company) withdrew its controverson and refused to produce Dr. Bauer for testimony.
The Employee won!
Dr. Bauer said back injury was not work-related, only degeneration.
In LaBlanc v Alaska Inga’s Gallery Dec. No 20-0098 (10/23/20), Dr. Bauer opined that the back injury was not work-related and instead the result of degeneration. The Board found Dr. Bauer’s testimony deserved less weight in this analysis:
Dr. Bauer opined Employee's pain complaints were not consistent with the L3-4 herniation because it required pain radiating into her thigh and she did not report it to him during his examination. His opinion is given less weight than Drs. Bursell's and Pohlman's because the medical record is clear that Employee has experienced anterior thigh pain. AS 23.30.122; Smith; Moore. The preponderance of the lay and medical evidence is the work injury was the substantial cause of Employee's past and current need for low back medical treatment. Saxton.
And again, in regards to his opinion on acupuncture:
Dr. Bauer's opinion is given less weight than Dr. Hess's because he testified he did not discuss the effect of acupuncture with Employee. AS 23.30.122; Smith; Moore.
The Employee won!
Dr. Bauer diagnosed a pre-existing condition.
In Wise v Wolverine Dec. 20-0095 (10/13/20), Dr. Bauer opined the cervical condition was pre-existing. As in Cavitt, the Employer failed to produce him for testimony. His opinion was excluded. The Employee won!
Dr. Bauer said there was no need for treatment.
In Elardo v Walmart Dec. 19-0057 (5/8/19), Dr. Bauer opined the condition was not-worked related degeneration, there was no need for medical treatment and the Employee was medically stable. The Board held his opinion would be given less weight:
Dr. Bauer testified “all the findings on this MRI were due to aging”; they were related to the progression of the degenerative condition that would have occurred regardless of the work injury. He explained that a person constantly degenerates so his steady state is not a straight line across the bottom, but rather, a line of steadily increasing impairments and disabilities as he gets older. A 2015 study showed someone in his fourth decade of life would be 40 to 50 percent likely, even if asymptomatic, to have all the findings of Employee's MRI. Thus, just because Employee had an injury, it does not mean that everything that followed was caused by that injury. However, Dr. Bauer's opinions are given little weight and credibility as he neither addressed why degeneration would only show at one disc, and not in others, nor provided the basis for his conclusion degeneration pre-existed the work injury. AS 23.30.122; Smith. He did not consider other potential causes of degeneration; he did not explain why Employee would belong to the 40 to 50 percent group, rather than the 50 to 60 percent group, absent the work injury. Id.Emphasis added.
If the insurance company set up an appointment for you to see Dr. Bauer or someone like him, chances are they are preparing to cut off your benefits. Call an experienced Workers Compensation attorney.
Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 35 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com.
All consultations are free. To make an appointment, email: keenan@keenanpowell.com or call: 907 258 7663.
