Neverending case/EMR Nightmare
Watson
47 Posts
We had an offsite employee injured back in 1998. At the same time, her boyfriend, also an employee, was injured. The job straddled 2 states and their cases were eventually handled each out of a different state. The boyfriend called and said they had both had injuries before and knew how to work the system and wanted to both be in the same state. His case has since settled, but every time we get close to settling hers, she mysteriously begins experiencing extreme pain. Our EMR is well over 1.00 now and this case isn't helping the matter. The high EMR is preventing us from bidding a lot of work we would be able to do. Is there any way to force this to settlement? We've put an investigator on her but can't prove she's faking the injury in order to keep it going. We've changed doctors on her. Something is fishy though because she'll go the whole year with mild symptoms, the doctor will be at the stage of issuing his MMI letter, and usually a week or so before he mails the letter, she gets extreme symptoms that flare back up. Our EMR is set to be recalculated for the year next month.
Help!
Help!
Comments
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James Sokolowski
HRhero.com
The chance you take is that the IME's show she is fixed and stable and both panels agree. Make sure you have all the medical data together to send the IME doctors prior to the appointment, so their report won't wait on supporting documentation.
The another track you might consider is assigning a nurse case manager to consult with your ee. Sometimes employees don't understand that closing a claim does not mean they will never get further benefits. If they realize that the claim needs to be closed now, but they can reopen if there is an "aggravation" of the claim, they feel more secure. Many times, the "aggravation" will be the result of another incident, therefore a new claim can be opened.
Hope this information helps you. I have answered to the best of my knowledge of Washington State regulations. Good luck
I agree with the other reply from Washington State regarding this posting - a minimum of two IME's should be set up 6-8 weeks apart and see what the results may bring. Also, I would work with your worker comp. carrier and see if they too see the trends that you do in regards to relatively minor complaints throughout the year that escalate near the IME evalation.
ESBVNR (Ergonomics Should Be Voluntary Not Regulated)
I am the human resources administrator for a large company, but due to the sedentary nature of our business I see very few (less than 3) claims per year --most of which are for reptitive stress or minor injuries.
My husband was seriously injured at work. If you have never personally had to deal with WC, count your blessings. I don't know who in their right mind would want to get invovled with this system.
The IMEs that are referred to are a joke -- doctors who spend 5 minutes with an employee and then determine that everything is perfectly fine -- despite two or three specialists saying the contrary. PLEASE.
The bureaucratic nightmare for an employee is unbelievable -- late checks, no authorization for medical, stalling in court. You wonder why people are out for years on WC? Not because they want to be but because the carrier will delay, delay, delay, in the hope that the employee will give up because they need money to eat! For minor injuries WC does not seem to be a problem, but suffer a serious injury and see what happens.
Since this has happened to our family personally I have talked with numerous other people about this -- both human resources administrators and injured employees. This is not uncommon. In fact, it is to be expected. Why do you think there are so many WC attorneys out there? People need help.
Just my perspective from the other side.
You are only half right, just like you had to give your perspective, I must throw in my $0.02 worth. GOOD employers do not jerk people around with claims. I have handled workers' comp for over a decade and my approach has always been the same, do what is the best interest of the employee in getting them well. IF they do not hold up their end or are less then honest with me then I must also make sure I protect the companines interest.
Typically wherever I have been hired there were a fair number who were getting lawyers, however once I get established very few due as I explain how the system works, and what each step entails. I have found one of the biggest issues is that most people do not explain to the employees truely how the system works and what to expect next.
I have handled many serious injured employees, and more times than not when it is all said and done, they tell me thank you.
Now anyone who is trying to work the system, well lets just say they never send me Christmas cards!!!!!!!
My $0.02 worth.
DJ The Balloonman
>sides to every story.
>
>I am the human resources administrator for a large company, but due to
>the sedentary nature of our business I see very few (less than 3)
>claims per year --most of which are for reptitive stress or minor
>injuries.
>
>My husband was seriously injured at work. If you have never
>personally had to deal with WC, count your blessings. I don't know
>who in their right mind would want to get invovled with this system.
>
>The IMEs that are referred to are a joke -- doctors who spend 5
>minutes with an employee and then determine that everything is
>perfectly fine -- despite two or three specialists saying the
>contrary. PLEASE.
>
>The bureaucratic nightmare for an employee is unbelievable -- late
>checks, no authorization for medical, stalling in court. You wonder
>why people are out for years on WC? Not because they want to be but
>because the carrier will delay, delay, delay, in the hope that the
>employee will give up because they need money to eat! For minor
>injuries WC does not seem to be a problem, but suffer a serious injury
>and see what happens.
>
>Since this has happened to our family personally I have talked with
>numerous other people about this -- both human resources
>administrators and injured employees. This is not uncommon. In fact,
>it is to be expected. Why do you think there are so many WC attorneys
>out there? People need help.
>
>Just my perspective from the other side.
I do see your side of the issue, however, it's not what the original posting was about. According to the posting, this case has been going on since 1998. In addition, it was stated that the injured employee seems to do well, until it's time for her medical review - then her symptoms worsen - again, according to the posting. My response was only intended to address those types of issues, because unlike you, I have worked with many, many cases of Worker Comp. Claims over the past 10 years that I have been involved in HR (I'm the HR Manager for my company). I must say that I don't agree with your statement about IME's - IN GENERAL - because, just like every profession, there are good ones and bad ones. In Washington State, the review usually takes about 1-2 hours and a series of tests are required in order to objectively determine whether the employee is fixed and stable, has some sort of partial disability or a permanent disability. If the injured worker disagrees with the findings, their primary doctors are given the opportunity to review the results and either concur or non-concur with the findings. There's also an appeals process the injured worker can utilize.
Finally, injured workers should be protected and allowed access to medical care and treatment; after all it's a no-fault system. However, just like everything else in life, there are people who use a system to as it is intended and then there are those who milk it. Harsh, I know, but a reality.
ESBVNR (Ergonomics Should Be Voluntary Not Regulated)