IME Exams in Wisconsin

IME Exams in Wisconsin

by | Apr 27, 2022 | Workers Compensation

Mays Law Office, LLC. is here to protect you from the intimidation of the so-called “IME/Independent Medical Examination” allowed in Wisconsin.

A Wisconsin injured worker files for workers compensation benefits with their employer’s workers compensation insurance carrier and before paying benefits, the insurance company demands that the injured worker see an “independent medical examiner.” 

What is this and what should the injured worker expect?

To be clear, in Wisconsin, these appointments are completely selected and scheduled by the workers compensation carrier, and not the injured worker.  They are far from being  “independent” or impartial.  In fact, a better description, would be to call them an “adverse medical examination” because there is NO medical treatment rendered and the medical report is created solely for the workers compensation carrier with a desired outcome to deny workers compensation benefits.  Ultimately, the insurance carrier is hoping for a medical opinion from their examiner that gives a medical basis and opinion that will allow them to deny the injured worker benefits.     

In Wisconsin, an adverse medical examination can only take place with a physician, chiropractor, psychologist, dentists, podiatrist, physician assistant, or an advanced nurse practitioner.  It is the workers compensation insurance carrier that gets to choose who the injured worker will see for a medical examination.  The location of such an examination can be no further than 100 miles of the injured workers primary residence as the crow flies.  The time and date should be discussed before the examination is scheduled in the event the injured worker has a scheduling conflict.  However, this respectful communication with the injured worker is rarely communicated and instead a date and time is given.   The insurance company is required to provide, in advance of the examination, prepaid roundtrip mileage.  Not providing such advanced payment ahead of time can give the injured worker a basis to not appear.  Also, reimbursable to the injured work, prior to the examination, is anticipated wage loss, meals, and lodging, if applicable.  Information regarding the adverse medical examination must be provided to the injured worker in advance and in writing.  The notification must provide clearly the following information:

  • Date, time and location of the appointment;
  • Details for changing such date, time, and location, should a conflict exist;
  • The injured workers right to have their own physician, chiropractor, dentist, and so on, present at such appointment;
  • The right to receive the adverse medical examiner’s report(s) once completed and received by the insurance company or employer;
  • The injured worker’s right to have a translator present at the exam if a language barrier exists.

Generally, the workers compensation insurance carrier provides the medical examiner with the injured workers medical information and records prior to the examination, but often the examiner never reviews or looks at the information before the examination.  In fact, during the medical examination, the medical examiner very often seems to know little to nothing about the injured worker’s medical condition, diagnosis, prognosis and will rely on the injured worker to fill him in on his medical history and details of the work injury and subsequent medical treatment.  Obviously, this is infuriating for the injured worker who has been compelled to go to this examination with a doctor, who at the time of the appointment, appears ignorant to the injured worker’s medical condition.

In preparing to meet with the adverse medical examiner, the Wisconsin injured worker should:

*Dress casually with an eye toward removing their shirt or pants in the event the examiner wants to do a limited examination of their body.  Wearing a pair of athletic shorts, athletic top/bra can prevent the injured worker from being instructed to disrobe.  In almost every situation, an injured worker should never be naked during these examinations;

*Do not take any pain medication ahead of the examination.  This way the examiner sees the injured worker in their purest form, without medication to mask the pain.  So, for example, if it hurts to raise your arm because of a shoulder injury occurring at work then the examiner should see such pain exhibited.

*Respond only to the examiner’s questions and never be too talkative.  The more the injured worker speaks and tells the examiner, the more such information will be misconstrued, taken out-of-context, and used against the injured worker.

*Take pictures of the examination room if it is dirty or unprofessional appearing.  Keep a journal/notes/recordings of anything unusual.  Such information can be used to discredit the adverse examiner’s credibility/opinions.  Mays Law Office had a client that was put into a dirty examination room and asked to sit on an examination table that was soiled/wet from the last patient!  A picture was taken and used against the insurance company for relying on an unprofessional physician to support their denial of benefits.

*Be consistent in your behavior and movements with your injury and physical restrictions.  So, for instance, if you have a low back injury and you have a restriction of no bending, then do not be seen bending over to remove your shoes for the examination.  Or, if you require a cane for mobility then make sure you have and use your cane at the examination.

In sum, the Wisconsin injured worker needs to keep in mind that they are being watched from the moment they enter and leave the examiner’s parking lot as the examiner and/or his staff are hoping to see and document anything that puts the truthfulness of the work injury in question.  So, if the injured worker is prohibited from climbing stairs due to their knee injury, then use the elevator, and not the stairs, to reach the examiner’s second floor office.  

Attorney Lisa Pierobon Mays is proud to have been involved in changing Wisconsin law in favor of protecting injured workers during adverse medical examinations.

In the past, Wisconsin law allowed the medical examiner to meet with the injured worker, male or female, alone and without any observation from a witness, such as a spouse, parent, other family member, or even a friend.  This policy was obviously problematic, especially where it was a male doctor examining female injured workers.  Often, these adverse medical examinations require a certain level of disrobing and a hands-on physical exam of the injured worker.  Such a situation is intimidating, and downright creepy, where a trusted doctor-patient has NOT been selected or even established. 

Attorney Pierobon Mays initiated awareness with the Wisconsin Worker’s Compensation Advisory Council pushing for a change to be made in the workers compensation legislation.  The Council on December 13. 2021 approved such a change and the agreed upon bill will now allow observers present, chosen by the employee, during such examination.  The Agreed Upon bill is expected to pass the Wisconsin legislature.                        

Lastly, the best course of action for the Wisconsin injured worker who is asked to submit to an “independent medical examination” coordinated by the workers compensation insurance carrier is to call Attorney Lisa Pierobon Mays at (608)257-0440 so that she can remind you of these Do’s and Don’t’s and get you properly prepared.  Initial consultations are always free.  

Top 10 Questions to Ask when Hiring a Wisconsin Workers Compensation Attorney

Top 10 Questions to Ask when Hiring a Wisconsin Workers Compensation Attorney

by | Apr 8, 2022 | Workers Compensation

When Should I Hire a Wisconsin Workers Compensation Attorney?

If you are hurt on the job in Wisconsin, you should immediately file an Incident Report with your employer for submission to their workers compensation insurance carrier.  If the injury causes you to miss time from work due to physical restrictions set by your medical doctor and the workers compensation insurance company has not paid you a lost time benefit or medical treatment expenses, within a reasonable period of time, then you should call an attorney.  Once the insurance carrier raises a “dispute” or suggests that your claim will be denied then you need to look into hiring a Wisconsin attorney who concentrates their practice in workers compensation, like Attorney Lisa Pierobon Mays at Mays Law Office.

Do I Have to Meet with You at Your Office?

No, to hire Mays Law Office you do not have to step foot in our office if not convenient or desired.  Mays Law Office is located in Dane County in the Madison/Middleton area.  If visiting, please know that we have ample free parking with handicap accessibility.  We have a first floor office so accessibility is a breeze for our clients.  Moreover, our office is always open from 8am until 5pm.  Often, client’s will stop in without the need for an appointment to drop off necessary documents.  We are also able to conduct phone and Zoom meetings with our clients.  U.S. Mail, facsimile, and E-Mail are all ways to exchange necessary documents and information too.  We represent people from all over the State of Wisconsin and around the United States who often are not able to visit our office.  Mays Law Office strives to litigate your claim as stress-free as possible.

If I Hire You, Will You be Handling My Workers Compensation Claim?

For almost three decades, Attorney Lisa Pierobon Mays has been representing and winning for Wisconsin’s injured worker in workers compensation claims.  From your first to your last call, all questions and concerns, will be solely handled by Attorney Pierobon Mays.  While we have a friendly and knowledgeable legal staff that may assist in the simple clerical matters of your claim, the strategy, timing, progress, and resolution of your workers compensation claim will be handled by Attorney Pierobon Mays.  Attorney Pierobon Mays will meet with you at the initial consultation, handle all your questions and concerns throughout the litigation, communicate with you directly as to issues and updates, and appear at all hearings on your behalf.  We do not believe in signing up client’s to then transfer their file to an associate attorney or paralegal.  Attorney Pierobon Mays is a managing partner at Mays Law Office and the buck stops with her when it comes to representing her clients.

Can I Find Reviews from Your Former Clients?

Absolutely and we encourage you to research us because we are so proud that 100% of Mays Law Office client’s who reviewed us on Google gave a 5-Star rating as to their experience.  Please know that a Google Review is highly reputable because the recipient of the Review, whether good or bad, is never allowed to review, alter, change, or delete it.  Google notifies us only after the Review has been submitted.  So check us out on Google and see what our past clients are saying about the lawyers at Mays Law Office.

What is Mays Law Office’s Success Rate for Getting Their Client’s Money?

Attorney Lisa Pierobon Mays has never taken on a workers compensation client that she did not feel that she could win.  Keep in mind, Attorney Lisa Pierobon Mays gets paid only when her client gets paid.  So, if Attorney Pierobon Mays does not perform intelligently, aggressively, and efficiently in representing her client then her work is for nothing.  So, the old saying, “you eat what you kill” is appropriate when answering this question.  Mays Law Office has every incentive to work hard for their workers compensation clients because they only get paid when you do.

How Much Does Mays Law Charge to Represent an Injured Worker?

In Wisconsin, injured workers are charged under a contingency fee rate that can be no higher than 20% of the amounts recovered for the injured worker.  In addition, expenses (such as interoffice copies, postage, mileage, and charges incurred to get certified medical records and doctor’s reports) paid for litigating/pursuing the workers compensation claim are reimbursable if agreed to in the retainer agreement/contract.

How Do I Know If My Workers Compensation Claim is Worth Hiring An Attorney?

If you were hurt at work, reported the injury timely, sought medical treatment within a reasonable amount of time, suffered lost time from work, and the injury is serious (more than a sprain or strain lasting only a few weeks) then it is very likely that a workers compensation attorney should be hired to pursue your workers compensation benefits.  An injury claim that has been factually or medically denied by the workers compensation carrier may not be an easy win but it does not mean that it should not be appealed to the State.  Keep in mind, workers compensation insurance company’s hate paying out on injury claims.  If they have any basis to deny a workers compensation claim, no matter how small, then they will do it.  Do not be intimidated into thinking that your injury claim is not worth fighting for.  A denial of workers compensation benefits raises a lot of negative emotions – anger, rejection, fear, stress, frustration.  Attorney Lisa Pierobon Mays knows and understands these emotions and her goal is to ease your mind, worries, and stress from the moment you hire her to pursue your workers compensation claim.

What Kinds of Workers Compensation Benefits Can You Get for Me?

In the State of Wisconsin, workers compensation benefits are governed by state statute, Chapter 102 (also called the Workers Compensation Act).  Allowable benefits for the injured worker are dictated by this statute and very different from other types of civil damages.  The injured worker can expect recovery of their lost time/wage for missed work due to being on medical restrictions.  The lost time wage is based on 2/3 of their average weekly wage, subject to a statutory cap for high income earners, fixed as of the date of the injury.  It is 2/3 because it is tax-free.  The calculation of the average weekly wage (a/k/a AWW) can be complicated due to certain legal nuances and should be reviewed by the State of Wisconsin Department of Workforce Development for accuracy.

The injured worker is also entitled to 100% payment/reimbursement of their medical treatment related to the injury, along with medial mileage reimbursement at .51 cents for roundtrip doctor and therapy appointments, plus mileage incurred to pick up related prescription medications.

Once the injured worker reaches a “healing plateau,” meaning that moment in time when the injury has healed to the best it is going to get, a treating practitioner/doctor should be asked to consider assigning a percentage of permanent disability, called permanent partial disability or PPD rating for the worker’s functional loss.  If PPD is assessed, then it is payable at a weekly rate equal to two-thirds of the employee’s average gross weekly earnings at the time of the injury, subject to a maximum rate determined by statute.  The calculation is a mathematical formula that can be determined by a workers compensation attorney, such as those at Mays Law Office.

It is significant to understand if the injury and resulting PPD is deemed scheduled (pertains to limbs, eye and ears) or non-scheduled (pertains to torso/back, head, systemic and mental).  The distinction is important because each are compensated differently.  Scheduled injuries can lead to a vocational claim for Retraining.  While non-scheduled injuries can lead to claims for Loss of Earning Capacity or Permanent Total Disability.  Each claim encompasses significant and distinct monetary consequences.  If an injury causing permanent disability with resulting wage loss occurs, then an analysis should be conducted by an attorney who concentrates their practice in handling Wisconsin workers compensation claims.  Mays Law Office offers free consultations for such an analysis.

Another monetary benefit called Disfigurement can be awarded if scarring or a limp results from the injury.  Disfigurement awards compensation for the likelihood that wage loss will arise from a negative perception that may not be justified by a functional limitation or loss.  It is a quasi anti-discrimination statute to counter the potential for wage loss for unsightly scars that may cause conscious, or even unconscious, discrimination during the hiring process.  The award for such a claim can be up to one year the worker’s average annual earnings, subject to a cap.  Such an award is dependent on several factors and a workers compensation attorney should be consulted when considering and pursuing such a claim.

Lastly, if a Wisconsin worker dies and their death is proximately related to the work injury then death benefits are awarded to their dependents at four times the employee’s annual earnings, subject to caps. When death occurs to the Wisconsin injured worker who was permanently and totally disabled, or  permanently partially disabled, but it is unrelated to the work injury, limited death benefits are also payable to dependents.

Burial expenses are also payable where a Wisconsin workers dies from a work injury.

Do I Have to Go to a Hearing or Will You Settle My Claim?

Unlike some of the bigger injury law firms in Wisconsin, Mays Law Office does not take on new clients with an eye toward just settling them out.  To do so, is not truly advocating for the client.  Attorney Lisa Pierobon Mays has a reputation for aggressive representation when dealing with workers compensation insurance companies.  Mays Law Office never settles a workers compensation claim until every potential benefit has been pursued and a true valuation of the claim can be determined and discussed with the client and the client has a good understanding of the strengths and weakness of their claim.  The client is given a full opportunity to ask questions and provide input.  Sometimes a settlement cannot be reached because the workers compensation insurance carrier is not offering a fair monetary settlement.  In that case, Attorney Lisa Pierobon Mays will encourage the client to proceed to a hearing to present the claim to an administrative law judge for a determination.  Before any hearing, Attorney Pierobon Mays will have thoroughly prepared the client so that he/she feels confident and ready to proceed.  Ultimately, it is always the client’s decision as to whether to settle their workers compensation claim or proceed to hearing.

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