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When your Doctor and the Insurance Company Doctor Disagree: A Workers Compensation primer

Posted by James Aspell | Jan 28, 2023 | 0 Comments

If the insurance company's doctor disagrees with your doctor in a workers' compensation case, it can lead to a dispute over the nature and extent of your injuries, as well as the appropriate course of treatment. In some cases, the insurance company may deny your claim based on the opinion of their doctor. However, the ultimate decision on your claim will be made by the state workers' compensation board or a judge, who will consider all of the evidence and testimony presented. If necessary, you may need to hire your own attorney to represent you in the dispute.

In a workers' compensation case, the insurance company's doctor and your doctor may disagree about a number of things related to your injury or illness, including:

  1. The cause of your injury or illness: The insurance company's doctor may dispute that your injury or illness is work-related.

  2. The severity of your injury or illness: The insurance company's doctor may dispute the severity of your injury or illness, which could impact the amount of benefits you are awarded.

  3. The need for medical treatment: The insurance company's doctor may disagree with your doctor regarding the necessity of certain medical treatments, such as surgery or physical therapy.

  4. The ability to return to work: The insurance company's doctor may have a different opinion about your ability to return to work and whether or not you are permanently disabled.

  5. The need for compensation: The insurance company's doctor may disagree about the extent of your disability and whether you are eligible for compensation for your injury or illness.

Ultimately, the state workers' compensation board or a judge will consider all of the evidence and testimony presented, and make a decision based on that information.

If the RME  doctor says that you are fine, it does not necessarily mean that your case is over. The opinion of the insurance company's doctor is just one piece of evidence that will be considered by the state workers' compensation board or a judge when making a decision on your case.

You have the right to present evidence and testimony from your own doctor, as well as any other medical experts, to support your claim. You can also present evidence of your lost wages, medical expenses, and other related costs. Additionally, you may hire an attorney to help you present your case and argue on your behalf.

Ultimately, the decision on your case will be based on the evidence and testimony presented, and the laws and regulations of the state where your case is being heard. If the insurance company's doctor says that you are fine, but you and your doctor disagree, and you have evidence to support your claim, your case can still be successful.

 


About the Author

James Aspell

Principal since August 1, 2006 James F. Aspell is the principal and managing attorney of the firm which he started in 2006 following 20 years of litigation practice in a mid -size firm in Hartford, Connecticut. Jim focuses his practice in the areas of worker's compensation and personal injury l...

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