The IME report is simply an opinion from a hand picked doctor by the insurer. The IME doctor does not have the final say- the Work Comp Judge does! You will be able to have your doctor’s reports, or deposition, taken to defend any allegation of a recovery, in addition to your own testimony.
If the IME doctor claims you are fully recovered from your work injury, the insurer’s attorney will file a Petition to Terminate benefits. The mere filing of the petition, or the receipt of the IME report, does NOT stop your checks if you are currently receiving them. The checks can only stop via Court Order in this context (there are a few exceptions which we’ll discuss later). Once the petition is assigned to a Work Comp Judge, then a notice of hearing will be sent. The first hearing is called a Supersedeas hearing. The insurer’s attorney will submit a copy of the IME report and ask the Judge to cut off the wage loss benefits. The Judge will allow the Claimant (ie, injured worker) time to respond. It is imperative that you retain an experienced Pennsylvania Workers’ Comp Attorney right away to defend the request for Supersedeas. If you win the Supersedeas issue, your checks will continue as the litigation takes place. Winning at the Supersedeas level is critical because the litigation can take up to a year or longer so you will need that cash flow as the months pass by.
Short of a Court Order cutting off the wage loss checks, there are only a few situations where the insurer can stop sending you your work comp checks. One situation is if they send you LIBC forms asking you about whether your condition has changed, whether you are working, whether you are receiving unemployment, social security (old age), pension, or severance payments. If you fail to return these forms within 30 days, the insurer can cease payments until they receive them. Another example of the insurer being allowed to stop your checks (or reduce them), short of a Court Order, is if you return to work of course- you must report the earnings so that the insurer can calculate what if any payments are due based upon your pre-injury average weekly wage and the amount of current gross weekly earnings.
Do not panic if you receive a Notice of Ability to Return to Work and/or an Independent Medical Exam (it’s not “independent”- it’s a defense exam). If you are receiving work comp checks, the receipt of these documents will not stop your checks in and of themselves. For more info about how Pennsylvania Work Comp works, call or email me 7 days a week.
Michael W. Cardamone – Certified Pennsylvania Work Comp Lawyer For Injured Workers
The Cardamone Law Firm, LLC