I reviewed a workers’ compensation claim for a potential client nine months ago. At the time, I told him of several items that I saw as upcoming issues in his case and shared my opinion about why it would be important for us to start clearing those issues off the deck sooner rather than later. Would he be found employable with no services or would he receive just a bit of training to allow him to continue working in his field as a welder but in a lighter-duty capacity? Would the onset of depression be addressed under the claim and taken into consideration when making employability decisions? Would his level of permanent impairment be under-rated through the typical Independent Medical Evaluation (IME) process or would his surgeon be willing to provide a rating that more accurately reflects his limitations? I shared my concerns about his case, explained the process I would recommend for addressing these concerns and discussed the fees and costs to be expected. He indicated he wanted to go forward with representation.
I did not hear from him again, until yesterday. He left me a message asking for help with his claim. I looked at the case this morning before returning his call. He has been found to be employable with no additional retraining, so he will likely not be able to continue with his favored career but, instead, can look forward to his new line of work as a small parts assembler. He underwent an IME that conservatively rated his level of permanent impairment and approved the job analysis for small parts assembly. His attending physician signed the form letter to indicate concurrence with the IME results and, on this basis, the Claims Manager has found him employable and is closing the claim. What about the depression? Not addressed by the IME, so the Claims Manager is construing the attending physician’s signature on the concurrence form letter to mean that he is also not contending that depression is an issue, so she is denying this condition under the claim.
I know there are two sides to every argument, and I know that an employer representative would look at this same fact pattern and see a job well done, but I am a claimant’s advocate, so I share my thoughts from only that perspective. I see a situation where I now have a 15-day deadline for filing a dispute with the Vocational Dispute Resolution Office if I want to argue that Continue reading